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Lamar Alexander (R-Tenn.)

Six GOP senators press CMS' Tavenner for Stage 2 exemption details

By Joseph Conn
Posted: March 7, 2014 - 2:45 pm ET

Six Republican senators have asked CMS Administrator Marilyn Tavenner for more details about her plan to give some wiggle room to providers who fail to meet Stage 2 requirements under the federal electronic health record incentive payment program.

In her keynote speech at the Healthcare Information and Management Systems Society convention last week in Orlando, Fla., Tavenner said there would be no roll backs of Stage 2 compliance dates, but providers' applications for “hardship exemptions” would be considered on a case-by-case basis.

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In their letter, Sens. Lamar Alexander (R-Tenn.), John Thune (R-S.D.), Richard Burr (R-N.C.), Tom Coburn (R-Okla.), Mike Enzi (R-Wyo.) and Pat Roberts (R-Kan) said, “providers across the country (are) struggling to meet the burdens of new electronic health records regulations.”

“We are disappointed by your announcement last week that CMS will not give the extra time providers need to properly upgrade their systems,” the senators said. “CMS seems to view hardship exceptions as a solution, yet so far has offered no details about how the exemptions will be granted or how the exemptions will address widespread concerns about timing.”

One example Tavenner cited was if a provider's health IT vendor were delayed in supplying the needed upgraded products in a timely manner.

A steep drop in the number of software developers that have tested and certified their software products to the program's new, more stringent technical requirements has been viewed by health IT industry watchers as a harbinger of a impending shakeout in the health IT market.

Tavenner provided few other details about the proposed new addition to the program's existing hardship exemption and none have been posted to the CMS website in the week since her speech, a delay that prompted the senators to ask Tavenner “to respond to our request for clarification as soon as possible.”

Their letter notes that the CMS website “currently says hardship exceptions are available only in certain narrow circumstances—such as a lack of broadband Internet or an unforeseen natural disaster.”

And they ask, “How will these categories be expanded? Will the applications be due April 1? What documentation or standard of proof must be met to obtain an exception? What is the timing for review, and will there be an appeals process?”

In addition to losing their incentive payment for the year, providers who fail to comply with Stage 2 requirements will be penalized 1% of their Medicare reimbursements in 2015.

Multiple healthcare organizations have called for delays, or for more flexibility in the reporting requirements, for Stage 2 of the federal program. The American Hospital Association, for example, expressed its displeasure “that CMS will not make changes to the timelines or provide additional flexibility in the meaningful use requirements,” in a statement by Chantal Worzala, AHA director of policy.

David Muntz, the former principal chief deputy in the Office of the National Coordinator for Health Information Technology at HHS, now senior vice president and CIO of GetWellNetwork, called for a delay in Stage 2 compliance requirements.

The start dates for Stage 2 were Oct. 1, 2013, for eligible hospitals, for which the program operates on the fiscal year; and Jan. 1, 2014, for physicians and other eligible professionals, whose program runs on the calendar year.

Both hospitals and physicians and other EPs must meet Stage 2 meaningful-use criteria for 90 consecutive days, with those periods beginning only on four possible start dates, the first day of each quarter during their respective payment years. For hospitals that have not yet begun their 90-day counts, it means they have only two start dates left, April 1 and July 1. Physicians and other professionals have three start dates remaining, April 1, July 1 and Oct. 1.

Follow Joseph Conn on Twitter: @MHJConn

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