Healthcare Industry Enters Meaningful Use Waiting Game

The federal government is working on a rule to relax the requirements for stage 2 of meaningful use.

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After a flurry of activity, there hasn't been much recent news from Washington about the future of the meaningful use incentive program. That has left the healthcare industry to play the waiting game. Few are happy about it.

At issue is the status of a proposed rule to relax the requirements for stage 2 of meaningful use. Under the HITECH Act, failing to attest for stage 2 after completing stage 1 subjects hospitals and eligible providers (EPs) to financial penalties as soon as next year.

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Meaningful use stage 2 flexibility, as outlined in the proposed rule, would give organizations the option to use 2011 certified electronic health record (EHR) technology to complete stage 2 attestation in 2014. This acknowledges that the majority of providers and EHR vendors alike haven't rolled out the 2014 certified EHR technology meant to be used in stage 2.

Flexibility, then, offers a life preserver to those treading water but with no finished rule in hand, they don't know when it will be thrown or how large it will be.

Organizations Seek Meaningful Use Clarity, Flexibility

The public comment period for the proposed rule closed on July 21. (The final rule will take a few weeks to write.) Many professional organizations weighed in by asking for additional clarity and flexibility on deadlines, eligibility and stage 3 of meaningful use.

The College of Healthcare Information Management Executives (CHIME) offers support but proposes a retroactive application of all meaningful use changes made in 2014 to "help give providers the assurance they need to take advantage of the new flexibilities proposed in this rule."

The Medical Group Management Association (MGMA) says providers should be allowed to use 2011 certified EHR technology for 2015 reporting as well as 2014, since there's no guarantee at this point that EHR vendors will be able to meet the 2014 certified EHR requirements.

The Health Information and Management Systems Society (HIMSS) wants clarity on how providers will attest for clinical quality measure data. "It appears that there is a disconnect between the reporting of CQMs and the reporting of [meaningful use] objective measures," the organization says. This could force some institutions to use 2011 certified EHR for one purpose but 2014 certified EHR for the other, and the proposed rule isn't clear on whether this is OK.

The American Hospital Association (AHA) joins HIMSS in calling for flexibility in quality reporting requirements and for more examples of circumstances that would prevent a provider from "fully implementing" 2014 certified EHR technology. In addition, AHA says it's premature to say stage 3 will begin in 2017 and suggests instead that stage 2 criteria remain "effective until updated by future rulemaking."

The American Medical Association (AMA) asked for an extension of the hardship exemption deadline from July 1 until 30 days after the final rule is published, as providers have no way of knowing if they will meet the meaningful use requirements until they see the rule.

Finally, HIMSS' EHR Association (EHRA) wants clarity on the "timing-related challenges" that could prevent "fully implemented" 2014 EHR technology from being used. The group also asked for additional options for those who attest in 2014, noting that "working backwards" to retrieve 2013 reporting features "would generally be time intensive and not particularly valuable."

In addition, CHIME, MGMA, HIMSS and AHA all specifically call for a 90-day reporting period for attestation in 2015. (The current rule calls for the entirety of fiscal year 2015 for hospitals and calendar year 2015 for EPs.) This, the groups say, recognizes that 2015 will be a transition year for providers attesting to meaningful use.

Meaningful Use at Crossroads as Healthcare Industry Waits

These comments emerge as the Medscape EHR Report 2014 suggests that 22 percent of physicians either plan to abandon meaningful use or never supported it in the first place. Previous reports also show that, as of mid-June, only eight hospitals had attested for meaningful use stage 2 in 2014.

At the same time, meaningful use incentives are approaching $25 billion, with more than 4,700 hospitals, 317,000 Medicare-eligible EPs and 157,000 Medicaid-eligible EPs participating. (There are separate Medicare and Medicaid EHR Incentive Programs.) The future of meaningful use may be in question, but the present seems to suggest continued interest in the program or, at the very least, in its incentives.

The Office of the National Coordinator for Health IT (ONC) has stressed meaningful use flexibility for several months now. It has also asked for patience. The more the ONC test the industry's patience, though, the less difference that flexibility may make.