CMS Proposed Revisions to Meaningful Use – A Welcome Delay

CMS has issued proposed revisions to meaningful use Stages 2 and 3 in response to numerous industry complaints that hospitals and provider groups will not be able to implement the 2014 certified EHR technology with enough time to meet meaningful use in 2014.  CMS, recognizing that EPs and hospitals are either using 2011 CEHRT, 2014 CEHRT, or a mixture of both, issued proposed rules addressing what each category must attest to in 2014.  In a substantial change from the Final Rules issued in September 2012, CMS has agreed to extend Stage 1 in 2014 for those EPs and hospitals that cannot successfully obtain or deploy 2014 CEHRT.  Further, CMS has proposed to delay Stage 3 meaningful use by one year. 

Medicaid Modification

The proposed rule modifies the AIU (adopt, implement and upgrade) exception for those EPs and hospitals attesting for the first time in 2014.  Hospitals and EPs attesting to AIU in 2014 must adopt, implement or upgrade to 2014 Edition CEHRT only, attesting to the 2011 Edition or a combination Edition will not satisfy the definition in 2014.

Meaningful Use Timeline

Originally, all Medicare EPs and hospitals were required to meet meaningful use using the 2014 Edition CEHRT for Stage 1 or Stage 2 in 2014.  This proposed rule delays this process as follows:

Table 2:  Proposed CEHRT Systems Available for Use in 2014

 *Only providers that could not fully implement 2014 Edition CEHRT for the reporting period in 2014 due to delays in 2014 Edition CEHRT availability.  Note: Table 2 is directly from the CMS proposed rule (similar table in press release does not contain asterisk).

To take advantage of the delays, EPs and hospitals must attest that they were not able to upgrade or fully implement to the 2014 Edition CEHRT because of issues related to availability.  Providers that were planning on meeting Stage 2 in 2014 and are now going to attest to Stage 1 in 2014 will be required to begin Stage 2 in 2015.

Stage 3 Delay

CMS also proposed a delay in Stage 3 for a year.  This is welcome news considering that CMS has not yet built-out Stage 3 and is waiting for the results from Stage 2 to “inform [its] development of the criteria for Stage 3 meaningful use.”  Stage 3 will begin on January 1, 2017 for EPs and October 1, 2016 for hospitals and CAHs.  The proposed revised schedule is as follows:

TABLE 3–PROPOSED STAGE OF MEANINGFUL USE CRITERIA BY FIRST PAYMENT YEAR

*3-month quarter EHR reporting period for Medicare and continuous 90-day EHR reporting period (or 3 months at State option) for Medicaid EPs.  All providers in their first year in 2014 use any continuous 90-day EHR reporting period.  Note: Table 3 is directly from the CMS proposed rule (similar table in press release does not contain asterisk).

Clinical Quality Measures

CMS has also relaxed the requirements related to reporting on clinical quality measure in 2014.  Specifically, the method of CQM submission to CMS will depend on the edition of CEHRT deployed by the provider (States will still have discretion for submission requirements).

For those providers using a combination of 2011 and 2014 Edition CEHRT to report on either the 2014 Stage 1 measures or Stage 2 measures or the 2014 Edition CEHRT they should report CQMs as originally indicated in the Stage 2 final rule (i.e submitting electronically) and subsequent rule making.

ONC Modifications

In order to support the CMS revisions, ONC has made modifications to its CEHRT definition to reflect the proposed new required start dates.  ONC’s proposed revisions would move the required start dates for the 2014 Edition of CEHRT to October 1, 2014 for hospitals and CAHs and January 1, 2015 for EPs.

For more information on the EHR Incentive Program and meeting meaningful use please contact Elana Zana.