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Few hospitals, docs at Stage 2 meaningful use

Few hospitals, docs at Stage 2 meaningful use, CMS official says


By Joseph Conn
Posted: May 6, 2014 - 2:45 pm ET
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(Story updated at 2:50 p.m. ET)

Only four hospitals have achieved Stage 2 meaningful use of electronic health records seven months into the reporting period for hospitals enrolled in the federal EHR incentive-payment program, a CMS official reported today.

Among physicians and other eligible professionals—who are four months into their reporting year—only 50 have attested to Stage 2 meaningful use, said Elisabeth Myers, policy and outreach lead at the CMS' Office of eHealth Standards and Services, during a presentation to the agency's Health Information Technology Policy Committee.

Those low numbers mean that many hospitals and vendors will be under tremendous pressure in the closing months of their incentive payment years to hit Stage 2 or suffer lower Medicare reimbursements.

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Asked by a committee member if the Stage 2 program was successful, Myers said, “We don't have enough data.”

The first Stage 2 attestation period for hospitals began at the start of the federal fiscal year, Oct. 1, 2013. Their second 90-day period started Jan. 1, 2014. Under current program rules, hospitals that have completed two or three years of meaningful use at Stage 1 of the Medicare portion of the program have to advance and achieve 90 consecutive days of meaningful use at more stringent Stage 2 meaningful-use levels during the 2014 fiscal year, or face losing their incentive payments and incurring a 1% reduction in future Medicare reimbursements.

Physicians and other eligible professionals who have attested to two or more years at Stage 1 of the Medicare EHR incentive program also must step up to Stage 2, but must do so by the end of 2014. The payment year for physicians and other professionals is measured by the calendar year; consequently, their first 90-day attestation period began Jan. 1, 2014.

More than 90% of hospitals and nearly 70% of physicians and other eligible professionals have been paid under the Medicare, Medicaid and Medicare Advantage portions of the EHR incentive payment program, sharing $22.9 billion in payments, most under Stage 1, according to the latest CMS data.

According to survey data from the American Hospital Association conducted between November 2013 and February 2014, roughly three-fourths of hospitals surveyed had already installed electronic health record systems that were capable of carrying out 15 of 21 selected Stage 2 functions, but only 10% had systems that would allow patients to view, download and transmit their EHR information. Less than half of EHRs, (49%) could create a summary of care.

Pushback from providers

Some of the pushback in the provider community on the Stage 2 program stems from reports that vendors—also beset with product upgrades to meet ICD-10 coding requirements—have been late in readying their systems for the demands of the EHR incentive-payment program.

In 2014, all providers that qualify for the program at either Stage 1 or Stage 2, must use EHRs that have been tested and certified to new functional criteria, the so-called “2014 Edition” software standards.

Hospitals are faring somewhat better than physicians in their vendor readiness for needed EHR systems upgrades to meet Stage 2 criteria, according to data presented by Jennifer King, acting director, office of economic analysis, education and modeling, at the HHS' Office of the National Coordinator for Health Information Technology.

As of April, 95% of hospitals that have already attested to having previously met Stage 1 meaningful use are deemed by the ONC as “likely” they'll be able to upgrade their current products, or add new products from their current vendors to meet the 2014 Edition “base EHR,” according to a presentation from King using an ONC analysis of program data.

For physicians and other professionals who have previously attested to meaningful use, 83% are using EHRs in which it's likely they can upgrade to a 2014 Edition EHR without needing to switch vendors. Of those that have attested previously, 5% of hospitals and 17% of physicians and other eligible professionals are currently using systems that don't have a 2014 certified-base EHR product.

Presumably, those providers will either have to wait for their vendors to upgrade, test and certify their products, or switch to another vendor's system if they expect to make Stage 2.

For some medical specialists, radiologists, pathologists and anesthesiologists, 24% are using a vendor's product that hasn't been tested and certified to 2014 Edition certified-base EHR standards, King reported. Non-physician “eligible professionals” fare far worse, with 44% of podiatrists and 87% of chiropractors using systems from vendors that don't yet have a 2014 Edition certified-base EHR product.

One problem with “base EHRs” as a gauge for Stage 2 preparedness, however, is that providers cannot meet Stage 2 requirements with a base EHR alone.

To date, 72 eligible hospitals have applied for hardship exceptions from complying with meaningful use; 66 were granted the exceptions.

Follow Joseph Conn on Twitter: @MHJConn


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