Hospitals are imploring CMS to slow down its pace as it works to have providers adopt and meaningfully use electronic health records.
In March, the agency released a proposed rule for what it called Stage 3 of getting providers to make the digital change. The proposed rule would require nearly all providers to report on a full calendar-year cycle beginning in 2017 and would require electronic reporting of clinical quality measures beginning in 2018.
The CMS believes greater use of electronic health records will ensure patient engagement, allow patient access to their own records and ultimately improve the way care is delivered and the way information is shared. Comments on the proposals were due May 29. The CMS received more than 400, mostly negative, responses.
Hospitals are still trying to implement Stage 2 of the switch, which was spelled out in a 2012 rule. That policy included asking physicians to use secure electronic messaging in order to communicate relevant health information to patients and to track medications from order to administration.
“While the Stage 3 proposals offer promising ideas that could further health information exchange and support greater patient engagement, we do not yet have sufficient experience at Stage 2 to be confident that the proposals for Stage 3 are feasible and appropriate,” The American Hospital Association said in a comment letter.
“We are concerned that CMS is trying to force providers to move toward meaningful use of EHRs at a pace that is too fast and impossible to meet,” Catholic Health Initiatives said in another comment.
CMS should refrain from finalizing a Stage 3 meaningful use rule and instead should evaluate the experience in Stage 2, the AHA adds.
“This proposal places an enormous burden on all new adopters of EHRs but also those struggling to modernize their practices and meaningfully use an EHR,” the American Academy of Family Physicians said in a comment.
Rural hospitals are especially concerned about a proposed requirement that's attempting to build upon Stage 2 by having patients use an online portal to upload information.
“It is entirely possible that a provider place significant effort and resources behind this objective only to have their patients fail to visit the portal or transmit their information,” the National Rural Health Association said in a comment. “There are some challenges that are unique to the rural environments and that make this objective particularly concerning to rural providers. These include access to broadband, the local population's ability to navigate the portals and the transient nature of some rural populations.”
Physicians and other eligible professionals who fail to meet the requirements are expected to pay $500 million in Medicare penalties between 2018 and 2020, according to the proposed rule.
Upgrading EHRs to meet the requirements, the agency estimates, will cost physicians $54,000, plus $10,000 in annual maintenance costs. That's at the high end of what the Congressional Budget Office calculated in 2008. The CMS said upgrades would cost hospitals $5 million, plus $1 million for annual maintenance.