HHS is garnering praise for extending the compliance date for Stage 2 meaningful-use requirements to early participants in its incentive program for electronic health records. But the change likely comes too late to produce the full effect of its stated intent to speed the adoption of EHR systems.
Extension to speed EHR adoption too late for some
HHS Secretary Kathleen Sebelius announced the extension while pitching the administration's health IT push as a job creator during a visit last week to Cleveland's Cuyahoga Community College, which offers certificate and degree programs in health information management.
Sebelius said HHS intends to give hospitals, office-based physicians and other “eligible professionals” one more year to step up to the more stringent Stage 2 meaningful-use requirements of the Medicare EHR incentive payment program if they met Stage 1 requirements in 2011. An official notice of proposed rulemaking will be published in February 2012.
The rollback comes as no surprise. In May, a workgroup of the federally chartered Health IT Policy Committee recommended the extension for first-year meaningful users. It was supported by Dr. Farzad Mostashari, head of the HHS' Office of the National Coordinator for Health Information Technology.
Under current program rules, providers that qualify for incentive payments as Stage 1 meaningful users in 2011—the program's first year—have to meet Stage 2 standards in 2013. The first year of Stage 1 ended Sept. 30 for hospitals and ends Dec. 31 for physicians and other eligible professionals.
In both cases, providers have up to 60 days after the end of their years to submit needed data and attest to the CMS that they had met the meaningful-use criteria for at least 90 consecutive days. That means the extension may be of little use to hospitals. The final day for them to make a submission to HHS was Nov. 30, the day of Sebelius' announcement, which would have given hospital officials who might have been swayed by the rollback less than eight hours to file their data and attestations, according to Marie Copoulos, a consultant with the Advisory Board.
The mental image of which gave her colleagues there a chuckle, she said.
“Unfortunately, there won't be an opportunity for additional (hospital) people to get in under the wire,” Copoulos said. “There is an opportunity for physicians. They're in play until Feb. 28.”
This year, the Advisory Board began counseling clients—even those ready to attest in 2011—to hold off until 2012, citing the time squeeze and the lack of final Stage 2 meaningful-use criteria, which are not expected to be published until summer 2012. Also, the Advisory Board observed, the incentive money will be the same whether providers first attest in 2011 or 2012.
Even if HHS in its new rule allowed hospitals to squeeze into the 2011 payment year—which was not proposed—Copoulos said the Advisory Board would stand pat with its recommendation to wait.
“Once you complete your 90-day reporting period, the next year is a 365-day reporting period,” she said. “For hospitals, it would still mean their 2012 reporting period has already been under way since Oct. 1 this year. Honestly, I think where a lot of folks will have to step back and question whether they're ready to make that jump right now.”
Richard Umbdenstock, American Hospital Association president and CEO, said in a statement that the AHA's members “are committed to implementing electronic health records” to support quality patient care, “but the rushed timelines and complex regulatory requirements of meaningful use have made the process difficult.” He added that the delay brings the process more in line “with market realities, such as limited vendor capacity to work with providers.”
Even with a one-year extension for early adopters, providers won't be lollygagging.
“It really isn't an extra year,” said Dr. John Halamka, chief information officer for Beth Israel Deaconess Medical Center, Boston. “Vendors will have until Oct. 1, 2013, to create and install certified products so that clinicians can begin their year-long reporting period in time for the October 2014 attestation deadline,” he said. “Eighteen months to create new software, integrate it with health information exchanges and ensure broad adoption does not give us substantial free time.”
In Cleveland, Sebelius also announced the results of a National Center for Health Statistics survey of office-based physician practices indicating significant increases in the use of electronic health-records systems.
The NCHS, an arm of the Centers for Disease Control and Prevention, found that 57% of respondents had a self-described EHR, up from 51% in 2010; 34% had a basic EHR system with key capabilities, including patient medication lists, electronically prescribing, viewing labs results and images, up from 25% in 2010.
The 2011 report omitted the results for a third category for providers reporting they use an even more feature-rich “fully functional” EHR system. That figure was only 10% in 2010. Report co-author and NCHS researcher Esther Hing said the question was asked on the 2011 survey—and the figure rose to 17%—but she cautioned that the results are not directly comparable because the category included 12 functions in the 2011 survey, down from 14 in the 2010 version.
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