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Meaningful Use Final Rules Move Forward to OMB

September 8, 2015
by Heather Landi and Rajiv Leventhal
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CMS will not comment on if Stage 2 modifications rule and Stage 3 rule will be finalized as one

The Centers for Medicare & Medicaid Services (CMS) has sent the final rules for both meaningful use Stage 3 and Stage 2 modifications to the Office of Management and Budget (OMB) for review.

The two rules were combined and delivered to OMB on Sept. 3. However, it is unclear on if the rules will be finalized as a single rule or two separate ones.  Some media reports initially stated that the two final rules would be combined into one, but according to a statement from a CMS official to FierceEMR, that is not necessarily the case. What’s more, a CMS official has told HCI that the agency cannot comment on the rules being combined or not when the rule is in the rulewriting process. Indications are that the final rules will be signed by OMB and published in early fall.

Throughout the last few months, Congressional leaders and industry stakeholders have called for CMS to publish final rules for both Stage 2 modifications and Stage 3. In April, CMS issued a new proposed rule to align meaningful use Stage 1 and Stage 2 objectives and measures with the long-term proposals for Stage 3. The proposed rule would streamline reporting requirements and would shorten Medicare and Medicaid meaningful use attestation for eligible professionals and hospitals to a 90-day period in 2015. Comments for that proposed rule were due on June 15. Since then, provider groups have been consistent in their public push for the confirmation of a 90-day reporting period and streamlining of meaningful use objectives and measures in a final Stage 2 modifications rule.

Further, even more recently, in addition to pushing CMS to publish final rule for the modifications to the meaningful use program from 2015-2017, the Medical Group Management Association (MGMA) has asked the feds to extend the 2015 reporting period into the first quarter of 2016. Last week, Halee Fischer-Wright, M.D., MGMA president and CEO, said in the statement, “Even if the final rule came out today, the window of time that CMS is leaving medical groups and vendors to adjust workflows and update systems is both unacceptable and unrealistic. Forcing groups and their EHR vendor partners to scramble in a short period of time to meet the Oct. 3 start date for the last reporting period essentially guarantees that a significant number of program participants will fail in 2015.”

Regarding Stage 3, stakeholders have pushed for that final rule to be issued soon as well. Going further, in July, Congressional leaders called for a delay of Stage 3 rulemaking, with a bill known as the “Further Flexibility in HIT Reporting and Advancing Interoperability Act,” or the “Flex-IT 2 Act.” Shortly after the bill was proposed, the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME) spoke with HCI about its Stage 3 recommendations for the feds, including the alignment of meaningful use rulemaking with other programs, particularly with the requirements that are being developed for the new Merit-Based Incentive Payment System (MIPS), which was created under the new Medicare and CHIP Reauthorization Act (MACRA) passed in April and signed into law by President Obama.

As such, despite these calls for delays and for final rules all summer, CMS has not been heard from until now. “CMS intends to finalize a set of requirements that addresses attestation deadlines and reduces the overall reporting burden on providers and provides flexibility for the reporting periods in 2015,” Jibril Boykin, press officer for CMS, said in an email to HCI.

 Stage 3, which was proposed back in March, is set to begin in 2017 and includes measures to earn incentives or avoid payment penalties. One of the major proposals for Stage 3 is CMS will establish a single set of objectives and measures tailored to eligible providers (EPs), eligible hospitals (EHs) and critical access hospitals (CAHs). This will be optional for providers in 2017 and required by 2018, regardless of a provider’s prior participation in the EHR incentive program. And, it would also require reporting on a calendar-year basis starting in 2017.

In the proposed Stage 3 rule, CMS outlined eight objectives focused on advanced use of EHR systems with heavy focus on interoperability and patient engagement. If the final rule for Stage 3 meaningful use closely follows the proposed rule, here is a run-down of the top changes and requirements that will be in store for healthcare providers and hospitals:

Patient engagement measures:

  • The threshold for getting patients to view, download or transmit their health data has been set at 25 percent, up from 5 percent in Stage 2.
  • 35 percent of all patients seen by a provider or discharged from a hospital receive a secure message using the EHR’s electronic message function or in response to a secure message sent by the patient successfully .
  • More than 15 percent of patients must contribute patient-generated health data or data from a non-clinical setting into the certified EHR technology during the EHR reporting period.                                                                                                                                                                    

Health information exchange (HIE) measures:                                                                                                                                                  

  • For more than 50 percent of patients referred to a provider there must be a summary of care record using certified electronic health record technology (CEHRT) and an electronic exchange of the summary of record.
  • For more than 40 percent of new patients, providers must incorporate into the EHR an electronic summary of care document from a source other than their EHR system.
  • For more than 80 percent of patients, providers must implement clinical information reconciliation with medication and the patients’ current problems.

Public health measures:

  • Providers must have bidirectional data exchange between the certified EHR technology and an immunization registry.
  • Provider or hospital must have active engagement with a public health agency to submit data to public health registries.

 


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