MACRA proposal would ease EHR burden for docs, but not hospitals

Although the CMS today proposed giving physicians a yearlong reprieve before having to upgrade their certified electronic health record system, hospitals may still be on the hook.

The agency today proposed easing some requirements for physicians under the Medicare Access and CHIP Reauthorization Act, including allowing them to continue using the 2014 certified version of their EHR. The proposal only applies to physicians. Under meaningful use requirements, hospitals must have a 2015 certified product in place by the end of this year in order to have reporting data for the first three quarters of 2018. Failure to do so would result in Medicare penalties.

But there's a catch: Vendors aren't ready, which means hospitals will be under a time crunch to deploy a system once it comes to market and is certified by the Office of the National Coordinator for Health Information Technology. As of June 20, there are 74 products—including some from Epic Systems Corp. and Cerner Corp.—that are certified under the 2015 Edition Health IT Certification Criteria, according to the ONC's Certified Health IT Product List. But, said Steve Posnack, director of the ONC's Office of Standards and Technology, some of the products certified are among the most popular and are therefore used by many providers.

"The shift in moving things from meaningful use to MIPS added a little bit of time to the development cycle for the EHR developers," he added. So might have some of the new requirements, said Mari Savickis, vice president of federal affairs at the College of Healthcare Information Management Executives. She pointed specifically to the API requirements as a challenge. "That's a fairly big jump," she said. "It's a lot of work, and it's complicated. They need more time."

Though many providers have their products certified, "that's not the end of the story," said Pamela McNutt, chief information officer of Methodist Health System, Dallas "You still have to install it, and these upgrades are huge." Methodist recently switched to Epic, and the version installed was already certified. That's fortuitous, McNutt said, because implementing a new EHR can take up to eight months or so for a hospital system. Even physicians face monthslong implementation times.

"Even once you've got the software installed, you have to exercise it," she said.

Providers that use software-as-a-service EHRs, such as Athenahealth, may fare better, McNutt said, since upgrades to those systems are more easily pushed out. (Athenahealth has yet to release 2015 edition-certified products, though it will by year-end.)

"Vendors are very aware of the deadlines," said Justin Seger, vice president of product management for Athenahealth.

Providers that don't use a product on the list could rush to get certified EHRs in place in time, but "do you really want to see a situation where providers are jamming in the new technology?" Savickis said. "It's not enough time."

For some of these providers, there may be an option that allows them to avoid penalties: filing for hardship, which providers can do if they cannot meet the criteria "for a reason beyond their control," which can include the availability of a certified EHR.

There's hope that the CMS will give hospitals more time, as it is proposing to do for physicians.

"We think it behooves HHS to take a reasonable step to push the deadline out to allow the provider community an additional year using the 2014 edition," Savickis said, a sentiment echoed in a letter to CMS Administrator Seema Verna from CHIME, in which the organization wrote that its members are "very apprehensive about the looming requirement."

An edited version of this story appears in Modern Healthcare's June 26 issue.