With the new Stage 2 proposal, providers can continue using 2011 edition software and stay at Stage 1 for another year if they are willing and able to attest that they couldn't make the step up to Stage 2 because they were “unable to fully implement 2014 Edition” software due to “availability delays.” It was the second time the feds pushed back the Stage 2 compliance date.
The reason that this week's announcement was no surprise is that the first warning bells that healthcare's big ship was nearing shoal waters on Stage 2 came as early as January 2013.
It wasn't until then that the first of the independent organizations involved were deemed by the ONC to be worthy of certifying the test results of software developers' EHR products to 2014 Edition criteria for use by providers in Stage 2. That late date meant that hundreds of EHR vendors had less than 9 months to have their systems tested and certified for use in the program.
It also meant that providers would have far less time than 9 months to get those systems—once they'd been tested and certified—purchased, installed and in efficient use in their organizations before the Stage 2 meaningful-use program started—on Oct. 1, 2013, for hospitals and Jan. 1, 2014, for physicians and other “EPs.”
By September 2013, the software testing and certification portion of the program was in deep trouble and multiple vendors were already in panic mode. A Modern Healthcare review of the official Certified Health IT Product List showed that just 79 companies, providers and other organizations that had developed 2014 Edition software had it tested and certified. That compared with nearly 1,000 developers with software tested and certified for 2011 Edition standards and useful in the first three years of the program.
This was not just a problem for Stage 2 aspirants—those who had attested and received payments for Stage 1 in 2011 and 2012 were obliged to move up a stage in the 2014 payment year. Because the CMS had made changes to the Stage 1 requirements, the feds also required that all EHR incentive-payment program aspirants – even those still seeking to meet Stage 1 meaningful use -- had to upgrade and use 2014 Edition software as well. That meant that more than 300,000 providers would need to upgrade to 2014 Edition software within the narrowing 2014 payment year window.
The CMS also didn't help itself with another program change, requiring Stage 2 aspirants to start their clocks to meet 90 consecutive days at Stage 2 only on the first day of the quarter instead of when they were ready – say, mid-month -- robbing providers of precious flexibility and giving them only four possible starting days – Oct. 1, 2013, Jan. 1, 2014, April 1, 2014, and July 1, 2014, for hospitals, and the first of January, April, July and October for physicians and other EPs.
Earlier this month, the Stage 2 ship finally hit the rocks.
A CMS official reported to the Health IT Policy Committee that, so far, just four hospitals and only 50 or so physicians and other EPs had achieved Stage 2 meaningful use.
An ONC report also delivered at that committee meeting, based on provider responses to survey questions, indicated that most hospitals, many physicians and other EPs were “likely” to be able to upgrade to 2014 Edition technology. The report said that only relatively small percentages of both hospitals (5%) and physicians/other EPs (17%) were using software from a developer that did not yet have a 2014 Edition product.
But 17% of 300,000 meant that perhaps 51,000 physicians and other EPs were left in the lurch by vendors who had not yet upgraded their products to 2014 Edition standards.
In their proposed rule, the CMS and ONC said the reason for stretching out Stage 1 and giving providers an out on meeting Stage 2 was the trouble providers were having in obtaining and installing 2014 edition software.
“Through letters to CMS, public forums, listening sessions and public comment at CMS meetings, many provider associations have expressed concern that, although 2014 Edition (technology) may be available for adoption, there is a backlog of many months for the updated version to be installed and implemented so that providers can successfully attest for 2014,” the rule writers said.
The feds were careful, however, not to affix blame for the software backlog on developers or providers.
The Electronic Health Record Association, a developers' trade group affiliated with the Chicago-based Healthcare Information and Management Systems Society, was equally careful not to point fingers at the feds over its timing of 2014 Edition technical requirements and testing and certification procedures.
“We appreciate that CMS and ONC have acknowledged the very tight timing available for vendors and providers with the move to 2014 certified EHR technology and Stage 2,” an EHRA statement said.
As are many providers, EHRA members are still evaluating the complex proposed rule, which has timing issues of its own. And they're careful not to burn bridges with the feds they'll have to cross in the future as Stage 3 criteria – now scheduled for use in 2017 – are still being developed.
“Recognizing that the last 2014 reporting periods for EHs (eligible hospitals) and EPs 2014 are fast approaching and that the final rule is likely to come near the end of these reporting periods, this proposed rule, issued mid-way through 2014, has many complex implications for our members and their customers,” the EHRA said. “We are still, therefore, evaluating the provisions and scenarios in order to assist our members and customers, and to develop our detailed response to the NPRM.
“While making a mid-course correction, as this new NPRM represents, will be complex and may be confusing, we do appreciate that CMS and ONC appear to have listened to us and other stakeholders on the timing challenges associated with new certified EHR editions and Meaningful Use stages, and hope that these learnings are reflected upfront in policy decisions on the scope and timing of Stage 3.”
Follow Joseph Conn on Twitter: @MHJConn