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Mixed Reaction to MU Stage 2 Extension, Stage 3 Delay Announcement

December 9, 2013
by Gabriel Perna and David Raths
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The reactions came pouring in not long after the Centers for Medicare and Medicaid Services’ (CMS) announced a new timeline for the implementation of meaningful use under the Medicare and Medicaid EHR [electronic health record] Incentive Programs.

The changes that CMS and Office of the National Coordinator of Health IT (ONC) announced on Friday were an extension of Stage 2 through 2016 and that Stage 3 would begin in 2017 for those providers that have completed at least two years in Stage 2. ONC’s acting national coordinator Jacob Reider, M.D. said this extension was to allow the government to focus on patient engagement, health information exchange, and interoperability efforts in Stage 2, and use Stage 2 data to formulate Stage 3 policy.  

Some provider organizations, such as the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME), claimed that the extension of Stage 2 isn’t as much help as a delay in the start of Stage 2 would have been. They had proposed that the 2014 eligibility period be extended by six months and the 2015 penalty measurement period be extended by six months. 

Indeed says Jason Fortin, senior advisor at Impact Advisors. After the initial wave of excitement that came with the news, he begun to understand that if a healthcare organization was struggling with Stage 2 of meaningful use, this did little to solve their problems.

“It only has an impact for folks who are attesting to Stage 2 this year and the impact is in 2016. If you are planning on attesting to Stage 2 next year or in 2015, this actually doesn’t change anything…other than the fact Stage 3 is going to be a little bit more time,” Fortin says.  

Jason Fortin

The change to Stage 3 wasn’t exciting, Fortin says, but rather “expected.” He says, the 2016 fiscal year start date for Stage 3 was never truly set in stone by CMS and it’s not a shock that it will begin in 2017.

Ultimately, it seemed many in the industry were bothered that the proposal didn’t address 2014, and as John Halamka, M.D., CIO of the Boston-based Beth Israel Deaconess Medical Center wrote in his blog all of those certification and attestation deadlines are “still in force.” Dr. Halamka, however, did note while it may have seemed this decision wasn’t as vital as a decision to change the upcoming deadlines, this was a decision that needed to be done.

“The fact that today's announcement did not address 2014 issues does not imply that no one is listening to those concerns. Some may complain that they were expecting lunch and dinner but only got lunch.  It's fair to say that lunch comes before dinner,” Halamka said.

In Fortin’s opinion though, the window for an extended 2014 eligibility period has passed. He says it would be hard to make those changes, with the attestation having already begun.

Opinions weren’t universally negative though. At NJ-HITEC, the phones began ringing at the offices of the regional extension center in New Jersey, last Friday afternoon and continued early this week as providers call to get an explanation of the changes being proposed by CMS to Stage 2 MU timelines.

 Bill O’Byrne, executive director of NJ-HITEC, called the decision a “wise choice” by the ONC and CMS. He said the change is a sign that they have their fingers on the pulse of the industry. “It is recognition that Stage 2 is complex and involves difficult work for providers and that having an additional year provides the opportunity to phase in work that needs to be done.”

O’Byrne conceded that for provider organizations whose ambulatory EHR vendors do not yet have Stage 2 (2014) certified software, they may have only the July-September attestation period to meet Stage 2 and avoid 2015 penalties. But he added that many of the EHR providers NJ-HITEC works with do have Stage 2 (2014) certified software. “I think this just takes some of the panic out of the marketplace,” he said. “The longer we have to work on this, the better the results will be in terms of improving health care.”

O’Byrne also said that ONC is in the process of extending the contracts of the RECs for one year. For instance, NJ-HITEC’s contract was scheduled to expire March 31, 2014, but although there is no additional funding from Congress, the REC will be able to spread out the funding it has until March 31, 2015 and continue helping providers. In the mean time, NJ-HITEC is offering an array of services to ACOs and other organizations to help make the organization sustainable.

Randy McCleese, vice president and CIO of St. Claire Regional Medical Center in Morehead, Ky., said the extra year for Stage 2 would be valuable. Requirements such as clinical quality measure will take significant time to get in place, he said in an e-mail interview.  “Workflow adjustments are necessary for providers to incorporate additional data into their routine and change the way they collect data for electronic entry,” he said.  Hospitals and eligible providers that already have 2014 meaningful use certified systems are working on those changes. However, some providers have yet to install the appropriate software.”

McCleese described the confluence of ICD-10, the Affordable Care Act, Accountable Care Organizations, payment reform, Meaningful Use Stage 1 and now Meaningful Use Stage 2 as a “perfect storm” for the industry. “IT resources are being stretched to the limits trying to keep up with everything.  And with payment reform (reduction), there are limited, if any, funds to hire outside help.”

 Looking ahead to Stage 3, Anita Samarth, president of Clinovations, a Washington, D.C.-based consulting firm, says that from the CMS and ONC, this change makes a whole lot of sense.

“Now you have the ability to put out proposed rules for a reasonable amount of time, potentially get some feedback, maybe run some pilots. What I’m hoping for is when vendors come out with 2017 certified product and the providers are ready to buy those products for Stage 3, that they are at a much more mature place in the industry,” Samarth says.

Anita Samarth


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