Federal officials are proposing to give physicians some extra time to move to 2014 edition certified electronic health record technology and still qualify for incentives under the Medicare and Medicaid EHR Incentive Programs.
Under a proposed rule released on May 20, the Centers for Medicare & Medicaid Services and the Office of the National Coordinator for Health Information Technology (ONC) would allow physicians, hospitals, and other eligible health care providers to continue using 2011 edition certified products or a combination of 2011 and 2014 edition certified products during the 2014 reporting period in the EHR Incentive Programs.
Though 2014 edition certified EHR products are currently available, there is a backlog of several months for the newer versions to be installed in hospitals and physician offices, according to CMS.
Dr. Karen DeSalvo
"Increasing the adoption of EHRs is key to improving the nation’s health care system and the steps we are taking today will give new options to those who, through no fault of their own, have been unable to get the new 2014 Edition technology, including those at high risk, such as smaller providers and rural hospitals," Dr. Karen DeSalvo, national coordinator for health information technology, said in a statement.
Physicians and hospitals would need to complete the switch to 2014 edition certified products in time for the Medicare and Medicaid programs’ 2015 reporting periods.
But there are some exceptions, the proposal states that to qualify for an incentive payment under Medicaid for adopting, implementing, or upgrading certified EHRs for 2014, the provider must use 2014 edition products only.
Physicians and hospitals may have to adjust their plans for attesting to EHR meaningful use depending on which edition of the certified technology they have available. For instance, the 2011 edition technology alone does not have the functionality required to meet the Stage 2 objectives and measures.
Providers who are scheduled to begin Stage 2 for the 2014 reporting period, but can’t fully implement the functions of their 2014 edition certified technology, have the option of attest to Stage 1 objective and measures for 2014. But they must attest that they are unable to fully implement their technology due to delays, according to the proposal.
The proposal also formalizes the government’s plan to extend some of the deadlines in the "meaningful use" program. In December, CMS announced in a blog post that it would extend reporting for Stage 2 of meaningful use through 2016 and would begin Stage 3 in 2017.
The change primarily affects physicians who began attesting to meaningful EHR use in 2011 and 2012. Those physicians were scheduled to advance to Stage 3 in 2016, after 2 years working on Stage 2. The change gives them an additional year before advancing to Stage 3.
While the proposed rule responds to concerns raised by physicians and vendors about the problems in implementing 2014 edition certified products, it does not address other critiques of the meaningful use program. The American Medical Association noted that the proposed changes are helpful, but they still leave intact an all-or-nothing approach to meaningful use requirements.
"Our chief concern remains unaddressed, and we worry that current requirements will slow the adoption of technology that will help coordinate care and improve quality, and that many physicians will drop out of the meaningful use program if the current all-or-nothing approach remains in place," Dr. Steven J. Stack, the AMA’s immediate past board chairman, said in a statement. "To date, approximately 20% of eligible professionals – mostly doctors – have dropped out of the program, and we expect this number to grow unless more changes are made."
The AMA recommends using a 75% pass rate as the standard for achieving meaningful use, and allowing physicians who meet 50% of meaningful use requirements to avoid financial penalties. CMS should also do a better job of aligning the Physician Quality Reporting System, the Value Based Modifier, and meaningful use requirements.
mschneider@frontlinemedcom.com
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