Meaningful Use

Several groups have submitted comments on CMS' proposed meaningful use modifications for 2015 through 2017, Clinical Innovation & Technology reports (Walsh, Clinical Innovation & Technology, 6/15).

Under the 2009 economic stimulus package, providers who demonstrate meaningful use of certified electronic health records can qualify for Medicaid and Medicare incentive payments.

Details of Proposal

In April, CMS released a proposed rule that would shorten Medicare and Medicaid meaningful use attestation for eligible professionals and hospitals to a 90-day period in 2015.

Overall, the proposed rule would:

• Realign the reporting period starting in 2015 to allow hospitals to participate on the calendar year instead of the current fiscal year period;
• Reduce the number of meaningful use objectives to improve advanced use of EHRs; and
• Remove redundant measures and those that have become widely adopted.

In addition, the proposed rule would change Stage 2 meaningful use requirements related to patient engagement. Specifically, CMS proposed reducing the requirement for patients to use technology to electronically download, view and transmit their medical records from 5% of eligible providers' patients to just one patient (iHealthBeat, 4/13).

Comments on the proposed modifications were due June 15 (iHealthBeat, 5/28).

American Medical Group Association Comments

The American Medical Group Association in its comments praised CMS for easing the program's reporting requirements, as well as for proposing a shorter 90-day reporting period.

AMGA CEO Donald Fisher said, "This proposed rule reflects that CMS has been sensitive to the struggles that the health care industry has had with meaningful use by simplifying some of the reporting requirements through 2017."

The group also urged CMS to help strengthen the health IT infrastructure to support future data sharing requirements (AMGA release, 6/15).

College of Healthcare Information Management Executives Comments

Russell Branzell, president of the College of Healthcare Information Management Executives, in his comments called for a middle ground on patient engagement. He wrote that rather than requiring every specialist to demonstrate that patients can "view, download and transmit" their health information, those data should be aggregated into a single location for patients.

He added, "I definitely want patient data made accessible to patients or those taking care of them. But I don't want to get every note out of some subspecialty office" (Pittman et al., "Morning eHealth," Politico, 6/16).

Consumer Partnership for eHealth Comments

Meanwhile, a group of 50 advocacy groups organized by the Consumer Partnership for eHealth and the Consumer-Purchase Alliance in its comments expressed disappointment, saying CMS' proposal to reduce patient engagement requirements would undermine patient engagement efforts (Clinical Innovation & Technology, 6/15). Specifically, CPeH said, "CMS' proposed amendments constitute a dramatic retreat from essential efforts to make patients and family caregivers true and equal partners in improving health through shared information, understanding and decision making" ("Morning eHealth," Politico, 6/16).

Debra Ness -- president of the National Partnership for Women & Families, which was part of the coalition -- said the groups "urge CMS to keep the existing patient engagement thresholds."

Meanwhile, Bill Kramer, co-chair of the Consumer-Purchase Alliance, noted that maintaining efforts to give patients and caregivers "electronic access to and use of their health information" is key to achieving interoperability in the U.S. health care system (Clinical Innovation & Technology, 6/15).

Healthcare Information and Management Systems Society Comments

The Healthcare Information and Management Systems Society in a letter to CMS supported the agency's proposal to ease reporting requirements but urged CMS to be cautious moving forward with other proposals, Health Data Management reports.

Among other things, HIMSS recommended that CMS:

• Phase-in the new thresholds for the Patient Electronic Access Objective;
• Reconsider the "unrealistic goal" of the 2016 hospital electronic prescribing requirement; and
• Take into account the timing of the release of the final rule in terms of the "short turnaround in meeting" its requirements (Slabodkin, Health Data Management, 6/16).

A recent opinion piece and blog post take different positions on the overall success and potential effects of the meaningful use program.

Under the 2009 economic stimulus package, providers who demonstrate meaningful use of certified electronic health records can qualify for Medicaid and Medicare incentive payments.

Washington Post Opinion Piece

Charles Krauthammer in a Washington Post opinion piece argues that the federal government's EHR "mandate" has "degraded medicine" and has even driven some physicians to leave the profession.

Krauthammer -- a former health care provider -- writes that the Obama administration's 2009 promise that EHRs would save $77 billion per year "became a joke," and the $27 billion that was allocated for the transition "is gone." Moreover, he adds that a 2014 HHS Office of Inspector General report found that "'EHR technology can make it easier to commit fraud,' as in Medicare fraud."

Krauthammer cites a former medical school classmate who wrote in their school's 40th reunion report that adopting EHRs at his office has meant that he "can only see about three-quarters of the patients [he] could before, and has prompted [him] to seriously consider leaving for the first time."

Krauthammer also cites an American Journal of Emergency Medicine study that found emergency department physicians "spend 43% of their time entering electronic records information, 28% with patients" and a JAMA Internal Medicine study that showed "family-practice physicians spend on average 48 minutes a day just entering clinical data."

Krauthammer adds, "That's just the beginning of the losses. Consider the myriad small practices ... facing ruinous transition costs in equipment, software, training and time, have closed shop, gone bankrupt or been swallowed by some larger entity." In addition, he notes, that providers who had not adopted EHRs by January will receive lower Medicare payments.

