Updated Statement Regarding CMS’s Changes To Meaningful Use 2014
**UPDATE**
On the surface, there seems to be reason for optimism regarding the notice of proposed rulemaking (NPRM), announced in a press release by CMS last week, which appears to delay the onset of Stage 2. But, as we at STI have reviewed the document, we see a few big questions that are unanswered. Therefore, we’re going to make the following recommendations now, and we’ll provide updates as soon and as often as possible.
What does the proposed rule say?
CMS proposes 4 options (3 of them new) with Meaningful Use attestation in 2014 for Medicare
- Meet ONC 2014 Edition Stage 2 Objectives and Measures using one of the following
- 2014 Edition CEHRT
i. This was the original rule for 2014 and it’s still an option. ChartMaker® v5.1 is certified as an ONC 2014 Edition Complete EHR and is capable of providing everything needed to meet meaningful use Stage 2 for eligible providers.
- a combination of 2011 Edition and 2014 Edition CEHRT
i. N/A. Since ChartMaker is a complete EHR this is not applicable. There is no cobbling together of old and new modules from different software vendors.
- Meet ONC 2014 Edition Stage 1 Objectives and Measures using one of the following
- 2014 Edition CEHRT
i. ChartMaker® v5.1 supports this option.
- a combination of 2011 and 2014 Edition CEHRT
i. N/A
- Meet ONC 2013 Stage 1 Objectives and Measures using one of the following
- 2011 Edition CEHRT
i. ONC changed the requirements for Stage 1 in 2013, therefore an EHR designed to meet the original 2011 Edition objectives and measures isn’t an option. But we’ve got you covered. Even though ChartMaker® v5.1 is 2014 Edition CEHRT, it will support meeting 2013 Stage 1 criteria.
- a combination of 2011 and 2014 Edition CEHRT
i. N/A CMS modifies Medicaid Meaningful Use attestation in 2014 by writing “to qualify for an incentive payment under Medicaid for 2014 for adopting, implementing, or upgrading CEHRT, a provider must adopt, implement, or upgrade to 2014 Edition CEHRT only”. (A provider adopting an EHR in the first year of attestation cannot adopt an EHR that is certified against only the ONC 2011 Edition.)
What does the proposed rule not say?
With options #2 and #3 above, CMS repeatedly writes in the NPRM that these options are available to the eligible provider “if they are unable to fully implement 2014 Edition CEHRT due to delays in 2014 Edition CEHRT availability.” CMS writes “We understand, based on information gained from EHR technology developers and ONC-Authorized Certification Bodies on timing, backlogs, and the certification case load, many EHR products were certified later than anticipated, which has impacted the corresponding time available to providers—especially hospitals—to effectively deploy 2014 Edition CEHRT and to make the necessary patient safety, staff training, and workflow investments in order to be prepared to demonstrate meaningful use in 2014.” They recognized that 350,000 providers had attested to Meaningful Use Stage 1, and preparing that many providers for Stage 2 is a lot of work. According to an article in Healthcare Informatics, as of May 1,2014, only 4 hospitals and 50 eligible providers had attested to Meaningful Use Stage 2. Further, CMS writes, “Through letters to CMS, public forums, listening sessions, and public comment at CMS meetings, many provider associations have expressed concern that, although 2014 Edition CEHRT may be available for adoption, there is a backlog of many months for the updated version to be installed and implemented so that providers can successfully attest for 2014.” In an important section, they write, “In an effort to grant more flexibility to providers who have experienced 2014 Edition CEHRT product availability issues that impact the ability to fully implement 2014 Edition CEHRT to attest to meaningful use using 2014 Edition CEHRT, we are proposing the following changes for the Medicare and Medicaid EHR Incentive Programs for 2014 for providers that are not able to fully implement 2014 Edition CEHRT for a full EHR reporting period in 2014. When you combine the underlined statement above with a continued emphasis of “Only providers that could not fully implement 2014 Edition CEHRT for the reporting period in 2014 due to delays in 2014 Edition CEHRT availability”, it raises an important question: What is the criteria that makes a provider “unable” to fully implement 2014 Edition CEHRT? What if CEHRT was available 12 months before the last reporting period of 2014 starts? Is that enough time in the eyes of CMS? Is 6 months enough time? 3 months? Can you as an eligible provider merely attest that in your own opinion, you don’t have time for staff training and adaptations of workflow to the new meaningful use rules that CMS requires? We think CMS needs to address this by further clarifying the proposed rule.
What should we do about it?
As with many proposed rules, there is a 60 day public comment period, during or after which CMS may make changes to the rule. Unfortunately, this 60 day period concludes near the end of July, well into the 3rd Quarter of 2014. By then it’s too late to have made a decision about that quarter, and arguably the 4th quarter as well. That alone may be reason enough for some to delay MU2, but that reason isn’t in the NPRM, at least for now. It doesn’t pay, to think “delay”. We advise you to plan conservatively. At this time, we think it’s prudent to continue moving forward as if Stage 2 is a requirement in 2014. If you’ve already started, great. If you haven’t upgraded to ChartMaker® 5.1 or higher, make plans to do so. Don’t consider this CMS rule a delay in the start, but a chance to have more time to plan and implement. Here are several reasons why:
1. Many customers have upgraded already, but if you haven’t, ChartMaker v5.1 still gives you the option of Stage 1 or Stage 2. One of the scenarios described in the NRPM indicates you can have ONC 2014 Edition CEHRT and still report on Stage 1 Objectives and Measures. It appears that having Stage 2 capable software doesn’t force you to meet Stage 2 based on this proposed change.
2. If you were planning on attesting in the 4th quarter of 2014, this represents merely a 3 month delay in the start. Additionally, the rule still requires a full year of Stage 2 reporting for 2015. That’s not much of a delay, and a full year of reporting puts a greater emphasis on being prepared on day 1.
3. Most practices have year-end accounting, holidays, and other factors that make the 4th quarter particularly eventful. Do you want to start preparing for Stage 2 during this period?
4. If everyone waits until the end, there could be a longer queue for custom training requests and hardware upgrades—one of the reasons CMS gives in the NPRM for delays in implementation. If you haven’t incorporated patient engagement with the ChartMaker® Patient Portal, you can get that out of the way now.
STI has a wealth of scheduled live webinars, training videos, and other tools to help you make this transition to Stage 2 as smooth as possible. Take advantage of them and give us feedback on areas in which we can do more!
When will we have an answer?
It’s hard to know if CMS will make changes and clarifications early or wait until the end of the 60 day period. We are constantly following CMS, ONC, and other government organizations’ websites and social media channels because we’re as interested in this as you are. As soon as we have updated information, we’ll relay that to you through the STI website and other media channels, modifying our recommendations as needed. Stay connected with us on Twitter, facebook, and www.sticomputer.com. We plan on submitting comments to CMS shortly. We also encourage you to give CMS direct feedback on your own or through any professional organizations you are involved in. CMS needs to know we all need clarification. You can find out how to provide feedback on page 3 of the proposed rule.
Link to official STI statement – http://tinyurl.com/q66c4xs