Healthcare groups have registered their thoughts on suggested conditions for the second round of health IT incentives under the 2009 stimulus law: They're onboard for the trip but want to slow down.
Looking for the brakes
Groups' comments show apprehension over timetable for achieving meaningful use
All told, about $27 billion in federal IT incentive payments are at stake under the American Recovery and Reinvestment Act during the life of the program, which runs through 2016 for Medicare and 2021 for Medicaid. The industry push-back against the Stage 2 proposals has been broad and deep.
Joshua Seidman, the director of meaningful use at the ONC, acknowledged there has been push-back on the timeline in the public comments, but other groups, including some healthcare purchasers, consumer groups and disease management organizations “have actually been asking that the time frame be maintained, so we will be summarizing all that.” The law does give HHS latitude on the timing of the meaningful-use criteria, Seidman said.
Many of the proposed Stage 2 criteria involve dialing up participation levels for measures in Stage 1, such as moving from 30% to 60% of medication orders placed using computerized physician order entry, along with 60% of lab orders.
The work group also proposes a few new measures, including a requirement that 30% of a hospital's medication orders be tracked automatically by an electronic medication administration recording system.
The American Hospital Association produced a 38-page response to the mere 19 pages of Stage 2 rules that the Health IT Policy Committee work group suggested.
“While the AHA strongly supports the accelerated adoption and use of electronic health records to improve patient care, we have significant concerns with some of the recommendations being considered by the HITPC and the 2013 proposed date for beginning of Stage 2,” the AHA said.
The Federation of American Hospitals chose a similar tack—taking whacks at the work group's draft recommendations, but beginning with the diplomatic assertion that it “continues to be a strong supporter” of the federal stimulus law's health IT initiative.
“However,” the federation said in its 11-page response, “we are seeing early evidence that there may be a need to rethink the current staging of the program and build in additional time for providers” to meet “the high bar” of Stage 1 requirements already in force. The Stage 1 criteria became effective for hospitals Oct. 1, and for physicians and other “eligible professionals” on Jan. 1.
The two hospital groups have been joined by the American Medical Association and a coalition of 39 medical specialty societies and associations, the College of Healthcare Information Management Executives and the Electronic Health Record Association, an affiliate of the Healthcare Information and Management Systems Society, in calling on the work group to dial back many of its proposed requirements or stretch out their compliance timelines.
HIMSS, itself, which counts CHIME and EHRA members among its own general membership, issued a policy statement at its annual convention last month generally in support of moving ahead with the new meaningful-use criteria, but also asking CMS rulemakers to “help mitigate” the time pressure providers and developers are facing.
HIMSS and others cited the full agenda the healthcare industry is facing in adapting to changes wrought by other federal regulations, including the healthcare reform law, and, particularly other federal healthcare IT projects.
“We are very concerned with the current schedule for release of the final rule for 2013-2014 meaningful use, and when it will be necessary for eligible hospitals and physicians to be able to implement 2013-2014 certified software,” the EHRA statement said.
“With the time required to develop software, perform adequate quality assurance, obtain (federally required EHR) certification and deploy the software in provider organizations (including internal testing, implementation of new features, and end-user training), currently proposed timelines are simply not sufficient—particularly as regulatory pressures on providers are exacerbated by 5010, ICD-10 and other regulations that will go into effect in the next 24 months,” the EHR vendors said (See story, p. 38).
The ONC's Seidman is a long-distance runner, according to his online biography. He will need considerable stamina in helping members of the Health IT Policy Committee's meaningful-use work group distill the 422 responses to their call for comments.
“We're right in the middle of that process,” Seidman said. The goal is to provide an analysis of the comments to the work group by month's end, in time for its members to read and do some digesting of their own before their scheduled April 5 daylong meeting in which review of the public comments will likely loom large on the agenda.
The work group will present at least some of its interpretations on those comments to its parent Health IT Policy Committee on April 13, Seidman said. A sister Health IT Standards Committee will be briefed April 20 and the work group is expected to present a full set of draft recommendations to the policy committee May 11.
The policy committee is expected to make its recommendations to HHS in June, and HHS will then work toward a proposed rule to come out by the end of the year, Seidman said.
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