When on Wednesday, March 20, during the HIMSS13 Conference being held in New Orleans, Marilyn Tavenner, R.N., acting administrator of the federal Centers for Medicare & Medicaid Services (CMS), announced that the federal government would not release a preliminary rule for Stage 3 of meaningful use during calendar year 2013, her announcement—re-confirmed by Farzad Mostashari, M.D., national coordinator for health IT, in a press conference immediately following Tavenner’s appearance—signaled an important concession on the part of federal officials regarding the challenges inherent in the meaningful use process.
As Tavenner put it in making the announcement during a speech to HIMSS13 attendees, she, Dr. Mostashari, and other CMS and ONC (Office of the National Coordinator for Health IT) officials want to “digest” input from healthcare providers before moving onto Stage 3 of meaningful use under the HITECH (Health Information Technology for Economic and Clinical Health) Act, which many anticipate to be considerably more rigorous in its requirements of providers than Stages 1 and 2 have been.
But of course the delay in releasing the Stage 3 preliminary rule could likely foreshorten the period of time available for providers to fulfill the requirements of Stage 3. So we at Healthcare Informatics asked for our readers’ opinions on the matter. The result? Fully two-thirds—66 percent—of respondents to our online poll supported the Stage 3 preliminary rule release delay, while one-third—34 percent—disapproved.
Meanwhile, industry leaders had a variety of perspectives on the ONC/CMS decision, with some welcoming the opportunity for providers to be more successful at meaningful use under Stage 2, and others wondering whether the potential time lost under Stage 3 might take away from the benefit of the Stage 3 preliminary rule release delay.
Christopher Longhurst, M.D., CMIO at Lucile Packard Children’s Hospital at Stanford University (Palo Alto, Calif.) views the delay positively. “Meaningful use has clearly had more unintended consequences than hoped, and delaying should allow a more thoughtful discussion of what will truly provide the best value. Despite what hopes some federal officials might harbor for a potential ‘Stage 4,’ given that HITECH funding expires after MU3, I believe this will be the last round for some time, so we need to make the most of it.”
Fran Turisco, a director at the Pittsburgh-based Aspen Advisors, says that the reality for providers is that “Most are struggling to get Stages 1 and 2 in meaningful use; and to be honest, I see a lot of work to check the box versus installing the software for true meaningful use.” That having been said, Turisco adds, “The practices and hospitals that have met Stages 1 and 2 will now have time to assess the impact and have a chance to optimize and complete what they started in order to meet those deadlines. They can use the resources poised to tackle Stage 3 to reassess how they did with the first two stages and to prepare for the changes coming in Stage 3.” In addition, she adds, “This will provide a breather for both the ONC/CMS side and the provider side to see if the plan is working, and what needs to be changed.”
Difficulties of Stage 2 cited
Citing the difficulties of meeting the requirements under Stage 2 of meaningful use, Bill Bria, M.D., the chairman of the Association of Medical Directors of Information Systems (AMDIS), the nationwide association of CMIOs, says, “I was glad that Stage 3 will be delayed for one key reason: until the end of last November, I was responsible for the MU program for all 21 Shriners Hospitals for Children centers around North America. There is no question that the changes incumbent on Stage 2 were significantly more impactful on our system and those who had concerns in Stage 1 really started to become perturbed seeing what Stage 2 and 3 were headed for. These changes are, as we all know, needed, necessary and ultimately in the best interests of our patients,” Bria adds. “however, an imbalance of healthcare systems and providers is not good for patient care and, although we cannot delay the change indefinitely, we need to be compassionate and mindful of our most important mission—care of our fellow man. It's for that reason I believe a slight change in pace is not only acceptable, but necessary to avoid undesirable changes/impacts on American healthcare while we continue to move forward.”
Meanwhile, Chuck Podesta, senior vice president and CIO at Fletcher Allen Health Care in Burlington, Vt., says he has a rather complex, broader view of the whole situation. “My take on MU in general and on Stage 3 could be a little bit controversial, but what the heck,” Podesta says. “As we all know, MU was a component of the HITECH law; healthcare reform is governed under ACA [Affordable Care Act]. I think someone needs to step back and look at the picture in totality. There are drivers in both programs that incent providers to do the same thing. Let’s assume that ACA stays on course more or less and by 2017 the shift from fee-for-service-based payment to population health management is in full swing. If we assume that the vast majority of Americans by 2017-2019 will be receiving care through an ACO, then why do we need MU? The incentives, drivers and penalties associated with not adopting the majority of MU measures stages 1-3 are already contained in ACA (i.e shared savings). EHR adoption, quality measures, patient engagement, health information exchange represent the majority of MU measures. Success in these areas is crucial for an ACO to survive. HHS [the Department of Health and Human Services] would save lots of money by letting the ACA drive change rather than force MU.”