That threshold decreased to 5% of patients seen by a provider who views, downloads or transfers data on their own from the proposed rule's threshold of 10%. Tennant said that while MGMA welcomed that change, this requirement still presents a number of challenges to providers. For instance, the online portal is an expensive addition to electronic health records, and providers must rely on patients to use it.
“What happens if you have a patient base that is not particularly attuned to online resources, or you're serving a patient base that doesn't have access to the Internet?” Tennant asked, adding that this resource is also difficult for geriatric or Alzheimer's patients. “Having the capability is one thing, but you can't arm-twist patients into going online and downloading the record. And if they don't, you run the risk of not meeting your meaningful-use requirement,” which he said poses problems for providers, both in terms of incentives on the front-end and penalties later.
The College of Healthcare Management Executives expressed similar concerns in a statement. "The final rule still puts providers at risk of not demonstrating meaningful use based on measures that are outside their control, such as requiring 5% of patients to view, download or transmit their health information during a 3-month period," said the setatement from CHIME President and CEO Richard Correll. "Some areas of clarification include some of the exclusionary language as well as nuances around health information exchange provisions, clinical quality measures and accessing images through a certified EHR."
Allison Viola, senior director of federal relations at the American Health Information Management Association, said an initial read of the regulation shows no major differences from the proposed rule. Tennant and Viola said both associations are glad to see that the Stage 2 meaningful-use requirements will begin in 2014, as opposed to the proposed starting date of 2013.
“We were happy to see CMS acknowledge and continue to make efforts to align meaningful-use quality reporting requirements with other quality reporting programs to reduce duplication and reporting burden,” Viola said, referring to programs such as the Physician Quality Reporting System and the Medicare shared-savings program. “Having the ability to kill two birds with one stone is more efficient and reduces cost,” she said, adding that the final rule indicated a move in that direction, but it will take some time for that to become a reality.
Meanwhile, the American Hospital Association released a statement (PDF) that expressed concern about the timeline providers have to meet the meaningful-use requirements.
“While we appreciate that CMS has allowed for a shorter meaningful-use reporting period for 2014, we are disappointed that this rule sets an unrealistic date by which hospitals must achieve the initial meaningful-use requirements to avoid penalties,” Linda Fishman, senior vice president of public policy analysis and development, said in a statement. “In addition, CMS complicated the reporting of clinical quality measures and added to the meaningful-use objectives, creating significant new burdens.”