CMS finalizes EHR meaningful-use rule, adds some flexibility

The CMS late Friday finalized a rule allowing hospitals and eligible professionals more flexibility in how they meet meaningful-use requirements for the electronic health-record incentive program. The agency had first proposed the idea in a May draft rule. Friday's final rule left the May proposal unchanged.

The rule would grant providers a longer timeline and more flexibility in meeting the incentive goals laid out by the stimulus program first created in the 2009 HITECH Act. The incentive program provides doctors and hospitals stimulus funding to implement electronic health records.

The rule pushes back the beginning of the third stage of meaningful use for the first cohort of adopters until Jan. 1, 2017, as opposed to the old standard of Jan. 1, 2016.

Also, some providers struggling with adoption of 2014 certified EHRs will be granted more flexibility. Providers essentially now have an extra year to use 2011 Edition software. The final rule notes that availability of technology was constrained because of late certification and high demand.

Stakeholders had a mixed response to the rule.

The American Hospital Association's Chantal Worzala, director of policy, said in a statement: “The American Hospital Association appreciates the flexibility offered by CMS today. Unfortunately, this rule offers little relief because CMS did not grant a shorter reporting period for FY 2015, which begins on Oct. 1.”

Others felt the rule penalized providers who had adhered to the original schedule.

Dan Haley, vice president of government affairs at cloud-based EHR firm Athenahealth, was somewhat disappointed by the final rule, though he said it was not unexpected. He agreed with the theory that the flexibility would hurt early adopters.

First, he argued, fewer providers will have stage 2 records. The lack of stage 2 users will make it harder for early adopters to fulfill interoperability measures, as they would have fewer providers to communicate with. As a result, he argued that the CMS should provide “some type of relief/exception for (interoperability) measure(s).”

“Overall, our opinion continues to be: Repeated delays only push off the date when healthcare in this country is truly connected,” he said.

Marilyn Tavenner, CMS administrator, said in a release: “We listened to stakeholder feedback and provided” flexibility for 2014.

In the final rule, providers unable to adopt 2014 technology because of availability of certified technology have three options. For providers intending to demonstrate Stage 1 meaningful use in 2014, they can use 2011 technology to show they met 2013 first-stage standards; or can use a combination of 2011 and 2014 technology to meet 2013-14 first-stage standards; or could use 2014 technology to fulfill 2014 first-stage standards.

The situation is similar for providers intending to attest to Stage 2 meaningful use in 2014: they may use 2011 technology to show Stage 1 objectives; a combination of 2011 and 2014 technology to meet 2011 or 2013 Stage 1 objectives or 2014 technology to show 2014 Stage 2 objectives; or, finally, 2014 technology to fulfill 2014 Stage 1 or Stage 2 objectives.

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