CHIME weighs in on MU Stage 3 with several suggestions

The College of Healthcare Information Management Executives (CHIME) submitted comments to the Centers for Medicare & Medicaid Services (CMS) calling for several important changes to the proposed rule for Meaningful Use Stage 3 that it deemed too ambitious. The organization also lent its overwhelming support for a corresponding CMS proposal that would shorten the reporting period from a full year to any continuous 90-day period.

While recognizing the agency's effort to streamline program participation through a reduced number of objectives and harmonized reporting periods, CHIME deemed the sum total of proposals for Stage 3 of the EHR Incentive Program "unworkable," according to a statement.

"Were all requirements finalized as proposed, we doubt many providers could participate in 2018 successfully," CHIME said. "And with so few providers having demonstrated Stage 2 capabilities, we question the underlying feasibility of many requirements and question the logic of building on deficient measures."

CHIME urged CMS to make several changes to the proposed rule for Stage 3, including the following:

• A 90-day reporting period for the first year of Stage 3 compliance, at least for payment adjustment purposes;
• Modify requirements for and retain the 90-day reporting period for providers attesting to meaningful use requirements for the first time, whether in a Medicare or Medicaid context;
• Eliminate patient action thresholds for the care coordination objective;
• Reduce the number of required measures in multi-measure objectives, health information exchange and care coordination;
• Create hardship exceptions for providers switching vendors;
• Allow providers to take a 90-day reprieve during any program year for upgrades, planned downtown, bug fixes related to new technology or optimizing the use of new technology within new workflows; and
• Allow, in limited circumstances, paper-based means to achieve measure thresholds.

Patient action requirements related to care coordination and "unrealistic" thresholds for health information exchange requirements were of particular concern for CHIME. Additionally, the organization said it was troubled over the requirement that all providers must attest to Meaningful Use Stage 3 by 2018, regardless of prior participation and experience with the program.

"While we acknowledge policymakers' intention to make each stage more difficult than the last, we are concerned with the strategy that envisions Stage 3 serving as both the apex of MU requirements and as a starting point for those providers with no experience at Stage 1 or Stage 2 of the EHR incentive program," CHIME stated. "We worry some of the objectives pose too great a stretch for seasoned meaningful users, let alone those who have never participated in the program."

CHIME CEO and President Russell P. Branzell, FCHIME, CHCIO, said though CMS has proposed limited flexibility for meeting objectives, many providers face a significant chance of falling short and incurring substantial penalties.

"In order to realize the network effects of Meaningful Use, we need as many providers as possible participating in the program," he said. "As proposed, this rule may do more to deter, rather than encourage, ongoing participation."

"We question the value of setting thresholds for technology and process not yet invented, let alone widely deployed in healthcare," said CHIME Board Chair Charles E. Christian, FCHIME, LCHIME, CHCIO, vice president of technology and engagement with the Indiana Health Information Exchange. "From the heavy reliance on APIs to an assumption that patient-generated health data will flow in standardized ways, our industry has a long way to go if it is going to catch-up with this rule by 2018."

Separately, CHIME submitted comments on two other pending regulations, the ONC 2015 Edition HIT Certification Criteria NPRM and the CMS proposed rule to change meaningful use Stage 2 criteria.

In its comments on the proposed rule to modify Meaningful Use requirements from 2015 to 2017, CHIME commended CMS for leading a series of changes to the program, specifically the provision to shorten the EHR reporting period in 2015 from 365 days to 90 days.

"The additional time afforded by this modification will help hundreds of thousands of providers meet meaningful use requirements in an effective and safe manner. Further, it will serve as positive incentive for those who optioned alternative pathways to meet MU in 2014 to continue their work in 2015 and beyond," CHIME said.

The group also supported modifications pertaining to Patient Electronic Access, Secure Messaging & Summary of Care measures, stating that it opposes requirements that place accountability for patient behavior beyond what clinicians or providers can control, but that CMS must address patient engagement more innovatively.

"As our industry continues the discussion of how best to engage the patient through technology, and how best to measure these efforts, we encourage CMS to think more innovatively around the concept of patient engagement, how to differentiate between those that do it well and those who do not, and how to incentivize laggards," CHIME stated.

Two provisions in the modified rule not supported by the organization were the proposed exclusion pathways associated with the public health objective and the requirement for bi-directional exchange for immunizations registries, both of which CHIME urged CMS to revisit in Stage 3.

"While much work remains to address misalignment between the positive changes proposed in the modifications rule and what will be required in Stage 3, regulators have clearly taken heed of providers' concerns," said Branzell.