Five societies blast CMS with meaningful use opinions

It’s no surprise that when a proposed rule on meaningful use is revealed, a litany of organizations want their voices heard. While May 7 was the last day to submit comments to the Stage 2 meaningful use proposed rule to the U.S. Department of Health and Human Services (HHS), five organizations have joined the din of democratic speech on the legislation.

Apparently, a fair amount of work needs to be done with the two Notices of Proposed Rulemaking (NPRM) on the Medicare and Medicaid EHR Incentive Programs.

Starting with the Healthcare Information and Management Systems Society (HIMSS), the organization focused mainly on timeline considerations. HIMSS "strongly" suggested that the government incorporate a 90- to 180-day reporting period for Year 1 of Stage 2 in 2014. As part of the preparation for the Stage 2 Final Rule, HIMSS is encouraging HHS to continue reviewing and reassessing the timeline to maximize the amount of time all eligible professionals (EPs), eligible hospitals (EHs) and critical access hospitals (CAHs) and vendors have to prepare for meaningful use Stage 2.

HIMSS also recommended that 2014 (the first year of the new certification criteria and clinical quality measures [CQMs]) be limited to a 90- to 180-day reporting period and that HHS reconsider the proposal that providers who are in Stage 1 will be required to meet all of the criteria changes to Stage 1 by fiscal/calendar year 2014. HIMSS also recognized the areas in which its members agree with Centers for Medicare & Medicaid Services (CMS) and Office of National Coordinator for Health IT (ONC) proposed rules and provides support—notably, this includes support for the “Base” EHR concept, and for the extension of meaningful use Stage 1 for 2011 attesters.

Finally, also HIMSS:
• Encouraged alignment between federal and state quality reporting requirements.
• Emphasized that Quality Measures should be utilized only if the standard and specifications supporting the quality measure have been tested and verified.
• Encouraged the utilization of mobile technologies to support patient engagement.
• Included several requests for additional clarity or definition.
• Addressed questions in the NPRM around accounting of disclosures and data portability.

The Chicago-based American Health Information Management Association (AHIMA) stressed the need for consensus-based quality measurement reporting and called for consistency among the various Stage 2 requirements for all federal programs whose requirements overlap with meaningful use. AHIMA additionally called for the proposed definition of a “base EHR” to expand to include the ability to produce a health record for legal, business and disclosure purposes.

Piggybacking on definition requests, the Chicago-based Certification Commission for Health IT (CCHIT) recommended that the ONC task the Health IT Standards Committee with making recommendations as to the characteristics that can be associated with a “mature” standard, taking into account it has been balloted by an appropriate standards development organization, has been piloted and has been widely adopted for a specified period of time for the purpose for which it is being proposed to be used. “When finalizing the rule, only standards that meet this level of maturity should be codified in statute,” wrote Karen Bell, MD, CCHIT chair.

One concern raised by CCHIT is the changes proposed for the definition of certified EHR technology are unnecessarily confusing for all concerned parties.

The Washington, D.C.-based American College of Cardiology’s (ACC) comments contain not only the CMS vision of the next phase of the EHR Incentive Program, but also a few minor changes to Stage 1. When it comes to Stage 1, the comments urged CMS and ONC to conduct a survey of program participants to learn more about their experiences than can be gathered from the attestation data. The ACC also recommended that CMS and ONC conduct a survey of eligible professionals who did not participate and a third of those who tried but were unsuccessful to thoroughly understand the implications of their proposals and activities.

Not all of the comments were glowing, however. For Stage 2, the ACC stressed that the proposed requirements “set the bar for success too high.” According to the comment letter: “The meaningful use criteria should encourage the appropriate, purposeful and accurate use of EHR tools, rather than mandate completion of tasks based on a particular timeline. There is too much emphasis on timeline orientation in the proposed criteria, and those timelines are too rigid … When the additional workload is coupled with new and constantly changing requirements, it is clear that the burden imposed by CMS through this proposal for Stage 2 goes above and beyond what providers and vendors are capable of addressing before 2014.”

While not as harsh, the Chicago-based American Medical Association, to make the Stage 2 program more reasonable and achievable, made the following principal recommendations:

• Evaluate Stage 1 to inform the final Stage 2 requirements;
• Create more flexibility in meeting measures including exclusion and relevancy factors;
• Delete the high thresholds for new measures and for measures that cannot be met due to the lack of available, affordable, well-tested tools or exchange capabilities;
• Incorporate more focus on measures within a physician's control;
• Include any proposed new measures for Stage 2 in the menu set of options;
• Allow a significant good faith effort to meet measures in Stage 2 to count for incentives and for avoiding penalties;
• Eliminate back-dating the meaningful use penalty program and establish a number of exemption categories for hardship cases;
• Synchronize and improve the overlapping health IT and quality program requirements;
• Establish an appeals process under both the meaningful use and e-prescribing programs; and
• Reduce the burden and add flexibility in regard to CQM reporting and requiring testing of electronic specifications prior to use of a CQM.