8 Things to Know about the Next Evolution of Meaningful Use

CMS recently released proposed changes to Stage 2 Meaningful Use as well as a proposed rule for Stage 3 which has been scheduled to begin for all participants in 2018. The comment period for the Stage 3 Notice of Proposed Rulemaking (“Stage 3 NPRM”) closed this past Friday, however, the comment period for the Stage 2 Notice of Proposed Rulemaking (“Stage 2 NPRM”) remains open until June 15.

Unless you've been living without social interaction or the Internet for the past few months (not an option for most of us), you are well aware of the changes CMS has proposed for moving forward with Meaningful Use. Some are drastic and have invited a host of public comment. Others are welcomed changes moving forward in this year and with Meaningful Use in general.  Here is our list of the top 8 changes to be aware of. 

  1. Stage 3 is the END.  But not Really.  All providers will be responsible for Stage 3 in 2018, regardless of their year of participation. CMS has stated that Stage 3 will be the final “Stage” of Meaningful Use.  However, it acknowledges that changes may be required as the program advances.  From past experience, we all know future rulemaking is a given. 
  2. Reporting Periods have Changed.  For 2015, the Stage 2 NPRM proposed to shorten the reporting period from a full calendar or fiscal year to a 90 day calendar reporting period - this is despite CMS specifically refusing to do so last summer in its 2014 CEHRT delay rule. In 2016, all participants will supposedly be on a full calendar year reporting period, including hospitals and critical access hospitals, except for new Medicaid participants. 
  3. Maxed-out Incentive Payments.  For many hospitals and EPs, 2014 was the last year the hospital or EP received an incentive payment.  That means moving forward, any CEHRT upgrades are solely on the hospital or EP’s dime.  However, failing to continue participation will result, at least for purposes of Medicare, in payment adjustments for each year that a hospital or EP does not successfully participate. Providers will need to each determine whether it is worth the cost to continue to participate in subsequent years.
  4. Vendor Certification Requirements.  The requirements for vendors to get their products certified to 2015 Edition CEHRT pose a significant time and resource burden.  Since we likely won’t see a final version of the Stage 3 NPRM or its accompanying certification rule until the fall, vendors have only a little over two years to develop or retool the necessary software, get it certified, and roll it out in time for the providers to start their own reporting clocks on January 1, 2018. It remains to be seen what impact this timetable will have on smaller CEHRT vendors, and more importantly, whether this is truly enough time to prepare everyone for Stage 3.      
  5. Elimination of Core/Menu Distinctions.  For Stage 3, CMS has proposed a single set of core objectives, with some flexibility options built in.  This means physicians and hospitals are expected to demonstrate measures that previously may not have been applicable to them.  To help move hospital and EPs towards this, similar changes are proposed for Stage 2. Both the Stage 2 and Stage 3 NPRMs also eliminate measures which CMS considers to be redundant, duplicative or “topped out” although data will still need to be collected on certain former objectives, such as Vital Signs or Smoking Status.  CMS states that its goal is to streamline, simplify, and reduce the burden on providers, while at the same time advancing the goals of Meaningful Use.  
  6. API.  The Stage 3 NPRM proposed changes to the former Stage 2 Patient Access and other measures would permit (or potentially require) use of an Application Program Interface.   It’s a set of programming protocols that would allow a third party application access to pull a patient’s health information from the provider.  CMS has requested comment whether providers should be given the option to use either an API or a Portal, both, or just an API to demonstrate this measure. 
  7. Patient-Generated Data.  The Stage 3 NPRM would require incorporation of patient-generated data in some format into a provider’s CEHRT.  This is information not originating with another EP or hospital, but from other sources such as home health and even medical device data.  A lot of questions remain open about how this data would be incorporated, how a provider would obtain such data, and the scope of data that would be covered (i.e., Fitbits?)
  8. Patient Access Modifications.  The Stage 2 NPRM proposes to eliminate the 5% percentage requirement that patients actually view, download or transmit their health information in favor of an “at least 1” requirement.  CMS acknowledges in the Stage 2 NPRM the difficulties providers have due to lack of control over this measure, yet for Stage 3, would nonetheless ramp this percentage up to 25%.  Although additional flexibility is proposed by permitting hospitals and EPs to choose 2 out of 3 to meet the threshold for, they still hinge upon factors which may be difficult for providers to control.

Several prominent industry groups are already calling on CMS to delay Stage 3 finalization, for example, because it is too soon to  overhaul Meaningful Use without fully measuring how the industry has responded to the first two stages. Comments posted to the Stage 3 NPRM up until the close of their acceptance reflected a mixed bag of support for flexibility but concern for implementation and timing.  However, we will almost certainly see material changes in the finalized versions of the rules if CMS's past regulatory history is any measure.  

As a reminder, the deadline for EPs to apply for a Hardship Exception for their inability to successfully participate in 2014 is July 1.  Although any EP who did not successfully participate last year will lose his or her incentive payment, filing for a Hardship Exception can potentially avoid the 2% reduction in Medicare payments which will begin January 2016.  The applications can be found on the CMS Payment Adjustments and Hardship Exceptions page.  There is no payment reduction for Medicaid participants.