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Guest Blog: “Shock,” “Dismay,” and Stage 2 of Meaningful Use

September 9, 2014
by Jeff Smith, Vice President of Public Policy at CHIME
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Jeff Smith, Vice President of Public Policy at CHIME

Sentiments of “shock” and “dismay” crowded my inbox at 5:00 pm a few weeks ago as healthcare CIOs reacted to a final rule modifying timelines and certified EHR definitions related to meaningful use in 2014.  These sentiments were tied to one, very specific provision that had nothing to do with program year 2014.

Make no mistake, this final rule was necessary.  The Centers for Medicare and Medicaid Sevices (CMS) and the Office for the National Coordinator for Health IT (ONC) have been hearing for more than a year and a half that 2014 would be a difficult year for meaningful use.  CHIME began sounding the alarm in May 2013 by suggesting regulators reevaluate timelines.  We knew there was a collective education gap on how difficult the leap from Stage 1 and the 2011 Edition would be to Stage 2 and the 2014 Edition CEHRT.  Four months later, in September 2013, a group of 17 U.S. Senators, all Republicans, asked regulators to slow the pace of change required by meaningful use – a move that should have provided appropriate political cover for the administration to do something – still nothing, no relief.

Then, during HIMSS14 in February of last year, nearly 50 national-level provider organizations asked CMS for more time and flexibility to adopt 2014 Edition EHRs and meet Meaningful Use.  Three months following this letter, CMS proposed an NPRM that enjoyed, as Administrator Tavenner said last Friday, “overwhelming support.”

This final rule was necessary. And after more than a year and half of pleading, after nine months of poor attestation figures, we have the federal government’s solution to what ails Meaningful Use. 

As expected, the rule was fairly unchanged from its proposed form:

  • It maintained roughly ten new pathways for providers to meet MU in 2014.  This dynamic essentially wiped the requirement to use 2014 Edition Certified EHR Technology (CEHRT) this year and allows providers to meet a lesser Stage than they were scheduled;
  • The rule extended Stage 2 through 2016 for providers who started the program in 2011 or 2012 and officially set the Stage 3 timeline beginning in 2017;
  • It kept the provision requiring providers who take advantage of the new pathways to attest that issues around 2014 Edition “availability” were to blame; and
  • Lastly, perhaps most importantly, it maintained requirements that all providers beyond their first year of MU report data for the entire year in 2015, using 2014 Edition CEHRT.


This last provision is the most important for those providers who must attest to Stage 2 in 2015.  This group is composed of roughly 237,000 physicians and 3,800 hospitals.  Last week, CMS released data detailing how many hospitals and physicians have met Stage 2 requirements in 2014.  At this point in the year, these figures are good proxies for understanding how many providers will be successful in 2015; if a hospital or physician has successfully attested to Stage 2 in 2014 for a quarter, they should be more likely to attest to Stage 2 in 2015 when they must do so for a full year. 

So how many hospitals have attested to Stage 2 with less than 30 days left in the reporting year? 143.  How many physicians have attested to Stage 2 with another reporting period to go? 3,152. 

Simple math should make policymakers nervous.  These figures translate to less than 4 percent of hospitals and less than 2 percent of physicians who will need to be ready in 2015.  For hospitals, the final rule released last week means they must have implemented 2014 Edition CEHRT and configured the software to meet Stage 2 measures and objectives within the next 30 days – if they cannot do this, they will fail MU in 2015.

Given this information, many groups like ours urged CMS to adopt a shorter reporting period in 2015.  We saw no way that 3,800 hospitals and 237,000 physicians would be ready by the beginning of 2015; rather, we suggested CMS enable these providers to meet Stage 2 requirements by giving them flexibility on the reporting period.  CMS did not agree:

“Changes to the EHR reporting period would put the forward progress of the program at risk, and cause further delay in implementing effective health IT infrastructure,” they said in the final rule.  “In addition, further changes to the reporting period would create further misalignment with the CMS quality reporting programs like PQRS and IQR, which would increase the reporting burden on providers and negatively impact quality reporting data integrity.”

Hence, the sentiments in my inbox.  We believed the recommendation that providers be required to implement 2014 Edition CEHRT and achieve Stage 2 measures in 2015 was a fair demand, but we knew they needed a little more time to do so.  By setting a full-year reporting policy for 2015, CMS has mitigated a disastrous year in 2014 at the expense of 2015 and beyond.