HIMSS14: Tavenner offers no delays

ORLANDO--During her keynote address at the Health Information and Management Systems Society annual conference, Centers for Medicare & Medicaid Services (CMS) Administrator Marilynn Tavenner offered the healthcare community no relief from looming compliance dates.

In response to ongoing calls to delay the implementation of ICD-10, Tavenner said, “There are no more delays and the system will go live on Oct. 1. Let's face it. We've delayed this several times and it's time to move on.”

However, CMS plans to be more flexible regarding hardship exemptions for providers working to meet Meaningful Use deadlines.  

The starting date for Stage 2 for eligible hospitals was Oct. 1, 2013, and they can start their 90-day reporting periods on April 1 or July 1. Physicians and other eligible professionals can start their 90-day reporting periods on April 1, July 1 or Oct. 1.

Tavenner said she has spent the last four years on health IT and, in a nod to healthcare.gov woes, “learned about projects that take more time, cost more money and need more resources. I am sympathetic to that.”

The true cost of healthcare can’t be understood until people have access to the system and those who need more assistance are identified so CMS can drive its resources appropriately, she said. The work already completed is starting to yield significant results. National healthcare expenditure is at an all-time low, she noted, and outcomes are improving with fewer adverse events and reduced 30-day hospital readmission rates, among other encouraging trends.

“We would not know where to begin and where to end without your help,” she told the audience. “The release of data is making a difference and people are paying attention.”

Tavenner called upon the audience to continue their efforts and work through the challenges because more positive results are possible and needed. Interoperability is key to further improvements, she said. The Stage 2 and Stage 3 start dates have each been delayed a year so “now is the time for us to start moving forward.”

Some providers and health IT vendors may have legitimate issues, though, such as the late delivery of tested and certified software or EHR vendors going out of business, that might preclude them from meeting Stage 2 compliance requirements, Tavenner said.

In those cases, Tavenner said, CMS is willing, on a case-by-case basis, to consider applications for “hardship exemptions.” Even with the exemptions, she said, CMS expects all Stage 2 providers to fully meet all Stage 2 criteria by 2015 while still encouraging everyone else eligible to meet them this year.

In response to the announcement of this flexibility on hardship exemptions, the College of Healthcare Information Management Executives (CHIME) welcomed the news of some relief. “Such relief is vitally important for the future success of Meaningful Use, as ICD-10 deadlines and continued shifts in payment policies demand an ever-increasing amount of IT and workforce resources. If the expansion of the office’s EHR hardship exceptions provides the kind of relief the industry desperately needs, CHIME pledges to assist policymakers in every way possible. Should CMS choose to define the new hardship exceptions in a way that does not address the core concerns of our industry we will continue to seek the kind of flexibility that nearly 50 national healthcare organizations communicated to HHS Secretary Kathleen Sebelius on February 21, 2014,” according to a statement from CHIME President and CEO Russell P. Branzell and CHIME Board Chairman Randy McCleese.

The question now is how CMS will determine who will qualify for an exception. The agency already has an application for hardship exemptions, though it and the process once an application is filed may need to be amended, according to Jeffrey Smith, CHIME’s senior director of federal affairs.

In comments to Clinical Innovation + Technology News, Smith said, “We have raised several issues with CMS over the last few months, particularly with regard to availability of 2014 Edition Certified EHRs and we have also tried to describe the kind of workflow challenges providers face, even after receiving updated code. I’m sure that more details will come to light over the coming days and weeks.” 

Until further word from CMS, Smith said we can’t know what the process will look like in the future and whether the agency will be swamped with requests. “We anticipate that CMS has made some determination of how many potential [eligible providers] and [eligible hospitals] may be eligible for the new exceptions.”