Higher thresholds, added flexibility, await Stage 2 meaningful users


The final rule on Stage 2 meaningful use requirements, released Aug. 23 by the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health IT, ups the ante on physicians and hospitals implementing certified EHR technology. Stage 2 includes higher performance thresholds than Stage 1; however, it also adds flexibility that will help providers qualify for CMS-administered EHR Incentive Program payments.

During an interview with Tom Sullivan, editor of Government Health IT (a sister publication of PhysBizTech), Foley and Lardner partner Rick Rifenbark, who’s a member of the law firm’s healthcare industry team, discusses the most important changes in the final rule, ways that Stage 2 makes qualifying more achievable and what’s not in the rule that perhaps ought to be.

A transcript of that interview follows:

Q: What are the most significant changes in the final rule? 

A: There are a number of important changes in the final rule, including changes to existing Stage 1 meaningful use requirements, new Stage 2 meaningful use objectives and associated measures, new clinical quality measures (CQMs) and reporting mechanisms for the CQMs, clarifications regarding Medicare payment adjustments, and the creation of specific Medicare payment adjustment exceptions.

However, given that eligible hospitals and eligible professionals (EPs) who are currently in Stage 1 of meaningful use will need to progress to the Stage 2 requirements to continue receiving incentive payments and to avoid Medicare payment adjustments, perhaps the most significant change is the delay by one year (from 2013 to 2014) of the start of Stage 2 for providers who became meaningful users in 2011. This extra year will give providers and vendors additional time to implement changes to their technology and workflow to accommodate the Stage 2 requirements.

As further relief for providers in this regard, the final rule also permits providers to attest to meaningful use in 2014 (which is the first year in which a provider could be required to meet Stage 2 meaningful use) based on a three-month quarter reporting period as opposed to a 365-day reporting period. This three-month quarter reporting period in 2014 also applies to providers who are still in Stage 1.

[See also: Slideshow: Is your EHR MU2-ready?]

Q. Does the final rule make meeting the measures, and thus obtaining incentives, more achievable for providers? And what about EHR vendors?

A: Consistent with the staged approach to meaningful use, the Stage 2 measures in the final rule generally include higher thresholds than the Stage 1 measures, as well as the addition of new meaningful use objectives. By way of example, Stage 1 requires EPs to record demographic information for at least 50 percent of unique patients seen by the EP during the relevant reporting period. Under Stage 2, the applicable percentage is at least 80 percent.

But the final rules do reflect a number of ways in which CMS incorporated more flexibility into the EHR incentive program to better accommodate providers and vendors. As noted above, CMS delayed the onset of Stage 2 by a year for those providers who first achieved meaningful use in 2011 and also implemented a three-month quarter reporting period in 2014. This additional time will benefit providers and vendors.

In addition, CMS permits batch reporting of meaningful use measures for medical groups, allows for group reporting of CQMs, created categories of Medicare payment adjustment hardship exceptions, and made certain favorable changes to the Medicaid patient volume requirements for Medicaid providers. These changes should help make the satisfaction of meaningful use more achievable for providers.

Q: What's one thing you would have liked to see in the final rule that did not make it? 

A: I would have liked to see CMS adopt a mechanism whereby medical groups could achieve meaningful use through an averaging of meaningful use measures at the group level, as opposed to requiring each EP to individually satisfy meaningful use. Such a change would have been consistent with other aspects of the EHR incentive programs that permit medical groups and clinics to collect information at the group level and would have reduced the administrative burden on medical groups and clinics. CMS indicates in the final rule that it is not adopting this change, but does leave open the possibility that such a change may be implemented in the future.
 

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