Family physicians and other health care professionals mired in the federal government's Medicare and Medicaid EHR (electronic health record) Incentive programs -- and who are navigating a maze of meaningful use rules -- may get a reprieve of sorts.
CMS and the Office of the National Coordinator for Health Information Technology (ONC) recently proposed a rule that would give physicians and others another year to use 2011 Edition certified EHR technology (CEHRT). The same proposal would extend stage two of the EHR incentive programs through 2016 -- essentially giving physicians an extra year to work at meaningful use stage one before jumping into stage two.
CMS and ONC officials noted in the proposed rule, which was published in the May 23 Federal Register,(www.gpo.gov) that the agencies had heard a clear message of concern from physician organizations asking HHS to modify meaningful use timelines and requirements.
In fact, in February, the AAFP and 46 other organizations sent a letter to (then) HHS Secretary Kathleen Sebelius saying, "We fear the success of the program is in jeopardy if steps are not taken now to address our shared concerns."
Fast forward to a May 20 press release(www.cms.gov) in which CMS Administrator Marilyn Tavenner, M.A., said, "By extending stage two, we are being receptive to stakeholder feedback to ensure providers can continue to meet meaningful use and keep momentum moving forward."
- CMS and the Office of the National Coordinator for Health Information Technology listened to feedback provided by the AAFP and other stakeholders and proposed changes to meaningful use timelines and regulations.
- The proposed rule would give physicians another year to use 2011-edition software and extend stage two of the federal electronic health record (EHR) incentive programs through 2016.
- The AAFP supports much of the proposal and plans to submit comments on the proposed rule, but cautions physicians to keep working on EHR upgrades to avoid future meaningful use penalties.
Tavenner noted that the proposed changes would address stakeholder concerns and encourage continued adoption of CEHRT.
The AAFP reacted favorably to the news and will comment on the proposed rule by the July 21 deadline.
"The flexibility to do meaningful use stage two in 2014 is a good thing for family physicians," said Steven Waldren, M.D., director of the AAFP's Alliance for eHealth Innovation (formerly the Center for Health IT).
The downside, he added, is that the proposed wiggle room adds "complexity to an already complex program."
"There are members who will not be able to get their EHRs upgraded to the latest version that is certified for 2014," Waldren noted in an interview with AAFP News. And even those who do get upgraded still will need to implement and learn the new functions that are required as part of stage two.
"Some functions -- such as implementing the secure patient messaging and the transition of care requirement -- will require significant effort and time," he said.
Regarding CMS' suggested delay in cementing details for meaningful use stage three, Waldren said, "We really need to incorporate the evidence and learning from stages one and two before we finalize stage three," said Waldren. "This delay allows more time for that to happen."
When all is said and done, it's the final details that will matter most to family physicians in the trenches, said Waldren. "We'll have to wait and see how CMS will regulate these proposed changes," he said.
And even though the AAFP will lay out those all-important details if and when the rule becomes final, Waldren suggested AAFP members start tracking the situation now. Here are his important takeaway points for family physicians who want to avoid future penalties:
- Physicians planning to attest to meaningful use this year must start that process by July 1 -- barely one month away -- if they are to meet the Oct. 1 deadline that requires 90 prior consecutive days of reporting time.
- Physicians attesting to meaningful use of an EHR must use a certified product, and before this proposed rule, that had to be a 2014-certified system. The proposed rule says that physicians who have trouble getting a 2014-certificted product can attest using a 2011-certified EHR.
- Also prior to the promulgation of this proposed rule, physicians who started on meaningful use in 2011 or 2012 were required to use a 2014-certified product to attest to stage two in 2014; however, CMS is now proposing that if physicians have trouble getting a 2014 product fully implemented, they can instead attest to stage one in 2014.
However, there is a caveat to that reprieve, Waldren warned.
"Family physicians need to understand that if they opt to do stage one rather than stage two in 2014, then they need be ready on Jan. 1, 2015, to do stage two meaningful use for the entire year, because in 2015, the reporting period is an entire year rather than just one quarter," he said.
"So physicians should be wary about slowing down full implementation of their EHR because they'll have to be up and running on Jan. 1, 2015, to avoid incurring a penalty.
"Family physicians cannot lose their focus if they want to be ready for next year," said Waldren.
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