Not Everyone Is Pleased About Meaningful Use Extension

Posted on by Frank J. Rosello

After months of physicians, hospitals and IT groups calling for more time to complete meaningful use, the federal government has finally responded. But not everyone is pleased.

On Friday, Dec. 6, hours before the Centers for Medicare & Medicaid Services and the Office of the National Coordinator announced the new timeline, two stakeholders speaking at a CMS eHealth conference made the case for an extension. Whether or not they knew of the pending change, they may be breathing a sigh of relief now, on behalf of their customers and members.

One concern, said Robert Tennant, a senior policy advisory at the Medical Group Management Association, is that “everything is happening at the same time” – ICD-10, Medicaid expansion, insurance exchange, ACOs and value-based pilots, and meaningful use.

“We need to evaluable the first two stages,” Tennant said of designing the policy for Stage 3.

The proposed rules for Stage 2 came out in March 2012, as some providers were still just starting to participate. And the final rules came out in September 2012, “but critical supplemental materials were not available until the fourth quarter,” as Shiv Gopalkrishnan, VP and general manager at GE Health System Solutions, said at the CMS conference.

The timeline for Stage 2 — as some were predicting for Stage 3 — was hectic for both users and vendors.

“I think one of the lessons learned is that we really need a lot more time,” Gopalkrishnan said.

“Most of the development today happens as test-based development, so until you get the final test scripts and really understand the requirements, our engineers are putting their hands on their keyboards and starting to develop stuff. That really puts a compression on the back cycle, in what it takes to build the software, get it certified and installed.”

“I think we need at least three years between Stage 2 and Stage 3. But that doesn’t mean that we wait for three years; we need intermediate milestones right now,” he said, suggesting that 18 months at a minimum be given for final clinical quality measure specifications and certification test scripts.

Under the revised timeline, which still has some details to be worked out and still has to go through formal rulemaking, stage 2 will be extended through 2016 and stage 3 will begin in 2017 for providers that have completed at least two years in stage 2.

A Different View:
Although many vendors may be welcoming the extension, at least one sees it as a drag on progress.

“We have been against delaying implementation the subsequent stages each and every time, and we are against this delay,” said Dan Haley, VP of government relations at athenahealth.

“The fact that the delay is necessary is really a public policy failing,” he argued in an interview as the news fell on a Friday afternoon. It suggests that “the bar was too low” for Stage 2 certification.

While some provider groups were calling for an outright delay and some IT groups and vendors were calling for an attestation extension, Haley proposed that doctors not be penalized for failing to meet timelines, but that instead their vendors be subject to a certification review “with the possibility that they be revoked.”

“From 10,000 feet, the reason is health IT lags information technology in the rest of the economy and it’s never going to catch up if we keep slowing down,” Haley said. “From a more practical perspective, there are a lot of doctors who are using outdated technology.”

As far as Stage 3, Haley said there is one overriding idea that CMS and the ONC must keep in mind: having very strong interoperability rules.

“Creeping up on a decade and half in the 21st century, meaningful use has to include interoperation between vendor platforms. It’s the single biggest problem,” he said.

“Why is it that in 2013 different EHR vendors can’t talk to one another?”

Whatever the reaction of the HIT industry, physicians, nurses, CIOs and hospital leaders, the extension will give all involved some more time to make their suggestions heard.

Among the issues that will at the top is reducing compliance burden.

“One of the things that would be relatively simple,” said Tennant, “is why don’t you take a leaf from the physicians quality reporting system book and allow group reporting?”

“It streamlines the administration on both sides and avoid multiple reporting of the same data,” he said.

Another suggestion he has is to expand the hardship exemption of unforeseen circumstances “to include problems with the vendor.”

For example, he said, “if an EP attests successfully for Stage 1 but their vendor is unable to certify for Stage 2, that EP shouldn’t be subject to penalty adjustments.”

Not Flexible Enough
Another group that’s expressed dissatisfaction with the Stage 2 delay – albeit for a different reason – is the College of Healthcare Information Management Executives.

On Friday, CHIME put out a news release arguing that, while the delay appears to offer some much-needed breathing room for providers, it “does not change front-end requirements for meaningful use in 2014 and does not afford much needed flexibility to providers working to install and upgrade new technology.”

CHIME urged CMS to consider its previous recommendations to give EHs and EPs flexibility in meeting the Stage 2 start date, arguing that many providers will need an extra year to install, test, implement and operationalize new EHR software.

“There is a perfect storm brewing,” said CHIME CEO Russ Branzell in a statement. “With ICD-10 compliance coming into view, with HIPAA compliance demanding renewed attention and with all the activities associated with the Affordable Care Act converging in 2014, providers are nearing a breaking point.  Flexibility of the kind announced today is beneficial for Stage 3, but Stage 2 start-date flexibility is needed to ensure long-term success.”

Article written by Anthony Brino

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