Meaningful use on track, despite resistance

Earlier this month, panelists of the US Senate’s committee on Health, Education, Labor and Pensions, part of an ongoing a series of discussions focusing on how to improve electronic health records and create an interoperable health system, recommended that meaningful use stay the course.

Senator Lamar Alexander (R-Tenn.), who continues to push regulators on health IT capabilities and regulation, also pushed panelists about their thoughts on meaningful use Stage 3 asking them if it would be best to slow down finalization of the rule. “We can’t go back,” said Meryl Moss, chief operating officer at Providence, Rhode Island-based Coastal Medical, in response to the committee, Fierce reports.

Providers can’t improve quality if they can’t measure or track quality, which is what meaningful use is helping to do, she said.

“We have to stay the course … absolutely we have to stay the course,” Timothy A. Pletcher, executive director of Michigan Health Information Network Shared Services, said in the committee. “We’re getting better across the board, we’re all learning. Even the quality measures, which are such a challenge in Meaningful Use Stage 3, start to bring that into alignment.”

But Fierce points to an industry truth: Many industry leaders are not so supportive of meaningful use, including the American Medical Association, the Medical Group Management Association, the American Hospital Association and the College of Healthcare Information Management Executives.

Additionally, support is gaining for the softening of proposed rules of some of the requirements of the meaningful use program for 2015 through 2017, but there are concerns. For example, the MGMA is urging CMS to finalize the rule “as quickly as possible,” but also was “very disappointed” that the rule was not released as an interim final rule, which would have “significantly reduced industry confusion and provided eligible professionals (EPs) and their vendor partners much needed additional time.”

The American Hospital Association says that the rule provides “much needed relief” but that the multitude of additional program changes creates confusion and added burdens on providers.

The Healthcare Information and Management Systems Society’s comments take a more balanced approach, supporting much of the proposed rule, as well as suggesting there be an increased focus on outcomes over process and a phased-in approach for patient electronic access and secure measures. HIMSS also recommends that CMS address the tight timelines between the issuance of the final rule and the looming end of 2015.

Fierce reports, however, that the Consumer Partnership for eHealth and Consumer-Purchaser Alliance — comprised of 50 different patient, labor and related organizations – is not happy with the changes, specifically, to the requirement that 5 percent of patients view, download or transmit their electronic health information or securely message their providers, saying that the 5 percent is “more than attainable” and calling it a “dramatic retreat” from making patients and caregivers true partners in improving health.

The rule, published in the Federal Register in April, would grant providers additional flexibility in meeting Stages 1 and 2 of the program, such as shortening the reporting period for 2015 from one year to 90 days. The rule also makes changes to align Stages 1 and 2 to CMS’ proposed vision for Stage 3 of the program. Comments on the rule were due June 15.

It’s interesting to note that, in regard to meaningful use Stage 3 anyway, in a statement to CMS, CHIME stated, “We doubt many providers could participate in 2018 successfully, and with so few providers having demonstrated Stage 2 capabilities, we question the underlying feasibility of many requirements and question the logic of building on deficient measures.”

CHIME also urged CMS to make several changes to the proposed rule for Stage 3, including:

• A 90-day reporting period for the first year of Stage 3 compliance, at least for payment adjustment purposes;
• Modify requirements for and retain the 90-day reporting period for providers attesting to meaningful use requirements for the first time, whether in a Medicare or Medicaid context;
• Eliminate patient action thresholds for the care coordination objective;
• Reduce the number of required measures in multi-measure objectives, health information exchange and care coordination;
• Create hardship exceptions for providers switching vendors;
• Allow providers to take a 90-day reprieve during any program year for upgrades, planned downtown, bug fixes related to new technology or optimizing the use of new technology within new workflows; and
• Allow, in limited circumstances, paper-based means to achieve measure thresholds.

Additionally, the organization, which continues to voice its concerns with meaningful use, said it was “troubled over the requirement that all providers must attest to meaningful use Stage 3 by 2018, regardless of prior participation and experience with the program.

“While we acknowledge policymakers’ intention to make each Stage more difficult than the last, we are concerned with the strategy that envisions Stage 3 serving as both the apex of MU requirements and as a starting point for those providers with no experience at Stage 1 or Stage 2 of the EHR Incentive program,” CHIME said. “We worry some of the objectives pose too great a stretch for seasoned meaningful users, let alone those who have never participated in the program.”

CHIME CEO and president Russell P. Branzell, FCHIME, CHCIO added: “In order to realize the network effects of meaningful use, we need as many providers as possible participating in the program. As proposed, this rule may do more to deter, rather than encourage, on-going participation.”

As meaningful use continues its track, it’s fair to say there will be many developments ahead, and much support for and against the program as a whole or its parts. And, as long as interested parties in Washington (Alexander) remain interested in the regulation, we’ll continue to see headlines regularly.