This final rule considerably loosens the criteria eligible Medicare providers and hospitals need to earn their incentives and avoid penalties on reimbursements. One drastic change trims the reporting time from an entire year to any 90 consecutive days in 2015.
“So providers who have tried hard from the beginning of 2015 to meet their measures for Stage 1 or 2 are well-positioned to meet this Modified Stage 2. It’s more achievable,” says Carrie Gullidge, director of EHR with MediSYS.
Providers can also extend that period to help them meet an objective. For instance, if their numbers were good in June, September and October, but not in July and August, a provider could report on five months, because though the period must be consecutive, it can exceed 90 days.
Modified Stage 2 also radically drops the number of criteria from 25 to 10. Previously in Stage 1 and 2, providers had to meet certain core measures, along with choosing additional measures from a menu. “Now you have 10 objectives and that’s it,” Gullidge says. “No more choices.”
Tammie Olson with Management Resource Group sees this as a positive shift in the function of the objectives. Many of the core measures in previous stages did not benefit providers, such as tracking the number of obese patients. “That was a frustration,” she says. “Now the objectives have shifted more to clinical decision support. They are not just a tracking mechanism to beat the penalties.”
For McGinty, the changes focus more on the sharing of information. “I think they want to get people to swap information with one vital goal of collaboration,” he says.
One of the most frustrating objectives for providers had been enticing patients to use the EHR portal to access their medical information. “Smaller groups were having a hard time with this,” Olson says. “Even larger hospitals had problems, particularly because breaches in security everywhere have made patients leery of using portals.”
With Modified Stage 2, 50 percent of a provider’s Medicare patients must still have access to the portal, but instead of needing five percent to use it, only a single patient must have accessed it during the reporting period.
For a similar reason, the objective on referrals also got revised. Though Modified Stage 2 still requires providers to transmit a Consolidated Clinical Document Architecture (CCDA or CDA) through their EHR’s direct messaging for at least 10 percent of their referrals, now there is an exclusion. If someone has fewer than 100 referrals during the reporting period, they do not have to meet that objective.
“Part of the problem had been running into providers who are not using an EHR or using one in which direct messaging was not functional. So providers were hitting roadblocks they had no control over,” Gilledge says.
Qualifying for an exclusion or meeting the numbers for an objective has become far easier under Modified Stage 2, depending on what time period a provider chooses to report on.
Alternate exclusions offer another out to providers for many of the objectives. For example, the patient education measure that had been a menu option under Stage 1 for 2015 is now a required objective under Modified Stage 2. But if a provider had not chosen that measure, they may not have been creating the materials or situations required to satisfy it. “Then now they can use the alternate exclusion to say they had no intention of reporting this measure, so there’s no way they could implement it,” Gullidge says.
Because providers do not state ahead of time which menu measures they were striving to meet, the alternate exclusions could open a new way for bypassing the intent of Meaningful Use. “That’s what makes me fearful,” Gilledge says. “We keep looking for that gotcha, because Modified Stage 2 appears to be so easy.”
For Stage 3, the final rules made a major change only in the mandatory start date. Though as previously required, no provider can begin Stage 3 until 2017, they are now not required to start until 2018. And their EHR can still be certified to 2015, which relieves a financial burden off providers and EHR vendors alike. “This is like a Christmas present for me as a vendor, and hugely unexpected,” McGinty says. Now for the first time in three years, he says he will have time to work on improving his product beyond what Medicare dictates.
Gullidge warns that anything could change. Therefore, providers must stay up-to-date on Meaningful Use, because “you never know what changes may make you ineligible to participate,” she says. “With CMS, the final rule has proven before to not be final.”