CMS proposes Stage 2 delay

For the second time this year, the federal government is pushing back a major health information technology initiative, potentially giving early adopters of electronic health records an extra year to meet more stringent meaningful-use requirements.

The CMS and HHS' Office of the National Coordinator for Health Information Technology issued a proposed rule last week that would give hospitals, office-based physicians and other professionals eligible for the EHR incentive program an additional year to use 2011 Edition software for their systems and continue to meet Stage 1 criteria for meaningful use of the technology.

The proposed rule means providers that entered the program in 2011 could have as many as four years using 2011 software at Stage 1 meaningful use.

The rule also would make official a previously announced delay until 2017 for the start date of what is likely to be the even more difficult Stage 3 meaningful-use requirements now under development.

The new rule comes less than two months after Congress, responding to pressure from physicians and other groups, postponed the nationwide switch to the ICD-10 diagnostic and procedural coding system until Oct. 1, 2015.

Going into 2014, ICD-10 and Stage 2 deadlines were ranked as the two biggest HIT headaches for industry leaders, according to Modern Healthcare's annual IT readers' survey. Now, both have been eased.

“There is a thank you here,” said Russell Branzell, president and CEO of the College of Healthcare Information Management Executives, an association of hospital chief information officers. CHIME lobbied hard to give providers more flexibility with Stage 2. “Our general impression is the proposed rule is a good thing.” But, he added, “it is extremely complex.”

The CMS and ONC rule writers cited the slow delivery and implementation of the upgraded 2014 Edition software needed for Stage 2 as the reason for the delay.

Providers told the CMS in letters, forums, listening sessions and public comments that they were facing long backlogs for installations of updated technology, limiting their ability to attest to meeting the Stage 2 criteria for 2014. Those providers scheduled to step up to Stage 2 this year can remain at Stage 1 if they attest they're unable to advance due to software availability issues.

The proposed rule is subject to a 60-day public comment period, which started Friday when the rule was officially published in the Federal Register. The protracted rulemaking process virtually ensures that hospital leaders will make a decision on Stage 2 without a final rule being in place.

“Even if (CMS and ONC) get the final rule and put it out for adoption, that could be four months,” Branzell said. “So, do you roll the dice and collect data on Stage 1 based on this proposed rule, or do you go and try for Stage 2?”

So far, reactions from Medical Group Management Association members have been positive, said Robert Tennant, the MGMA's senior policy adviser. “It's not everything we were looking for, but it was a good start and recognition that the program parameters were proving challenging for vendors and their customers,” he said. “The extra time is going to allow the momentum to continue.”

One concern, he noted, is that the proposed rule says the program reverts “back to normal” in 2015. But given the need for delays thus far, “we're going to be looking hard at 2015 to make sure the vendors are ready for that year. What we don't want is all of the good effort to stop and the program ends at Stage 1. So I think it's a prudent move, and we appreciate the flexibility,” Tennant said.

Tom Leary, vice president of government relations for the Chicago-based Healthcare Information and Management Systems Society, a trade association for the health IT industry, also expressed relief over the proposed changes. But Leary wondered about the timing of a final rule after the 60-day public comment period for the proposed rule ends in July.

If the CMS issues an interim final rule, it could take effect 30 days from publication, he said. “One of the questions we have in to CMS is the timeline on that,” he said.

Follow Joseph Conn on Twitter: @MHJConn