Hospitals, Health Professionals Set For Stage 2 Meaningful Use; Senators Express Concerns

October 1 marked the beginning of the 2014 federal fiscal year. It also marked the beginning of the period when eligible providers and eligible professionals (EPs) start the process of demonstrating Stage 2 meaningful use of electronic health records (EHR) in order to qualify for incentive payments from the federal government. Even as some industry analysts say a majority of hospitals and providers are ready to take advantage of Stage 2, some Republican Senators have asked HHS Secretary Kathleen Sebelius to extend by one year the time that providers and EPs have to qualify for the incentive payments.

Background. Section 4201 of the American Recovery and Reinvestment Act of 2009 (ARRA) (P.L. 111-5), the Health Information Technology for Economic and Clinical Health (HITECH) Act, created incentive payments for development, implementation and “meaningful use” of certified EHR systems by eligible Medicare and Medicaid providers and health professionals. The meaningful use program is being rolled out in three stages over five years, from 2011 to 2016, with participating providers required to meet certain requirements for each stage in order to receive incentive payments.

As of August 2013, over 411,021 EPs and 4,547 hospitals had registered to participate in the Medicare or Medicaid incentive programs. CMS had paid out incentive payments totaling $6.2 million to 303,471 unique EPS and $9.7 million to 4,098 hospitals.

Stage 1 meaningful use. The Stage 1 criteria for meaningful use focused on electronically capturing health information in a coded format, using that information to track key clinical conditions, communicating that information for care coordination purposes, and initiating the reporting of clinical quality measures and public health information.

For Stage 1, which began in 2011, there were 25 objectives/measures for EPs and 24 objectives/measures for eligible hospitals. The objectives/measures were divided into a core set and menu set. EPs and eligible hospitals must meet all objectives/measures in the core set (15 for EPs and 14 for eligible hospitals). They could choose to defer up to five remaining objectives/measures.

Stage 2 meaningful use. The requirements for Stage 2 meaningful use were laid out in a Final rule published September 4, 2012 (77 FR 53967). To demonstrate meaningful use under Stage 2 criteria, EPs must meet 17 core objectives and 3 menu objectives that they select from a total list of 6, or a total of 20 core objectives. Eligible hospitals and CAHs must meet 16 core objectives and 3 menu objectives that they select from a total list of 6, or a total of 19 core objectives. For 2014, all providers regardless of their stage of meaningful use are only required to demonstrate meaningful use for a three-month EHR reporting period.

Both EPs and hospitals have new core objectives for Stage 2. EPs must use secure electronic messaging to communicate with patients on relevant health information. Hospitals must automatically track medications from order to administration using assistive technologies in conjunction with an electronic medication administration record. There are also several new menu objectives for both EPs and hospitals in Stage 2.

According to HIMSS Analytics, 75 percent of hospitals anticipated that their organization would qualify for Meaningful Use stage 2 incentives in 2014. As of June 2013, up to 68 percent of eligible hospitals had purchased software from a vendor that has been certified to the 2014 Edition certification criteria. However, according to HIMSS Analytics concerns remain that some of these hospitals have not yet upgraded to the most recently certified version.

Extension. While noting that the meaningful use program has played a “significant role” in spreading the use of health information technology, some Republican senators are concerned that “progressing to Stage 2 may not be feasible for all participants.” In a letter to HHS Secretary Sebelius, the senators noted that “onset of Stage 2 may widen the digital divide for small and rural providers who lack the resources of large practices and may not be vendors’ top priorities.” The aggressive Stage 2 timeline also may stifle medical innovation and lead to more medical errors, according to the senators. The senators asked that providers that are not yet ready to transition to Stage 2 should receive a one-year extension  before they must demonstrate Stage 2 meaningful use.