The chairman of the Senate committee overseeing healthcare policy is continuing to push the Obama administration to put the brakes on its program compelling hospitals and doctors to use electronic health records.
Lamar Alexander (R-Tenn.), chairman of the Health, Education, Labor and Pensions Committee, wants the CMS to postpone finalizing the Stage 3 regulations for the meaningful use of EHRs until Jan. 1, 2017, and for the requirements to be phased in at a rate that reflects the success of the implementation.
Key administration officials testifying before Alexander's committee Thursday didn't appear to support the strategy.
The Office of Management and Budget is currently reviewing the final Stage 3 rule and is on track to release it by the end of this year, according to a federal database.
The American Medical Association and the Medical Group Management Association have aggressively sought a delay in Stage 3 rules, which aim to expand sharing of patient records between providers.
Under a draft version of the Stage 3 rule published in March, the regulations would require providers to send electronic summaries for 50% of patients they refer to other providers, receive summaries for 40% of patients who are referred to them, and reconcile past patient data with current reports for 80% of such patients.
“Some of the leading medical institutions in the country with the best electronic health-record systems recommended that we take more time to develop the Stage 3 rule,” Alexander said at the hearing. “Physicians and hospitals have said to me that they are literally 'terrified' of Stage 3, because of the complexity and because of the fines that will be levied.”
Under Medicare's new Merit-Based Incentive Payment System—created under the legislation replacing the sustainable growth-rate formula for paying physicians—25% of the score that determines a provider's penalty or bonus payment will be based on participation in meaningful use.
“We are now entering a period where the government is penalizing doctors and hospitals if they do not adopt electronic health records systems,” Alexander said. He noted that only about 12% of doctors and 40% of hospitals have attested to meeting the Stage 2 requirements.
Further bolstering his case for delay was a recently released GAO report (PDF), in which several industry stakeholders suggested the meaningful-use program had diverted resources from other initiatives that would improve interoperability.
During the hearing, neither Dr. Karen DeSalvo, head of HHS' Office of the National Coordinator, nor Dr. Patrick Conway, the CMS' deputy administrator for innovation and quality, voiced support for a delay.
Conway appeared especially reticent to delay the Stage 3 rule. He noted that the draft rule made the Stage 3 requirements optional in 2017, giving providers and EHR vendors more time to implement changes, update workflows and adopt new technology. Stage 3 would be mandatory for EHR reporting in 2018.
In a separate proposed rule issued in April, the CMS said it would change the reporting period for the program from a full calendar year to 90 consecutive days so providers would have more flexibility to meet the Stage 1 and Stage 2 requirements through 2017.
The agency has not finalized that rule, however, and the American Medical Association called on the agency Thursday to create an automatic hardship exemptions in 2015.
“The AMA welcomed and supported the proposed changes, but it's now Oct. 1 and CMS has left physicians without any guidance or assurances that they will be capable of meeting program requirements before the end of the year,” AMA President Dr. Steven J. Stack said in a statement. “As a result, many physicians who were counting on this flexibility will be subject to financial penalties under the rules currently in place.”