Proposal Would Change EHR Technology Timelines and Quality Measure Reporting

On May 23, 2014, CMS will publish a proposed rule to amend the stage timeline for reporting the meaningful use of electronic health records (EHRs) and the requirements for the reporting of clinical quality measures for 2014. The proposal would allow eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) to use the 2011 Edition certified EHR technology (CEHRT), or a combination of the 2011 and 2014 Edition CEHRT, for the 2014 reporting period for the Medicare and Medicaid EHR Incentive Programs. The proposal would also extend Stage 2 through 2016 and begin Stage 3 in 2017. Conforming changes to the definition of CEHRT are also proposed.

Background

The American Recovery and Reinvestment Act of 2009 (ARRA) (P.L. 111-5) amended the Social Security Act to authorize incentive payments to EPs, eligible hospitals, CAHs, and Medicare Advantage (MA) organizations to promote the adoption and meaningful use of CEHRT. The amendments require that Medicare and Medicaid providers adopt, implement, upgrade, or meaningfully use CEHRT if they are to receive certain financial incentives under the Act. Beginning with fiscal year (FY) and calendar year (CY) 2014, all EPs, eligible hospitals, and CAHs must use 2014 Edition CEHRT to meet meaningful use under the Medicare and Medicaid EHR Incentive Programs.

Prior Regulatory Action

On September 4, 2012, CMS published a final rule (77 FR 53968) establishing the timeline for the stages of meaningful use through 2021 and the EHR reporting periods in 2014. Under the final rule, EPs, eligible hospitals, and CAHs that attest to meaningful use for 2014 for their first year of Stage 2 or their second year of Stage 1 have a 3-month quarter EHR reporting period in CY 2014 (for EPs) or FY 2014 (for eligible hospitals and CAHs). For the Medicaid incentive payments for meaningful use, EPs have an EHR reporting period of any continuous 90-day period in CY 2014 as defined by the state Medicaid program, or, if the state so chooses, any 3-month CY quarter in 2014. EPs, eligible hospitals, and

CAHs that demonstrate meaningful use for the first time in 2014 have an EHR reporting period of any continuous 90-day period in CY 2014 or FY 2014, respectively.

Proposed Changes to Meaningful Use Stage Timeline

In an effort to grant more flexibility, CMS is now proposing to allow EPs, eligible hospitals, and CAHs that are unable to fully implement 2014 Edition CEHRT for the

2014 reporting year due to delays in 2014 Edition CEHRT availability, to continue to use 2011 Edition CEHRT or a combination of 2011 Edition and 2014 Edition CEHRT for the EHR reporting periods in CY 2014 and FY 2014. CMS is proposing this change for 2014 only. All providers must still use 2014 Edition CEHRT for the EHR reporting periods in CY 2015, FY 2015, and in subsequent years or until new certification requirements are adopted.

In order to avoid inadvertently incentivizing the purchase of an outdated product that cannot be used to demonstrate meaningful use in a subsequent year, CMS is also proposing that to qualify for an incentive payment under Medicaid, a provider must adopt, implement, or upgrade to 2014 Edition CEHRT only. A provider would not be able to qualify for a Medicaid incentive payment for 2014 for adopting, implementing, or upgrading to 2011 Edition CEHRT or a combination of 2011 and 2014 Edition CEHRT.

Under the proposed rule, the three options for the use of CEHRT editions and the available Stage of meaningful use objectives and measure are as follows:

