IT incentives get more meaningful
Hospitals still see challenges in Stage 2
Final regulations for the second phase of the federal program to boost the use of electronic health records may have eased the burden on individual clinicians, but hospitals continue to consider it a challenging path. A pair of regulations, which finalize the Stage 2 requirements for achieving meaningful use of EHRs and qualifying for federal incentive payments, tweaked draft rules issued nearly six months ago. The final version of the rules slightly eased implementation timelines and somewhat softened the end use requirements.
Specifically, the final rule delayed the Stage 2 implementation date for reports due from hospitals from Oct. 1, 2013, to as late as July 1, 2014.
Similarly, the final rules reduced several requirements on the endusers of EHR systems. Those adjustments included reducing the summary-of-care documentation required at patient transitions to 50% from 65% and reducing the eligible hospital e-prescribing threshold to 10% from 50%.
The overall effect was to somewhat ease the number and frequency of data requirements that end-user clinicians must consistently satisfy to achieve meaningful use, but that did little for the hospitals that may be employing them, according to some industry experts and hospital advocates.
Those institutions will face the same underlying demands related to implementing EHR systems’ functionality and adopting new workflows to best utilize them.
That theme was generally echoed by other provider groups reviewing the hundreds of pages of regulations late last week.
Dr. Susan Turney, president and CEO of MGMA-ACMPE, formerly known as the Medical Group Management Association, which represents physician group practices, praised regulators for lowering the thresholds for end users to achieve meaningful measures, including those related to mandatory online access and the electronic exchange of summary-of-care documents.
“MGMA supports the rule’s expanded list of exclusions and believes it will allow physicians to achieve meaningful use with fewer hurdles,” Turney said in a written statement.
But the American Hospital Association blasted the final rules for making EHR adoption “more challenging.”
Specifically, even the shortened meaningful-use reporting period for 2014 remains “an unrealistic date” for hospitals to achieve the initial meaningful-use requirements and avoid penalties, according to Linda Fishman, a senior vice president at the AHA.
“Information technology holds the promise of making care better for patients and communities,” she said in a written statement. “That’s why America’s hospitals are committed to adopting the technology needed to do so, but today’s rule presents obstacles to achieving that goal.”
Hospitals that are furthest along may benefit from the new rules, which allow an additional nine months in 2014 to upgrade to the 2014 version of certified EHR technology, but only for providers that are beyond the first year of demonstrating meaningful use.
The new rule’s deadlines were similarly the focus of questions from providers and EHR vendors in an Aug. 24 call with representatives from the CMS and Office of the National Coordinator for Health Information Technology. Specifically, the latest hospitals can attest to meaningful use of qualifying EHRs in 2014 to avoid penalties is the three-month period that starts April 1.
And successful EHR use in that same 90-day period can be used to avoid Medicare cuts when regulators conduct penalty-related reviews of 2014 performance beginning in 2016, according to Robert Anthony, in the Office of eHealth Standards and Services at the CMS.
Federal health IT officials emphasized that eligible hospitals must continue to demonstrate meaningful use for the full year in every subsequent year to continue to avoid Medicare payment cuts.
The rule’s mandatory patient interactions with EHR systems create another coming challenge for hospitals. That will include hospitals providing at least half of their patients with the ability to view, download and transmit records of their visit within 36 hours of discharge.
Officials at the CMS acknowledged that many providers have raised “concerns” about those requirements. In response, CMS officials have touted not only the final rule’s reduction in the rates at which patients must participate to meet the program’s requirements but also the addition of “exclusions” for the lack of access to broadband in the provider’s area.
“CMS believes that the patient utilization thresholds are achievable and that the ability to access clinical information electronically promotes patient engagement,” the agency said in a statement on the rules.