Last month, the Centers for Medicare and Medicaid Services (CMS) published its proposed rule in the Federal Register for the third stage of the government’s electronic health record (EHR) incentive payment program.[1] See 80 Fed. Reg. 16732 (March 30, 2015). The primary focus of the proposed rule is the establishment of a single stage of meaningful use beginning in 2018. The proposed rule would also establish a full-year reporting period starting in 2017, streamline the meaningful use criteria, and contain fewer but more challenging objectives for meeting meaningful use.
Single Stage for Meaningful Use
CMS proposes to establish a single stage for meaningful use beginning in 2018, regardless of the eligible professional (EP), eligible hospital or critical access hospital’s (CAH) prior participation in the program. This would mean that all participating providers would need to meet the Stage 3 rules by 2018. Providers are permitted to participate in Stage 1, Stage 2 or Stage 3 in 2017; however, all providers would need to attest to Stage 3 in 2018. CMS expects Stage 3 to be the final stage of meaningful use, and plans to incorporate portions of the prior stages into the Stage 3 requirements. For providers already participating in the EHR incentive program, the implementation of a single stage is likely to simplify matters; but those who have just started would have to jump from Stage 1 to Stage 3, which could be a significant hurdle.
Change in Reporting Period
CMS is also proposing to establish several uniform definitions, including revising the definitions of “EHR reporting period” and “EHR reporting period for a payment year”. These proposed revisions would eliminate the 90-day EHR reporting period for providers who are demonstrating meaningful use for the first time, and would create a single calendar year reporting period starting in 2017. Medicaid EPs and eligible hospitals demonstrating meaningful use for the first time would be exempted from the full-year reporting requirement, and would remain subject to the 90-day reporting requirement.
Streamlined Meaningful Use Criteria
CMS is proposing additional means of simplifying the EHR incentive program. First, CMS is proposing to allow providers greater flexibility in meeting the Stage 3 meaning use objectives and measures. For example, providers need only attest to the numerators and denominators for all of an objective’s measures, and only need to meet two of the three associated thresholds for those measures. This flexibility would apply to the objectives and measures for coordination of care through patient engagement, health information exchange, and public health and clinical data registry reporting. Second, CMS is proposing to align the meaningful use criteria with other quality reporting programs such as the Physician Quality Reporting System. Finally, CMS proposes to eliminate “topped out”, redundant, and duplicative measures. “Topped out” measures are measures which are widely adopted at a high rate of performance, such as recording demographics from Stage 1.
Stage 3 Objectives and Measures for Meaningful Use in 2017 and Beyond
CMS proposes to establish eight objectives and measures for Stage 3 of meaningful use for 2017 and beyond. The proposed objectives and measures are: (i) protect patient health information; (ii) electronic prescribing; (iii) clinical decision support; (iv) computerized provider order entry; (v) patient electronic access to health information; (vi) coordination of care through patient engagement; (vii) health Information exchange; and (viii) public health and clinical data registry reporting. Under the proposed rule, providers would need to attest to these eight objectives and associated measures, unless an exclusion applies.
Although there are fewer proposed objectives, some of the objectives include several measures, and others may be more difficult for providers to meet. For example, CMS proposes higher thresholds for the objectives related to patient engagement and health information exchange. The higher thresholds in these objectives relate to the measures regarding patient engagement in viewing, downloading and transmitting their health information to a third party; sending secure messages to patients; creating an electronic summary of care for patients who the provider transitions or refers; incorporating an electronic summary of care document into the patient’s EHR record; and performing a clinical information reconciliation for transitions and
Comments to the Stage 3 proposed rule will be accepted on or before 5:00 pm, May 29, 2015. For further information, please contact Catherine Patsos at (212) 803-8193, or at cgpatsos@healthcarelawllc.com.
[1] The EHR incentive program was authorized by the American Recovery and Reinvestment Act (ARRA) of 2009, Pub. L. 111-5. The ARRA authorized incentive payments to eligible professionals, eligible hospitals and critical access hospitals to promote the adoption and meaningful use of certified electronic health record technology (CEHRT).
Catherine Patsos is a health care attorney with extensive experience in representing physicians and other health care providers. She concentrates her practice in health care reimbursement, regulatory and compliance matters, physician employment, HIPAA, and fraud and abuse issues. For more information, visit www.healthcarelawllc.com.
