With 2014 behind us, we are finally able to assess the implications of Meaningful Use Stage 2 for Eligible Professionals. It is now clear – as anticipated – that the updated criteria have presented a significant challenge to many. In fact, it is predicted that only a fraction of those who attained Stage 1 of Meaningful Use will attest for Stage 2 for the 2014 year. As a result, physicians who have received financial incentives under the program will now face penalties, and may see a real impact on their bottom lines.
If it’s any consolation, there is hope (and even some evidence) that the Centers for Medicare & Medicaid Services will make a few amendments to the Meaningful Use program over the next few months. This will allow for additional flexibility for providers, and with any luck, will mean more people qualify in 2015. In this column, we’ll highlight the proposed changes and share a few observations from the first year of Stage 2.
Here’s what’s new
On Jan. 29, 2015, CMS released a proposed rule that would adjust the reporting period for 2015 – currently set for the entire year – to 90 days. While this is the same length as 2014, it would give providers an extra 9 months to upgrade software, systems, and work-flows to attest for Stage 2. For those who were able to take advantage of the CEHRT [certified EHR technology] Flexibility and continue Stage 1 in 2014, this may be just the reprieve needed to stay on track. For those who made an unsuccessful attempt at Stage 2 last year, this just makes the second try a bit easier.
In case you are wondering, if you “miss” a year of Meaningful Use, you simply continue as if you made it. In other words, under the current rule, if you are due to start a full year of Stage 2 reporting in 2015, you are still obligated to do so even if you were unsuccessful with 90 days of Stage 2 in 2014. The proposed rule would change that, and keep everyone’s reporting period at 90 days regardless of stage or year. (Remember: A 1% per year penalty is assessed for every year an eligible professional fails to meet the requirements, up to a maximum of 5%. These penalties continue indefinitely.)
CMS is considering other changes as well. Specifically, their press release states they are looking to “modify other aspects of the program to match long-term goals, reduce complexity, and lessen providers’ reporting burdens.” As of now, it is unclear what that might include, but a review of the challenges from 2014 may point to some strong possibilities. We’ll start with a principle we’ve dealt with previously:
Interoperability is hard
The most noteworthy changes from Stage 1 to Stage 2 are all requirements to pass information into and out of the EHR. These include: making records available through a secure patient portal, the ability to communicate with patients through electronic means, and the transmission of “summary of care” documents between providers. These requirements also happen to be the most challenging for physicians, because they rely on other systems and individuals to make the connections possible.
Up to this point, EHR vendors have not prioritized adopting established standards for data transmission, and Stage 2 really brought this shortcoming to light. So much so, that CMS considered it a valid reason to invoke the CEHRT Flexibility. By “limited exception” providers could continue with Stage 1 this past year if “their referral partners [did] not upgrade to 2014 Edition Certified EHR Technology” (i.e., doctors are given a pass on the need to send “summary of care” data if there’s no one around to receive it). But secure and reliable electronic communication with other physicians is just one area of struggle. Another that is arguably more difficult is communicating electronically with patients. Compared with the challenges of interoperability, we’ve observed that:
Patient care is even harder
It’s one thing to incentivize (or penalize) physicians for adopting Health Information Technology, but it is an entirely different thing to hold them responsible for whether or not their patients choose to embrace it. Unfortunately, the 2014 Meaningful Use measures seem to do just that. With quotas for providing “secure electronic access” through a patient portal, the MU program forces physicians to engage patients on a new virtual “playing field.” This may seem like a good thing on the surface, but it has been riddled with headaches for providers and patients alike.