The CMS' long-awaited and much delayed set of proposed Stage 2 meaningful-use regulations released last week is a mix of old paths and new trails.
Ratcheting up compliance
Stage 2 regs focus on electronic exchange of info
The proposed regulations, issued by HHS on Feb. 23, contain many criteria familiar to providers that have achieved Stage 1 compliance under the Medicare and Medicaid electronic health-record incentive payment programs created under the American Recovery and Reinvestment Act of 2009.
For many of these recycled criteria, however, the proposed Stage 2 regulations would require somewhat higher or broader performance metrics than in Stage 1. The regulations also would add a few new challenges, most notably an increased emphasis on the electronic exchange of information.
Combined, these new requirements represent the climb providers would need to make to become meaningful users of EHR technology and receive payments—or avoid penalties—under the Medicare and Medicaid programs. That climb to Stage 2 won't be necessary until at least 2014, however, thanks to a decision by HHS in November to extend the compliance deadline for Stage 2 for an additional year for providers who met meaningful-use Stage 1 criteria in 2011.
HHS is expected to publish the proposed regulations in the March 7 Federal Register with a 60-day public comment period before making them final.
“We stayed the course,” said Dr. Farzad Mostashari, head of the Office of the National Coordinator for Health Information Technology at HHS, who previewed the proposed regulations on Feb. 22 at the Healthcare Information and Management Systems Society 2012 conference and exhibition in Las Vegas. (Read more from the HIMSS meeting.)
By that he meant CMS rule makers leaned heavily on recommendations from the federally chartered Health IT Policy and Standards committees submitted last summer to the ONC. Those recommendations included ratcheting up the levels of compliance in Stage 2 with certain meaningful-use metrics in Stage 1.
For example, under the proposed Stage 2 standards, to qualify for meaningful-use payments, hospitals as well as physicians and other “eligible professionals” would have to place orders through computerized physician-order entry systems, or CPOE, for more than 60% of their medication, laboratory and radiology orders. Under Stage 1, there was a 30% CPOE threshold and only medication orders were counted. These proposed higher performance metrics comport with the Health IT Policy Committee's recommendation for CPOE.
Mostashari also used the term “push” multiple times to describe the direction of the proposed regulations, including going beyond the recommendations of the advisory panels in some instances, most prominently, in the use of specific standards for the electronic exchange of information.
There are specified standards in the Stage 2 regulations for clinical messaging that “will become a required part of certified health information technology,” Mostashari said. They include the federally developed direct protocol for provider-to-provider messaging.
The proposed regulations also would require the use of specific, single standards for patient-care summaries, for storing and transmitting lab results, and for recording problem lists, representing “a very ambitious target for actual exchange, not just a test, across organizational and vendor boundaries,” Mostashari said.
First-blush reactions to the proposed Stage 2 regulations ranged from simple relief that they had finally arrived to wary skepticism—views sometimes expressed by the same person.
“Initially, the first reaction from all of us is we're glad to know what all of the rules are,” said Dr. Karen Bell, who listened as Mostashari gave the IT community a sneak-peak preview of the rules at HIMSS. Bell is chairwoman of the Certification Commission for Health Information Technology, a Chicago-based not-for-profit organization authorized by the ONC to test EHR systems.
“The second take is there's a lot here,” Bell said. The new emphasis on interoperability “is huge,” she said. “With that in mind, I think there is going to be a need for not only vendors, but public health partners, private labs and other entities” not eligible for federal incentive payments “to step up and be a part of this,” Bell said.
And, just as the Stage 1 proposed regulations were greatly amended in the final regulations in response to public comments, the new proposed regulations likely will be rigorously reviewed and most likely amended as well, Bell said.
“We're just going to have to wait until this whole process is over before we can see what Stage 2 will look like,” she said.
Dr. Steven Stack, board chair-elect of the American Medical Association, pledged in a statement that the AMA would “carefully review” and submit an official response within the 60-day public comment period. “To eliminate roadblocks and encourage greater physician participation, it is important that a full evaluation of the EHR Stage 1 incentive program occurs prior to finalizing Stage 2 requirements,” he said.
Christine Bechtel, vice president of the National Partnership for Women & Families, serves on the Health IT Policy Committee. Her laudatory comments, from a statement, focused on the interoperability requirements in the proposed regulations, particularly those requiring exchanges between patients and clinicians.
“The proposed rule moves us toward a new day when patients can download their health information from a range of providers to a secure place of their choosing, and transmit it to their care professionals or upload it to a mobile app,” Bechtel said. “We are pleased that it will allow patients to send secure electronic messages to their doctors—that is long overdue. All these advances will make life easier for patients and their family caregivers who are trying to navigate the healthcare system, while also making care delivery more efficient and effective for providers.”
—with Christine LaFave Grace
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