From The Editor | August 28, 2013

4 Reasons To Delay Stage 2 MU

ken congdon

By Ken Congdon

Over the past few months, several high-profile healthcare associations — including MGMA, CHIME, and AAFP — have recommended that the Stage 2 Meaningful Use (MU) deadlines be extended. HIMSS is the latest organization to join the cause, suggesting that Stage 2 launch as scheduled, but that year one of the attestation period be extended by six months. HIMSS made this recommendation after a review of data from more than 5,400 hospitals in the HIMSS Analytics database revealed that many eligible hospitals and professionals face timeline and certification challenges that will likely prevent them from meeting Stage 2 requirements within the current schedule.

HHS, CMS, and ONC are understandably hesitant to grant an extension — fearing that a delay would slow the momentum the program has gathered over the past two years. Under normal circumstances, I would be in favor of staying the course. All too often, delays of this nature simply push back the problem, rather than giving stakeholders more time to solve it. No doubt, this could be the inevitable result of a Stage 2 MU extension. However, as I see it, the healthcare industry (and the MU program) has more to lose if Stage 2 isn’t delayed. Here’s why I’m in favor of an extension:

  1. Something’s got to give —2014 brings with it a perfect storm of regulatory compliance issues (e.g. ICD-10, ACA, MU, etc.) for hospitals and healthcare providers to contend with. Each is a massive undertaking that requires substantial resources. Furthermore, each essentially transforms much of a healthcare organization’s underlying structure and processes (e.g. coding language, reimbursement model, patient/physician interaction, etc.). As such, each of these initiatives requires a great deal of focus and attention to ensure these transitions don’t jeopardize finances or patient care. ICD-10 has already been granted an extension. It’s a sure bet it won’t receive another. As for ACA, it’s important to the Obama administration that healthcare reform progresses as outlined. Delaying Stage 2 MU will not only give providers more time to successfully attest, it will allow them to dedicate more time and resources to other equally, if not more, pressing issues.
  2. For parity’s sake — If the MU program continues to move at such a rapid pace, it could create (or widen) a technology divide between hospitals or health systems with ample financial resources and smaller rural facilities. To work as anticipated, all players in the healthcare ecosystem must make strides in regards to health IT. However, financially strapped community providers are finding it difficult, if not impossible, to make the investments necessary to fulfill MU requirements within the existing timeline. An extension would provide these smaller facilities with more time to secure the funds necessary to achieve MU, which could keep them from falling too far behind larger providers from a technological standpoint. At the very least, an extension would lessen the financial burden facing these facilities in 2014.
  3. The technology isn’t quite there yet — While a review of HIMSS Analytics data shows that 68% of eligible hospitals and 41% eligible providers have purchased the necessary software to successfully attest for the Stage 2 certification requirements, it also suggests that many hospitals and providers are still awaiting the necessary upgrades to the certified version of the technology. An extension would provide vendors with more time to issue these upgrades. It will also provide vendors with ample time to enhance and improve their products in line with provider demands while preparing for Stage 3.
  4. It’s not a race —Ultimately, it’s not how quickly health IT is adopted, but how effectively it’s implemented that will be of utmost importance. While I’m a huge supporter of the MU incentive program, I’ve also seen, first hand, how this program has served to dilute the effectiveness of health IT in several instances. For example, MU has prompted many providers to rush to adopt EHRs simply to capitalize on the incentive dollars, rather than taking the time necessary to truly understand how to apply the technology to solve their specific clinical and operational problems. I don’t want to see this trend perpetuate itself in Stage 2. If it does, we’ll simply continue to read about how health IT isn’t delivering on its promise. Perhaps now is a good time to take pause and ensure we aren’t just incentivizing the act of technology adoption, but motivating providers to achieve the desired results as well.

I don’t want readers to mistake my arguments for delaying Stage 2 as an excuse to procrastinate. I think this is what occurred when the ICD-10 deadline was extended. Even with the delay, providers are woefully behind on their ICD-10 transition plans. This is due, in large part, to the fact that many providers simply put the initiative on the back burner for a year rather than using the extra time to perfect their strategies and marshal the appropriate resources. We can’t make this mistake again. If the Stage 2 extension I believe is necessary is granted (I am in favor of HIMSS’ proposed extension, by the way), then providers need to use that time wisely. They must continue to build upon their EHR progress to date, and ensure they put themselves in the best possible position to meet and benefit from not only Stage 2, but Stage 3 requirements.