- In response to the long-anticipated final use for meaningful use modifications and Stage 3 Meaningful Use requirements, industry experts have come forward to provide summaries and feedback of the rule.
One such group of experts is health IT consultancy at Impact Advisors, which recently provided summary and analysis of the newly released Stage 2 Meaningful Use revisions and the Stage 3 final rule with 60-day comment period.
The group’s analysis puts in plain terms what each of the new revisions and requirements means for eligible professionals (EPs) and eligible hospitals (EHs) and addresses the uncertainty surrounding Stage 3, with several powerful industry organizations and potentially Congress lobbying for the stage’s postponement.
The analysis begins first and foremost with a focus on reporting period for Stage 2 modifications, which drops down from 365 to 90 days for 2015. As noted, the reporting period will coincide with the calendar year for both EPs and EHs, with the exception of first-time Stage 2 participants for whom the reporting period will remain 90 days. In 2018, Stage 3 will be implemented and all participants will be required to follow a full-year reporting period.
Furthermore, the authors go through the reduced requirements for meaningful use between 2015 and 2017. In consolidating many requirements, the Centers for Medicare & Medicaid Services (CMS) has rid the program of those that were redundant or “topped out.” Overall, the revised Stage 2 rule has 9 objectives and 16 measures for hospitals and 10 objectives and 16 measures for EPs.
Additionally, the authors report that the measures that remain in the revised rule generally have the same scope of requirements as prior to the rule’s publication. The exceptions to this are:
In 2015 and 2016, the second measure of the “Patient Electronic Access” objective only requires that “at least 1 patient discharged from the hospital or seen by the EP during the EHR reporting period views, downloads or transmits his or her health information to a third party.” In 2017, this requirement increases to more than 5% of all unique patients.
In 2015, the EP-only “Secure Messaging” measure only requires a yes/no attestation to the statement: “The capability for patients to send and receive a secure electronic message was enabled during the EHR reporting period.” In 2016, a secure message must be sent using CEHRT to at least one patient seen by the EP during the reporting period; in 2017, that threshold will increase to more than 5% of all unique patients seen by the EP.
To meet the revised Summary of Care measure in 2015-17, providers will still have to generate the summary of care record using CEHRT, but will only have to transmit that summary of care record “electronically.”
Additionally, CMS has grouped together all of the public health reporting requirements, requiring hospitals to meet 3 out of 4 measures and EPs to meet 2 out of 3. This change was made to better streamline the transition from Stage 2 to Stage 3.
The good and the bad with Stage 3
As the Impact Advisors analysis observes, the Stage 3 rule is relatively consistent with what was proposed in April 2015. In this rule, hospitals and EPs each have 8 objectives with at least one measure.
While hospitals and EPs will be required to attest to each of those measures, it is indeed possible for providers to fail at meeting a certain measure while still achieving that stage of meaningful use because providers will only be required to meet the thresholds for some of these measures.
Furthermore, analysis indicates that these measures generally carry over from past Stage 1 and Stage 2 requirements but simply increase the scope of measurement. An exception to this would be the brand new measure of patient-submitted data from a non-clinical setting.
Generally speaking, Impact Advisors deem the requirements for Stage 3 to “very challenging,” stating that many of the required measures could potentially pose serious impediments in physician workflow.
Also, the group asserts that this final rule still contains many unknowns. For example, it maintains that the timing of the start of Stage 3 is still questionable because of the significant resistance from provider groups and potentially Congress.
“Although the Final Rule ‘officially’ requires Stage 3 in 2018 (with an option to start in 2017), there is still a reasonable chance it will ultimately be delayed by Congress,” the analysis states. “We should have a better sense of how (and if) Congress will get involved in meaningful use over the next few months after the dust settles from the publication of the Final Rule.”
Some Stage 3 Measures are Potentially Problematic
John Halamka, MD, MS, Chief Information Officer of Beth Israel Deaconess Medical Center has also offered his analysis of the new rules on his own blog. Specifically, Halamka discusses the Stage 3 provisions, offering his commentary on some of the more “controversial” measures.
First, Halamka touches upon the patient electronic access measurement, which requires 80 percent of patients to be given access to view/download/transmit their health information to a third party. Halamka maintains that this may be the most controversial of the measures.
“[A]t the moment, there are few patient facing applications that use APIs. Maybe in the future, the problem of multiple PHRs will be addressed by moving patients from portals to apps that consolidate data from multiple EHRs i.e. the patient’s PCP, specialists, urgent care clinicians, and hospital care team,” he wrote.
Halamka also considers the coordination of care through patient engagement measure to be of concern. He explains that because this measure is dependent on the patient interacting with the technology and participating in a technology market ecosystem, this measure may be more appropriate as part of a modified payment model.
The health information exchange (HIE) likewise strikes the BIDMC CIO as problematic. The measure entails sending and receiving information about patients, and requires that transition of care summaries be transmitted into data for at least 80 percent of new patients. However, this poses a problem because provider-generated problem lists (which would be part of these summaries) are noted in different ways due to different habits of physicians.
Halamka also gave a brief, bullet-point summary of his thoughts on the final rules:
The Stage 2 revisions that enable a 90 day reporting period and reduce some of the thresholds are good.
The Stage 3 API requirement and patient generated healthcare data are better done in merit-based payment approaches rather than Meaningful Use regulation
The collective burden of all the workflow changes required by three stages of Meaningful Use regulations will make it hard for clinicians to get through their day and spend time on direct patient care
The public health reporting requirements will be hard to achieve in many locations due to the heterogeneity of local public health capabilities
Many EPs and hospitals would welcome the end of Meaningful Use in favor of merit-based payment because at this point it is more effective and efficient for them to focus on achieving better outcomes for value-based care than being told exactly how they should get there.
There remains the issue of the 60-day comment period for the final rule for the public to provide feedback on the new provisions. Halamka welcomes the comment period and hearing what other industry stakeholders have to say about the “final” rule.