Healthcare groups support plans to delay Stage 3 of the meaningful-use rules, especially because those rules need to harmonize with the recently passed “doc fix” to the Medicare program.
This week, Sen. Lamar Alexander (R-Tenn.) said he would like to see rule-making delayed until Jan. 1, 2017, on the more stringent Stage 3 meaningful use, testing and certification criteria. That could push back provider start dates for Stage 3 into 2019 or beyond.
“I believe then that the Stage 3 requirements should be phased in at a rate that reflects how successfully the program is being implemented,” said Alexander, who chairs the Senate Health, Education, Labor and Pension committee, which has jurisdiction over the country's $31.3 billion electronic health-record program.
The American Medical Association said in a statement that the delay is necessary because it was developed “prior to and without consideration of the changes enacted by the Medicare Access and CHIP Reauthorization Act.”
MACRA, passed by Congress this year, replaces the sustainable growth-rate formula with a merit-based incentive payment system designed to prod physicians to move more of their patients into risk-based payment models.
“Given the vital role of the meaningful-use program in the reformed payment systems introduced by MACRA, proceeding with the proposed Stage 3 rules threatens to impede the healthcare delivery innovations Congress sought to promote when it passed the law,” according to the AMA statement.
Not that everything was running smoothly with the EHR incentive payment program anyway. Both the final rule for Stage 3, which was three years in the making, and a second set of rule-making tweaks to rules for the current and previously delayed Stage 2 of the program are being reviewed by the Office for Management and Budget and are expected to be released this fall.
A recent Modern Healthcare analysis of program data indicated physician participation dropped by 12% in 2014 compared with a year earlier.
“There is growing bipartisan recognition in Congress that the direction of the meaningful-use program needs to be reassessed in light of usability and interoperability challenges with electronic health-record systems,” AMA President Dr. Steven Stack said. “Poorly performing systems that do not facilitate the seamless exchange of data would severely undermine the ability of the health system to support the implementation of the payment reforms outlined in MACRA.”
Robert Tennant, senior policy adviser for the Medical Group Management Association, agreed. “The passage of MACRA changes a lot of things. This MIPS is important. It's going to require its own set of regulations, probably multiple ones. Can you really move forward with Stage 3 without the regulations in place for MIPS? I'd argue not.”
“He's saying don't make the rule until you've got a good set of data on the (physician) and hospital experience with Stage 2 of the program,” Tennant said. “We've not had any real success with Stage 2. He's saying let's delay moving ahead until we have better evidence. I would argue that's exactly the right approach."
In a statement, College of Healthcare Information Management Executives, the professional organization of hospital chief information officers, “applauded” Alexander's call for the delay, adding, “We appreciate his recognition that hospitals and health systems are still working to meet requirements under Stages 1 and 2.”
But Alexander's statement was unclear whether he wants to use any part of the Stage 3 rule—now with the OMB—or start rule-making afresh in 2017, which could take a year, or years, to come up with a replacement rule.
In addition, providers and developers of EHR systems, which must be upgraded to meet testing and certification requirements to match EHR functionality to any meaningful-use rule change, have historically asked for 18 months of lead time to upgrade, install and get comfortable with the new software and requirements before starting the clock on their meaningful-use reporting periods. Alexander's office did not clarify when providers might be subject to Stage 3 requirements.
The long rule-making period is one reason there's so much anxiety over the proposed Stage 2 rule modifications and Alexander's call for their immediate release by OMB.
“The continued delays in the release of this final rule only jeopardize the long-term outcomes of the program,” the CHIME statement said. “We must get the modification rule in the hands of providers as soon as possible to ensure that the well-intentioned relief offered by (the CMS) in the proposed rule can be realized.”