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Attestation Rate to Hinge on Possible Stage 2 Delay

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CSC’s Erica Drazen gives the scoop on Stage 1 progress

Since attestation for Stage 1 meaningful use began April 18, about 33 percent of U.S. acute care hospitals have applied for Medicare and Medicaid incentives. As of July 31 CMS reported these attestation statistics thus far:

  • 1,674 hospitals- Medicare and Medicaid (13 hospitals have registered for Medicaid only)
  • 62,110 eligible professionals (EPs) through Medicare
  • 13,610 EPs through Medicaid

Of those who registered, 1,078 EPs have received Medicare payments totaling $18.4 million, and 3,334 had received Medicaid payments totaling $70.2 million. Sixty-four hospitals have received Medicare payments totaling $129.9 million, and 199 had received Medicaid payments totaling $177.8 million.

For some perspective I asked Erica Drazen, Sc.D., managing partner in the Waltham, Mass.-based Emerging Practices division within the Falls Church, Va.-based CSC, for her perspectives on the progress toward meaningful use thus far.

“I was surprised at the low number of hospitals that have even registered, although there’s no need to register before applying for incentives, except to make sure you’ve got the hang of it and don’t run into any snags,” she says.

Drazen wasn’t surprised, however, by high number of providers that have attested for Medicaid incentives, as the bar is much lower than Medicare attestation. Providers only have to prove that they are working toward contracting an EHR vendor or in the process implementing an EHR. By July, 22 states were ready to go on their Medicaid programs, but as the program has no penalties, only incentives, it remains to be seen when the rest will be up and running. Drazen expects that provider organizations will start lobbying soon to get their states to register so that Medicaid money can start being distributed.

Unfortunately, CMS provides no information on hospital and provider numbers broken down by state or regions, so it’s impossible to predict what parts of the country are leading the way. The only detail it provides is the providers’ area of practice. Drazen is surprised about the large number of specialists that have attested for Medicare, and impressed by the numbers of nurse practitioners and even dentists that have attested for Medicaid incentives.

Drazen suspects that uptake has been slower on the hospital side because of a couple of factors. CMS recommends that hospitals that are registering for both Medicare and Medicaid do so at the same time, and since many states’ Medicaid programs aren’t up yet, many hospitals are waiting to attest for both. Also many have been waiting to see if the timeline for Stage 2 attestation will be pushed back.“Some of the more sophisticated entities are leery of registering in 2011 because as the rules stand now, that means they’d have to be at Stage 2 by 2013, and nobody expects that to be possible. For Medicare if you miss a year, you miss that payment,” Drazen says. “So there was some advice out there that you should not register for Medicare until 2012 because then you definitely have two years of attestation for Stage 1.”

The MU workgroup has presented recommendations suggesting a one-year delay for meeting Stage 2 meaningful use requirements, but the ONC hasn’t yet ruled on a timeline. Drazen says that CSC has been recommending its clients be ready to attest by Oct 1, but then decide whether to go ahead or not if the policy is changed.

“The proof is really going to come by November because if you want to meet the year one criteria, you had to be a meaningful user by July 1, but you don’t actually have to finish your attesting till sometime in November because the cutoff for hospitals is in October,” says Drazen. “Certainly we’ll see a whole flurry of attestations from the hospitals in that timeframe.”

Drazen predicts that there could be as much as twice the number of hospitals and providers that will attest to being meaningful users by the October deadline this year, especially as more state Medicaid programs come online. The other big driver will be if the Stage 2 timeline is delayed.

“It’s impossible to think of all the permutations and the consequences of these decisions because there’s so many decisions that have to be made,” Drazen says. “And they were made in such a short time frame.”