Tardy EHR upgrades loom as one of many Stage 2 challenges

Bob Asinof, CEO of the Urology Center of Colorado in Denver, describes starting on Stage 2 criteria for meaningful use of electronic health records while at the same time readying for ICD-10 as a “double whammy.” Still, he's optimistic that his 16-physician specialty group will achieve both Stage 2 attestation and ICD-10 compliance this year.

The combination of these two goals, plus pulling off everything else on their IT punch lists, has leaders like Asinof feeling stressed and anxious.

To get paid and avoid a 1% Medicare reimbursement deduction in 2015, eligible hospitals must start their counts of 90 consecutive days of meaningful-use attainment no later than July 1, while physicians and other eligible professionals must start by Oct. 1. Beginning this year, they also have to start their 90-day meaningful-use countdowns on the first day of each quarter. And before hospitals and physicians can start tackling Stage 2 performance measures, they must upgrade their current EHRs to 2014-edition tested and certified technology, not the 2011-edition software they have used previously. Even providers seeking Stage 1 meaningful use this year must use 2014-edition software.

“It's going to be painful,” Asinof said. “We have to train on the new EHR system and on top of it, we have to train for ICD-10.”

His group recently attested to achieving Stage 1 for a third straight year, so Asinof responded affirmatively to a survey question on whether his organization will meet and attest to Stage 1 meaningful-use criteria and qualify for subsidy payments in 2014. He was among 76% of respondents who answered yes. Asinof also was one of the 49% of respondents who said it was highly likely their organization will be able to meet Stage 2 criteria in 2014.

Of 20 possible hot-button IT priorities, meeting Stage 2 meaningful use ranked second, garnering 18% of selections, trailing only ICD-10 readiness at 22%.

Looking at IT priorities during the next 24 months, 16% of leaders selected Stage 2 as their top job out of 19 possibilities. That's double their next most popular selection of improving productivity and reducing costs, named by 8% of survey takers.

Asinof is nervous that his group still doesn't have a 2014-edition tested and certified EHR from its vendor, GE Healthcare. “It's ICD-10 ready, but not yet Stage 2 ready,” Asinof said. The Urology Center of Colorado should receive its 2014-edition upgrade later this winter. But even once it's installed, he added, the new software is likely to be in beta mode and still will have kinks that need to be worked out.

A Modern Healthcare analysis of the Certified Health IT Product List at HHS found that, through mid-February, only 245 software developers had EHR products certified to 2014-edition standards. That's a fraction of the 1,000 IT vendors with 2011-edition certified systems.

Small hospitals face some of the toughest IT challenges this year. Community Hospital-Fairfax in northwest Missouri has received nearly $560,000 in EHR incentive payments from Medicaid and Medicare, and recently attested to its second year of Medicare Stage 1 meaningful use. But the 18-bed hospital is down to only one medical staff physician and one locum tenens physician. So CEO Myra Evans responded in the survey that it was “somewhat unlikely” the hospital would make Stage 2 this year.

For now, she said, “I feel that's just too much to put on that one physician. The penalty is not as drastic as the cost of doing it right now.”

Many physician group practices will be unable to pull off both Stage 2 and ICD-10, Asinof predicted. And when push comes to shove, they will drop their Stage 2 efforts. Since HHS won't want that, he expects the feds to delay the Stage 2 requirements.

So far, though, HHS hasn't budged.

Follow Joseph Conn on Twitter: @MHJConn