Comments on proposed Stage 3 meaningful use rule given to CMS

Just in time for the May 29, 2015, deadline, a number of interested parties have submitted comments to CMS on a Proposed rule (80 FR 16731, March 30, 2015) that would set the meaningful use standards for eligible professionals, hospitals, and critical access hospitals  to meet for Stage 3 of the Medicare and Medicaid EHR Incentive Programs. The common elements in the comments are the belief that CMS’ timeline for Stage 3 is too short and a request for a delay in finalizing the Proposed rule. Many comments also suggested changes to the proposal.

Meaningful Use

To encourage adoption of certified electronic health record (EHR) technology, CMS’ Medicare EHR Incentive Program makes payments to eligible professionals that successfully demonstrate that they have used EHR in a meaningful way, known as “meaningful use.”

Meaningful use includes using EHR technology to:

  • improve quality, safety, and efficiency and reduce health disparities;
  • engage patients and family;
  • improve care coordination and population and public health; and
  • maintain privacy and security of patient health information.

Ultimately, CMS hopes that meaningful use compliance will result in:

  • better clinical outcomes;
  • improved population health outcomes;
  • increased transparency and efficiency;
  • empowered individuals; and
  • more robust research data on health systems.

The program involves stages of meaningful use, each with increased and cumulative requirements. Stage 1, Data Capture and Sharing, began in 2011. Stage 2 involved the use of Advance Clinical Processes, and Stage 3, which has not yet begun, will look at Improved Outcomes.

Stage 3 Proposed Rule

The Stage 3 Proposed rule builds on the Stage 1 and Stage 2 Final rules and focuses on the advanced use of EHR technology to promote improved patient outcomes and health information exchange. The Proposed rule would (1) encourage electronic submission of clinical quality measure (CQM) data for all providers, where feasible, in 2017; (2) require the electronic submission of CQMs where feasible in 2018; (3) establish requirements to transition the program to a single stage for meaningful use; and (4) change the EHR reporting period so that all providers would report under a full calendar year timeline with a limited exception under the Medicaid EHR Incentive Program for providers demonstrating meaningful use for the first time.

Comments on the Proposed Rule

The American Hospital Association (AHA) wrote that “While the Stage 3 proposals offer promising ideas that could further health information exchange and support greater patient engagement,” AHA member hospitals “do not yet have sufficient experience at Stage 2 to be confident that the proposals for Stage 3 are feasible and appropriate.” The organization requested CMS to refrain from finalizing a Stage 3 meaningful use rule. The agency should instead learn from the experience in Stage 2 and accelerate the availability of mature standards and the infrastructure needed for efficient and effective health information exchange.

In a similar letter signed by the AHA along with America’s Essential Hospitals, the Association of American Medical Colleges (AAMC), the Catholic Health Association of the United States, the Children’s Hospital Association, the Premier healthcare alliance, and VHA Inc., the organizations explained their belief that “providing additional time for maturation of implemented technology and optimization to support meaningful use and other regulatory requirements is the right policy to keep all stakeholders focused on the activities that will support the better quality care for patients and for populations.”

The AAMC separately encouraged CMS to “keep the meaningful use requirements for hospitals and physicians aligned,” and requested additional flexibility for 90-day reporting periods beyond 2015 and a group reporting option for eligible professionals.

The College of Healthcare Information Management Executives (CHIME) called the Proposed rule “too ambitious.” In its letter, CHIME noted that the meaningful use program “has demanded more of providers and their vendor partners than any comparable program managed by the federal government,” and also suggested a delay in implementation until after the 2016 program year, which the organization says would “give policymakers a chance to understand how the private sector performs relative to modifications proposed for program years 2015 through 2017.”