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Stage 2 and the Industry’s Full Court Pressure

August 30, 2013
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In basketball, when a team is losing a close game, they usually get a little desperate in the final minutes. This means full court pressure, causing havoc, heaving three pointers, and cutting the lead down by any means necessary. They can usual smell fear on the winning team, which typically wants to just run the clock out.

To me, this is a metaphor for the healthcare IT industry right now. The associations--the American Hospital Association (AHA), College of Healthcare Information Management Executives (CHIME), Healthcare Information Management and Systems Society (HIMSS), the Medical Group Management Association (MGMA) and the American Association of Family Physicians (AAFP)--are that losing team. The government is that winning team.

(Please keep in mind, this is a light-hearted metaphor, no one is actually keeping score here. Although, it is entirely possible that I picked five associations on purpose.)

The associations, though, smell a little bit of fear in the government. They're getting an assist from a number of high profile politicians (the crowd), who have publicly questioned the meaningful use program. So they're doing everything they can to get the meaningful use Stage 2 timeline modified, to give providers a "reasonable chance at success," as CHIME CEO Russ Branzell told me, which would be a huge, come-from-behind type victory.

Time is running out though. In October, Stage 2 attestation is slated to begin for eligible hospitals (EHs) and critical access hospitals (CAHs), the first day of the 2014 fiscal year (FY). In case anyone isn't near a calendar reading this, that's in approximately one month.

The subject of a possible modification to the Stage 2 timeline was one of the focal points of my feature in the September issue of Healthcare Informatics. Industry leaders like Branzell, George T. "Buddy" Hickman, executive vice president and CIO of Albany (N.Y.) Medical Center and CHIME’s board chair, and Randy McCleese, vice president of Information Services and CIO at St. Claire Regional Medical Center, are pushing hard for a modification to the timeline.

They have their reasons—a lot have to do with the other policy mandates that are covered in the feature. I won’t rehash them because you can find them there, as well as my HIT voices series interview with Hickman and Branzell, an added extra to the feature.

The government’s top health IT officials, including the outgoing National Coordinator for Health IT, Farzad Mostashari, M.D., spoke against a delay of any kind during the Senate Finance Committee hearings. As reported in EHR Intelligence, Dr. Mostashari said that a pause of any kind would take momentum away from the progress that has been made.  Others who want the timeline to stay the same are using what I’m calling the “homework assignment” argument.

“People will get use to the fact that the government comes out with regulation, whether it’s HIPAA [theHealth Insurance Portability and Accountability Act of 1996], ICD-10, and then there is delay after delay after delay, so they don’t worry about it. I think that would send the wrong message if you did that with Stage 2,” Ed Marx, senior vice president and CIO of Texas Health Resources, a large multiple hospital system based in the Dallas area, said to me.

It should be noted that Stage 2 has already been extended once and most of the discussion of this debate has been on the side that is proposing to modify the timeline. Right now, in our HCI poll, that side is winning 64 to 36 percent (sorry, I forgot I said no one was actually keeping score!). Yet despite that, it’s far from a certainty and it will be interesting to see what, if anything happens, and when it could happen.

Like my friend said, the last two minutes in a basketball game is usually the most interesting.

I’d love to hear your thoughts. Feel free to leave comments below or respond to me on Twitter by following me at @HCI_GPerna.