  • Using 2011 Edition CEHRT only. CMS proposes that all EPs, eligible hospitals, and CAHs that use only 2011 Edition CEHRT for their EHR reporting period in 2014 must meet the meaningful use objectives and associated measures for Stage 1 that were applicable for the 2013 payment year, regardless of their current stage of meaningful use.
  • Using a combination of 2011 and 2014 Edition CEHRT. CMS proposes that all EPs, eligible hospitals, and CAHs using a combination of 2011 Edition CEHRT and 2014 Edition CEHRT for their EHR reporting period in 2014 may choose to meet the 2013 Stage 1 objectives and measures or the 2014 Stage 1 objectives and measures, or if they are scheduled to begin Stage 2 in 2014, they may choose to meet the Stage 2 objectives and associated measures.
  • Using 2014 Edition CEHRT for 2014 Stage 1 objectives and measures in 2014 for providers scheduled to begin Stage 2. CMS proposes that providers who are scheduled to begin Stage 2 for the 2014 EHR reporting period, but are unable to fully implement all the functions of their 2014 Edition CEHRT required for Stage 2 objectives and measures due to delays in 2014 Edition CEHRT availability, would have the option of using 2014 Edition CEHRT to attest to the 2014 Stage 1 objectives and measures for the 2014 EHR reporting period.

CMS is proposing that the flexibility regarding use of the various editions of CEHRT would apply only to the EHR reporting periods in 2014 for the EHR Incentive Program. Providers that were scheduled to begin Stage 2 in 2014, but that instead meet the Stage 1 criteria in 2014, will still be required to begin Stage 2 in 2015. By 2015, all providers, except those in their first year of demonstrating meaningful use, are required to have a full year EHR reporting period. In addition, in 2015, all providers are required to have 2014 Edition CEHRT in order to successfully demonstrate meaningful use.

Extension of Stage 2

Under the current timeline, an EP, eligible hospital or CAH that first became a meaningful user in 2011 or 2012 would be required to begin Stage 3 on January 1, 2016 (the first day of CY 2016 for EPs) or October 1, 2015 (the first day of FY 2016 for eligible hospitals or CAHs). However, because CMS intends to analyze the meaningful use Stage 2 data to inform its development of the criteria for Stage 3 of meaningful use, it is proposing a 1-year extension of Stage 2. CMS is further proposing that Stage 3 would begin in CY 2017 for EPs and FY 2017 for eligible hospitals and CAHs that first became meaningful users in 2011 or 2012. This would allow EPs, eligible hospitals, and CAHs that first became meaningful users in 2011 or 2012 to begin Stage 3 on January 1, 2017 (EPs) and October 1, 2016 (eligible hospitals and CAHs).

Clinical Quality Measure Submissions

All providers are required to select and report on clinical quality measures (CQMs) from the relevant sets adopted in the Stage 2 final rule regardless of their stage of meaningful use or year of participation in the EHR Incentive Program. CMS is proposing that the method of CQM submission would depend on the edition of CEHRT a provider uses to record, calculate, and report its clinical quality measures for the selected EHR reporting period in 2014.

If a provider elects to use only 2011 Edition CEHRT for its EHR reporting period in 2014, the provider would be required to report CQMs by attestation as follows:

  • EPs would report from the set of 44 measures and according to the reporting criteria finalized in the Stage 1 final rule.
  • Eligible hospitals and CAHs would report all 15 measures finalized in the Stage 1 final rule.

The reporting period would be any continuous 90 days within FY 2014 for providers that are demonstrating meaningful use for the first time or a 3-month FY quarter for EPs or a 3-month CY quarter for hospitals that have previously demonstrated meaningful use.

If a provider elects to use a combination of 2011 Edition and 2014 Edition

CEHRT and chooses to attest to the 2013 Stage 1 objectives and measures for its HER reporting period in 2014, the provider would be required to report CQMs by attestation using the same measure sets and reporting criteria for providers who elect to use only 2011 Edition CEHRT for their EHR reporting periods in 2014.

If a provider elects to use a combination of 2011 Edition and 2014 Edition

CEHRT and chooses to attest to the 2014 Stage 1 objectives and measures or the Stage 2 objectives and measures, the provider would be required to submit CQMs in accordance with the requirements and policies established for clinical quality measure reporting for 2014 in the Stage 2 final rule and subsequent rulemakings.

CMS welcomes comments on the proposed rule.