House, Senate Ask CMS to Delay Meaningful Use Stage Three

Final Rule Issued Despite Arguments for Further Deliberation

October 07, 2015 11:05 am Michael Laff

Legislators in the House and Senate heard physicians loud and clear regarding their frustration with meaningful use (MU) requirements, and they took up the call for CMS to delay implementation of stage three.

[Physician working on laptop in office]

Last week, 116 House members sent a letter( to HHS Secretary Sylvia Burwell and Office of Management and Budget (OMB) Director Shaun Donovan asking for the delay to give officials time to evaluate how new Medicare payment models can be integrated with MU.

On Tuesday however, CMS and the Office of the National Coordinator for Health Information Technology issued the final stage three rule( despite the arguments for more deliberation, which legislators had pointed out would have had broad benefits.

"In order to ultimately reach our shared goals of better health care, smarter health care spending and healthier patients, the administration needs to take time to reevaluate the program," the House members wrote. "We ask that you refrain from finalizing meaningful use stage three at this time and work to refocus the program to better serve patients and the providers who care for them."

Story highlights
  • Last week, 116 House members asked HHS and the Office of Management and Budget to delay implementation of meaningful use stage three.
  • The message echoed an earlier demand for delay from the AAFP.
  • Two senators also joined the growing chorus of voices calling for a delay in implementation.

About 257,000 physicians will be penalized during the 2015 program year for failing to meet MU requirements, according to a CMS estimate that the House members cited in their letter. That substantial figure indicates a flaw within the program more than a failure on the part of physicians.

"We believe that the stage three rule should be paused, as it should rely on proven technology ­- designed outside the limitations of current federal requirements -- that can support a shift to outcomes and interoperability rather than measures and objectives," the House members wrote last week. "Unfortunately, the proposed stage three rule… exacerbates current problematic policies of stage two."

The letter emphasized that MU standards need to be revised to account for additional demands physicians face under new payment models that CMS introduced after stage three requirements were developed. This statement echoed concerns expressed by AAFP and others in earlier communication with CMS.

In September, the AAFP and 40 other medical specialty organizations asked Burwell and Donovan to delay MU implementation.

AAFP Board Chair Robert Wergin, M.D., of Milford, Neb., noted that physicians are still having trouble with MU stage two.

"In my view, meaningful use stage two is far too complicated," he said before the final stage three rule was issued. "Many of the EHR (electronic health record) systems did not meet the criteria because of their lack of interoperability. Even if you wanted to meet the standards, you have to work around interoperability issues and problems with extraction of data."

Wergin said MU should be harmonized with other rules that will be developed as part of the Medicare Access and CHIP (Children's Health Insurance Plan) Reauthorization Act (MACRA), which includes incentives for physicians to move into different payment models by 2019. He believes the requirements will continue to be a burden until vendors are held accountable, as well as physicians.

"There should be a set of standards for what EHR vendors do and penalties for them, not us," he said. "Because of the clumsy nature of EHRs, many people chose not to do it and accepted the penalty."

Two senators, Lamar Alexander, R-Tenn., chairman of the Senate Committee on Health, Education, Labor and Pensions, and John Thune, R-S.D., also wrote to Burwell( last week asking for immediate action to delay issuing final rules for MU stage three until Jan. 1, 2017.

"While all hospitals and most physicians met the requirements of the first stage of the meaningful use program, stage two requirements are so complex that only about 12 percent of eligible physicians and 40 percent of eligible hospitals have been able to comply," the senators wrote.

Following an Oct. 1 Senate Health Committee hearing, Alexander outlined several reasons why MU stage three should be delayed in a highly detailed press statement.( He said the program's complexity is contributing to low levels of compliance and noted that the new Medicare payment system issues bonuses and penalties based in part on MU compliance. Under the Merit-based Incentive Payment System, 25 percent of the score used to determine whether a physician receives a penalty or a bonus payment is based on participation in MU.

Alexander noted that several leading medical institutions with the best EHRs recommended a delay. He also cited a new Government Accountability Office report that indicated MU requirements were actually preventing EHR systems from communicating with one another.

The Senate Health Committee is working with the Obama administration to develop legislation to achieve interoperability, and Alexander wanted the legislation to be aligned with the final rule for MU.

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