Krauthammer concludes that while "many ... feasted" on the initial investment in the government's push to adopt EHRs, "the rest is waste: money squandered, patients neglected, good physicians demoralized" (Krauthammer, Washington Post, 5/28).

HIMSS Blog Post

In response to Krauthammer's piece, Tom Leary, vice president of government relations for the Healthcare Information and Management Systems Society, in a blog post writes that while the "[c]hallenges" to EHR adoption "are still evident ... the meaningful use program is lining up to have a long-term positive impact on health care delivery in the U.S."

He notes that Krauthammer's "implication that digitizing patient records has been anything but a bipartisan imperative for the country fails to acknowledge health IT as a critical tool for supporting health care transformation by improving  quality and controlling the cost of care delivery." He adds that the "march to meaningful use" started in January 2004 when then President George W. Bush (R) "declared that most Americans would have access to their electronic health record within 10 years."

Leary also highlights the benefits of health IT, noting that investments in the area "will ensure better quality data are available to providers, so they can make informed decisions about the right patient at the right time."

Leary points to recent data from HIMSS Analytics that suggests "over 70% of hospitals have made positive progress in the advancement of their EHR capabilities over the last five years, and over 60% of ambulatory facilities have shown positive progress in just the last three years." He also cites examples of "smaller practices using health IT solutions to make positive change for their patients," such as Fremont Family Care, which saw the number of patients who needed hospitalization for pneumonia drop by half after it implemented an EHR system.

Leary acknowledges that there is still "work to do," in terms of health information exchange and meaningful use of health IT. However, he concludes, "We know IT improves health, and we will continue to educate the public on its benefits" (Leary, HIMSS blog post, 6/3).

Several groups have offered recommendations for CMS' proposed rule for Stage 3 of the meaningful use program, Clinical Innovation & Technology reports (Walsh, Clinical Innovation & Technology, 5/29).

Background

Under the 2009 economic stimulus package, providers who demonstrate meaningful use of certified electronic health records can qualify for Medicaid and Medicare incentive payments.

The comment period for the Stage 3 proposed rule closed on Friday.

Under the proposed rule, all eligible professionals beginning in 2018 would report on Stage 3 of the meaningful use program regardless of their previous participation. Providers would have the option to move to Stage 3 starting in 2017 (iHealthBeat, 5/28).

AMA's Comments

In a letter, the American Medical Association called on CMS to address current program issues before moving on to the next stage.

The association made several recommendations should CMS choose to continue with the Stage 3 transition in 2018, including:

• Allowing quality measures that are reported to clinical registries to satisfy meaningful use reporting requirements;
• Establishing a reporting period that is less than one year;
• Seeking physician and vendor feedback before implementing or retracting measures; and
• Setting 2017 as a transitional year for providers and vendors to adapt to system and workflow changes (AMA release, 5/29).

AMIA's Comments

Meanwhile, the American Medical Informatics Association said that the transition to the Merit-based Incentive Payment System established by the repeal of Medicare's Sustainable Growth Rate formula would be "highly burdensome while offering only modest gains" under the proposed Stage 3 rule (Pittman et al., "Morning eHealth," Politico, 6/1).

HIMSS' Comments

In comments submitted last week, the Healthcare Information and Management Systems Society emphasized the importance of interoperability and the meaningful use program's role as a "critical tool for enabling health care transformation."

HIMSS also said that it supported CMS' efforts to align the meaningful use program with other CMS quality reporting programs that use certified EHR technology, citing the proposal's potential to ease the burden on providers.

However, HIMSS recommended that CMS:

• Allow 18 months between the finalization of relevant rules and the transition to Stage 3 for providers to prepare; and
• Lessen the "prescriptive nature" of the meaningful use program.

MGMA's Comments

In its own comments, the Medical Group Management Association also expressed concerns over the current state of the proposed rule.

MGMA said that the meaningful use "program has become a significant administrative burden and is proving to be counterproductive."

The group recommended that the proposed rule be "substantially modified" and urged CMS to delay finalizing the Stage 3 rule until:

• The effect of the Medicare Access and Children's Health Insurance Program Reauthorization Act of 2015 and its meaningful use provisions are determined; and
• Useful data on eligible professionals' participation in Stage 2 is made available.

MGMA also encouraged CMS to:

• Create additional categories for qualifying for hardship exceptions;
• Establish a 90-day reporting period for the entire program; and
• Set objectives and measures that are reasonable and do not discourage EPs from participating (Clinical Innovation & Technology, 5/29).

AHA's 2015 Health IT Certification Criteria Comments

Meanwhile, the American Hospital Association in a letter to National Coordinator for Health IT Karen DeSalvo applauded the 2015 Edition Health IT Certification Criteria proposed rule for its provisions to:

• Create a health information exchange infrastructure; and
• Improve interoperability.

However, AHA also urged the Office of the National Coordinator for Health IT to increase transparency and the reliability of certified health IT through:

• Surveillance of products being used "in the field";
• More disclosure requirements for vendors; and
• Testing (Dvorak, FierceHealthIT, 5/29).

Linda Fishman, senior vice president of public policy analysis and development at AHA, wrote, "While this may narrow the scope of a final 2015 Edition rule," it also could "improve both the ability of vendors to develop technology in conformance with certification requirements and the ability of providers to successfully implement technology to meet regulatory requirements" (AHA News, 5/29).