The Final Nail In The Meaningful Use Coffin?

By Ken Congdon

CMS and ONC dropped a bomb late last Friday afternoon — right before the long holiday weekend. The duo issued its highly anticipated finalized ‘modifications’ rule to the Meaningful Use (MU) program. The final rule touts added flexibility, and there is some. For example, the final rule allows eligible providers to use 2011 Edition CEHRT (Certified EHR Technology), or a combination of 2011 and 2014 Edition CEHRT, to meet MU requirements for 2014. The rule also extends Stage 2 reporting through 2016 and pushes the start of Stage 3 until 2017 for those that started the program in 2011 or 2012.

Some organizations, such as the EHRA, praised CMS for releasing the final rule so quickly. Others agreed that the changes offer the flexibility for more providers to participate in and meet important MU objectives such as drug interaction and drug-allergy checks, providing clinical summaries to patients, e-prescribing, and reporting on key public health data and quality measures. However, the vast majority of providers responded to the announcement with vitriol. The reason? One very important provision was absent from the final rule — a provision that would allow providers to attest for Stage 2 MU over any three-month quarter as opposed to an entire year.

Perhaps the most vocal of the final rule detractors was CHIME (The College of Healthcare Information Management Executives). In a strongly worded statement, CHIME president and CEO Russell P. Branzell made the feelings of his organization quite clear.

“CHIME is deeply disappointed in the decision made by CMS and ONC to require 365-days of EHR reporting in 2015,” he says. “This single provision has severely muted the positive impacts of this final rule. Further, it has all but ensured that industry struggles will continue well beyond 2014.”

The industry struggles Branzell refers to are well documented. It’s no secret that Stage 2 MU progress has hit a wall. While more than 264,000 eligible providers and 4,000 hospitals successfully attested for nearly $25 billion in Stage 1 incentive dollars, only $86 million in incentive payments have been issued to providers thus far in 2014 (104 physicians and 4 hospitals).

CHIME and other stakeholder organizations believed moving to a 90-day reporting period would help right the ship. According to Branzell, “this sensible recommendation would have assuaged industry concerns over the pace and trajectory of rulemaking; it would have pushed providers to meet a higher bar, without pushing them off a cliff; and it would have ensured the long-term viability of the program itself.” Now Branzell and others question the very future of MU.

One of the main reasons key stakeholders like CHIME feel this way is because without a change in the reporting structure, the final rule really provides little relief to healthcare providers. CHIME’s statement sums up this issue very well.

“Roughly 50% of EHs (eligible hospitals) and CAHs (critical access hospitals) were scheduled to meet Stage 2 requirements this year and nearly 85% of EHs and CAHs will be required to meet Stage 2 requirements in 2015. Most hospitals who take advantage of new pathways made possible by this final rule will not be in a position to meet Stage 2 requirements beginning October 1, 2014. This means that penalties avoided in 2014 will come in 2015, and millions of dollars will be lost due to misguided government timelines.”  

In a written statement, CMS Administrator Marilyn Tavenner said the final rule was drafted based on “stakeholder feedback” and there is “overwhelming support for this change.” However, many of the nearly 1,200 comments to CMS and statements from the AHA (American Hospital Association) echo CHIME’s concerns. Which begs the question — exactly who was CMS and ONC listening to if not these key stakeholders?