IT in­cen­tives get more mean­ing­ful

Hos­pi­tals still see chal­lenges in Stage 2

Modern Healthcare - - FRONT PAGE - Rich Daly

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.

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