Is it already time for Stage 3 Meaningful Use? While most health care providers and EHR companies work through implementations and workflows for the 2014 Edition of certified electronic health records (CEHRT) and have completed at most Stage 1 attestation, the Centers for Medicare & Medicaid Services (CMS) has been preparing the Stage 3 Rule. Stage 3 Proposed Rule will be published on March 30th. CMS proposes a final set of criteria for eligible professionals (EPs), eligible hospitals and critical access hospitals (CAH) to qualify for receipt of Medicare and Medicaid incentive payments and to avoid downward adjustments to future Medicare payments.
The Meaningful Use program created in 2009 offers incentive payments to EPs, eligible hospitals, CAHs and Medicare Advantage organizations by Medicare and Medicaid for demonstrating meaningful use of CEHRT and a subsequent downward adjustment of Medicare payments for failure to do so. The triple phased program is intended to improve healthcare quality and encourage innovation through technology while minimizing the burden on healthcare providers. The ultimate goal is that “meaningful use of CEHRT should result in health care that is patient centered, evidence-based, prevention-oriented, and equitable.” Proposed Rule, p. 27. Each phase involves more progressively advanced use of EHR functionality and IT-based processes in clinical or hospital settings.
Stage 1 (July 2010) set initial criteria for meaningful use and established timelines for incentive payments and Medicare payment reductions. Medicare incentive payments began in 2011 and end in 2016. Medicaid incentive payments are capped at 5 years and end in 2021. After 2016, to qualify for Medicaid incentives, a provider must successfully and successively attest to meaningful use. Medicare payment reductions begin in 2015. Stage 2 (September 2012) introduces interoperability, focuses on patient coordination of care through exchange of patient health information, and establishes a set clinical quality measures (CQMs) for all providers to report to CMS beginning in 2014. Under both earlier Stages, “meaningful use” could be met through paper and electronic documentation and participants who failed any two objectives could still meet meaningful use. Not so under the proposed Stage 3 Rule.
Stage 3 is intended to be the final rule under the Program, but CMS has left a window to address changes in technology and clinical care standards. The Rule proposes uniformity in reporting by consolidating meaningful use objectives under Stage 3 and merging Medicare reporting requirements for EPs and hospitals. In addition, Stage 3 addresses inconsistent reporting periods by, beginning in 2017, eliminating the 90-day EHR reporting period and transitioning participants to a calendar year reporting period. Thereafter, there will be a single calendar year reporting period for all participants.
In 2014, the EHR industry and providers faced a challenge after delayed publication of the final rule for Stage 2 and then unavoidable delayed availability of certified 2014 Edition CEHRTs prior to the end of the 2014 reporting period. Stage 3 drafters have attempted to anticipate and prepare for implementation issues relating to the 2015 Edition CEHRT. In 2017, the proposed Rule allows providers flexibility to repeat attestation for meaningful use at the prior year’s Stage and using the 2014 Edition; however, in 2018 and afterward, only Stage 3 attestation and 2015 or subsequent Edition CEHRT may be used in demonstrating meaningful use.
CMS identified eight objectives directed toward aligning advanced use of EHR technology with program foundational goals and overall national health care improvement goals. Proposed Stage 3 focuses primarily on moving providers toward a more electronic environment, encouraging patient engagement and care coordination through the CEHRT and certified third party technology, providing a more patient-centered health record, and utilizing more interoperability with third parties and public sources. Proposed Objectives are: (1) protect patient health information, (2) electronic prescribing, (3) clinical decision support, (4) computerized provider order entry, (5) patient electronic access to health information, (6) coordination of care through patient engagement, (7) health information exchange (HIE), and (8) public health and clinical data registry reporting.
While some objectives appear to mirror those found in Stage 2 and exceptions for hardship remain unchanged, there are important differences: (1) each measurement may be met only with electronic processes, (2) attestation measurements under each have been increased, and (3) participants must meet all eight objectives. Although patient access and engagement are dependent on patient participation and certified third-party applications (outside of the CEHRT), providers will still be required to meet these objectives.
Comments on the Proposed Rule are accepted for sixty days from the date of publication.
Beth Pitman and Zachary Trotter practice in the health law department in the Birmingham office of Waller.