Deciphering Associations Comments On Meaningful Use Stage 2May 24, 2012
The window for submitting comments on the Centers for Medicare and Medicaid Services (CMS) Notice of Proposed Rule-Making (NPRM) for Meaningful Use Stage 2 has officially closed. The deadline for submitting comments on the CMS NPRM for Meaningful Use Stage 2 was Monday, May 7, 2012. CMS now begins the arduous task of reviewing the multitude of comments submitted and face the challenge of how to best incorporate the feedback in the Meaningful Use Stage 2 Final Rule. Based on the comments submitted by two key medical and industry associations alone, to say that CMS have their hands full is an understatement.
The Healthcare Information and Management Systems Society (HIMSS) Electronic Health Records (EHR) Association, the most influential EHR industry group with its membership comprised of the top forty-two EHR companies in the U.S., submitted their comments directly to CMS Acting Administrator, Marilyn Tavenner, on May 3rd. The American Medical Association (AMA), the largest and most influential medical organization in the U.S. representing over two hundred and sixteen thousand physicians, followed by also submitting their comments directly to CMS Acting Administrator Tavenner on May 7th. It is important to note that the AMA collaborated with ninety-nine specialty and state level provider organizations and societies for the purpose of drafting their comments to CMS on the NPRM for Meaningful Use Stage 2.
Both organizations noted, on their respective submissions, that they support CMS’ proposed one-year extension of Stage 1 of Meaningful Use along with the recommendation to delay the start of Stage 2 for eligible providers (EPs) to January 2014. The comments both organizations submitted to CMS reveals that there is some common ground shared between providers and the EHR industry however, within the common ground different concerns are revealed.
The HIMSS EHR Association is urging CMS to expedite the release of the final rule for Stage 2 of Meaningful Use due to the development and operational implications associated with the proposed rule. The rationale for this ask is due to the immaturity of the proposed clinical quality measures (CQM), certification criteria, and that all providers will be required to upgrade to the 2014 edition of their EHR regardless of their stage of meaningful use. The HIMSS EHR Association concluded that the EHR upgrade requirement and the tight timeline would increase the number of upgrades required in a very short period of time for EP’s who attested in 2011 and those who will attest in 2012, 2013, and 2014. As a result of their conclusion, they are encouraging CMS to consider allowing eligible providers who are still in Stage 1 in 2014 to continue to use 2011 certified EHR technology at their discretion.
The AMA’s comments to CMS also recognizes the importance to expedite the release of the final rule for Stage 2 citing that physicians need to be assured that their EHR systems will be able to support Stage 2 measures well in advance of 2014. However, the AMA does not share the same view with industry that physicians that are still in Stage 1 in 2014 be allowed to use 2011 certified EHR technology. The AMA recognizes that physicians and their support staff need adequate training and have to adjust workflows in order to meet Stage 2 measures prior to the 2014 date.
What the AMA is bringing to light is the proposed timeline in the NPRM for Stage 2 is so tight that there is very little confidence shared by physicians that industry will be ready for the start of Stage 2 despite the delay to January 2014. Furthermore, allowing physicians who are still in Stage 1 in 2014 to continue to use 2011 certified EHR technology is not the right answer.
The AMA was very articulate in their comments to CMS on the NRPM for Stage 2 that while they share the Administration’s goal of widespread EHR adoption, they are concerned that the proposed meaningful use criteria for Stage 2 will actually discourage physician participation in the EHR incentive program rather that encourage it. The AMA cites that physicians face significant barriers with adopting EHR technology and attesting to meaningful use Stage 1 measures. The AMA referenced an April 2012 Health Affairs survey that revealed that while about half of all eligible office-based physicians intended to apply for either the Medicare or Medicaid meaningful use incentives, only eleven percent of physicians surveyed intended to apply for incentives and had EHR systems capable of meeting two-thirds of the Stage 1 core meaningful use measures. The survey highlights that physicians are facing technological and other challenges in meeting all of the required Stage 1 meaningful use program measures and are not adequately prepared to take on Stage 2.
The AMA, in an effort to increase physician participation rates, recommends to CMS to survey physicians who elected to participate and those who elected not to participate during Stage 1 of the incentive program and identify barriers to and solutions for physician participation prior to finalizing Stage 2 requirements. In addition, the AMA recommends that prior to moving a measure from the Stage 1 menu set to the core set for Stage 2, or prior to adding new core measures for Stage 2, the expected impact, the expected value, the clinical and administrative risks, administrative burden, costs to physicians, and technological standards of the move should be thoroughly assessed.
CMS should seriously consider the AMA’s recommendation to survey physicians and perhaps take it one step further by including industry in the discussion and analysis of the findings. The key to attaining CMS’s goal of widespread meaningful use of EHR technology by physicians that will improve quality of care delivery, enhance patient safety, and support practice efficiencies is effective collaboration between providers and industry. Only through effective collaboration will CMS move closer to achieving the desired outcome for the Medicare and Medicaid EHR Incentive Program which is to accelerate the adoption and meaningful use of EHR technology by physicians and other clinicians to improve the U.S. healthcare system and patient outcomes.