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MU Industry Reaction: A Stage 3 Final Rule That May Not be So Final

October 7, 2015
by Rajiv Leventhal
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Could more program changes be ahead?

Late yesterday afternoon, the Centers for Medicare & Medicaid Services (CMS) released what it calls final rules for both meaningful use Stage 2 modifications and Stage 3. But while the Stage 2 modifications truly are final, some in the industry are wondering if Stage 3 changes could still be on the horizon.

As HCI reported yesterday evening, various health IT leaders showed initial optimism in the flexibilities to the program provided by CMS; however, these same people—some industry associations, some folks gathered in Chicago for the Health IT Summit in Chicago, sponsored by the Institute for Health Technology Transformation (iHT2, a sister organization to Healthcare Informatics)—proceeded with caution, wanting to read the rules in full detail before offering more comment. One noteworthy thought that came up a few times was the fact that CMS announced a 60-day public comment period to facilitate additional feedback about Stage 3 of the EHR Incentive Programs going forward, in particular with regards to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) that requires the establishment of a Merit-based Incentive Payment System (MIPS) and consolidates certain aspects of a number of quality measurement and federal incentive programs for Medicare physicians and other providers into one more efficient framework.

Indeed, as HCI continued to garner more feedback on the EHR Incentive Program final rules, the added comment period continued to be a point of conversation. For one, Naomi Levinthal, consultant, research and insights at The Advisory Board Company (Washington D.C.), says that the fact that Stage 3 is not set in stone could signal some sort of response from CMS about all of the feedback they have been getting from the industry and from lawmakers about providers’ desire to delay the start date of Stage 3. “They essentially said they will continue on with the proposal of Stage 3, with everything starting in 2018, but they said finalized with air quotes, which allows providers to have another 60-day comment period. This significantly reflects a move on CMS’s part to continue the conversation and not have things set in stone,” Levinthal says.

Naomi Levinthal

Similarly, John Halamka, health IT luminary and the CIO for the Boston-based Beth Israel Deaconess Medical Center, wrote in his blog yesterday that “It remains to be seen how the comment period on the EHR Incentive Programs final rule will be used to align the meaningful use program  with the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) effort.   It would not surprise me that the CMS final rules are not really final.”

Leslie Kriegstein, interim vice president of public policy, at the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME), agrees with the sentiment that the recent calls for a Stage 3 delay could have been the driver for the added comment period.” Sen. Lamar Alexander and 116 members of the House exerted their oversight. He very clearly stated ‘we will fight you on this if you don’t do this yourself,’” Kriegstrin says. “You are seeing the provider community in lockstep in ways that are not traditional with sincere concern about timeframes and existing technology capabilities. Given that rules were so far along when we all discovered that Stage 3 was coming sooner than we had anticipated, that’s as far as CMS could go in terms of reopening the conversation,” she says.

Indeed, CMS was certainly facing harsh criticism on the Hill. More than once in the past several months, Sen. Alexander (R-TN) has called for a delay to the start of Stage 3 until Jan. 1, 2017, citing physicians and doctors who he has spoken to that are literally "terrified" on the next implementation stage of electronic health records. Following the release of the regulations yesterday evening, Alexander, not surprisingly, was dissatisfied. He released a statement saying, “The administration has a tin ear. We asked: ‘Why spend a year modifying rushed up mistakes? Why not spend a year getting it right in the first place?’ They listened but they did not hear. They’ve missed a golden opportunity to develop bipartisan support in Congress and throughout the country for an electronic health records system that would genuinely help patients. Instead, they’ve rushed ahead with a rule against the advice of some of the nation’s leading medical institutions and physicians.” He added, “Congress will carefully review this rule and has the option of fixing it through legislation or overturning it through the Congressional Review Act.”