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HIT Policy Committee: How Much Flexibility on Meaningful Use Deadlines?

February 18, 2010
by David Raths
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At first glance, the Feb. 17 presentation by Paul Tang, MD, chair of the Meaningful Use Workgroup of the Health IT Policy Committee, would probably be music to the ears of a lot of hospital CIOs.

Tang, chief medical information officer at the Palo Alto Medical Foundation, was leading a discussion about recommendations the committee would make in response to CMS’ Notice of Proposed Rulemaking (NPRM) about the implementation of meaningful use guidelines and incentives. Most of the 12 suggestions simply asked CMS to consider re-instating some of the Policy Committee’s earlier recommendations that had been cut out of the NPRM, such as the inclusion of the recording of advanced directives for Stage 1 meaningful use.

But suggestion No. 12 was the biggie. It recommended offering some flexibility in meaningful use criteria to ease the “all or nothing” aspect of achieving meaningful use and allow for organizations to defer a few aspects of fulfilling the requirements until Stage 2 while still receiving the incentive. The proposal before the committee was that eligible providers would still be eligible for incentives if they defer no more than:

  • 3 of the criteria in the quality domain;
  • 1 of the criteria in the patient/family engagement domain;
  • 1 of the criteria in the care coordination domain;
  • 1 of the criteria in the population/public health domain.

All the privacy and security criteria and those relating to clinical quality reporting would still be required.

Several Policy Committee members applauded the move toward flexibility, and even suggested that providers should be given credit for partially achieving a goal. For instance, if a measure is 80 percent of orders done a certain way, hospitals should get some credit for getting to the 70 percent mark, rather than none at all.

Yet during the discussion period, the committee could not agree on which elements might be deferred. Several people voiced opposition to deferring any elements of patient engagement or public health goals. After all, committee members had fought to have these measures included initially and one described it as asking them to decide which of their children to sacrifice. Eventually it was determined that the meaningful use work group and the committee needed to do more work on the recommendation or that perhaps individual members would have to submit individual recommendations on the topic, so it’s not clear how much weight CMS will give the flexibility idea. Still, it’s clear that the Policy Committee has heard from the provider community that the all-or-nothing approach is problematic, so maybe CMS will get that message, too.