Meaningful Use Stage Two Proposed Rules Spark AAFP Concerns

CMS needs to exercise "ample restraint" in modifying existing stage one meaningful use criteria. That is according to a May 7 letter (6-page PDF; About PDFs) to CMS Acting Administrator Marilyn Tavenner, M.A., from AAFP Board Chair Roland Goertz, M.D., M.B.A., of Waco, Texas. Too many changes too fast "will lead to significant confusion among eligible professionals as they begin their meaningful use journey," Goertz says.

In the letter, the AAFP lays out its concerns regarding the agency's proposed stage two meaningful use requirements, which were published in the March 7 Federal Register (132-page PDF; About PDFs) and which will govern the next phase of CMS' Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs.

Goertz notes that in the proposed regulation, CMS continually references modifications in stage two criteria there were based on experiences with meaningful use stage one. However, says Goertz, the capabilities of EHR early adopters should not be looked at as "predictive of the ability and efficiency of eligible professionals (physicians) who have yet to embrace meaningful use."

"We strongly urge HHS to use caution in assuming that outstanding performance on meaningful use measures so far indicates generalized success, and that the bar should be dramatically raised. Successfully onboarding later adopters is likely to require a gentler approach."

Goertz zeroes in on pieces of the proposed regulations that he deems unfair to family physicians. "We are deeply concerned with criteria that mandate action by individuals and organizations outside the control of the eligible professional," he says. For example, the AAFP opposes a criterion requiring that, during the EHR reporting period, more than 10 percent of all unique patients seen by a physician view, download or transmit their health information to a third party.

"We cannot support this criterion in its current form," says Goertz. Instead, the Academy suggests that CMS require physicians to document they have the appropriate technology to provide patient connectivity, that they have encouraged patients to use this technology and that they have a means of measuring the extent to which the technology is used.

The Academy also strongly objects to CMS' proposal to allow EHR vendors to "opt out" of complying with a standard that deals with simplification, interoperability and universality of EHRs.

To start out with "excessive optionality" on the part of vendors would almost certainly result in a continued lack of interoperability between EHRs, says Goertz. This would result in barriers that would make many physicians unable to meet the relevant stage two meaningful use objectives.

The Academy also offers some strong language regarding the issue of "payment adjustments," which the AAFP contends are penalties slapped on physicians who do not demonstrate meaningful use of EHRs.

Goertz argues that CMS' application of the implementation of the penalty phase coming in 2014 reflects a different interpretation than language contained in the American Recovery and Reinvestment Act (ARRA). "The AAFP does not believe that the ARRA describes penalties for not being a meaningful user in 2014," says Goertz.

He notes that the statute states the penalties must take effect in 2015. "Why not start the penalty … 90 days after the start of 2015? This would give eligible professionals all of 2014 to become meaningful users," says Goertz. He notes that application of the penalty for an entire year, even after a physician had successfully attested to meaningful use in that year, "does not promote the cooperative trust necessary to transform our disconnected health care system into a learning health care system."

In addition, says Goertz, a number of family physicians "still are seething from the premature application of penalties in the CMS electronic prescribing incentive program."

The Academy also cautions CMS against