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Washington Debrief: Snapshot of Proposed Objectives for Stage 3

March 23, 2015
by Jeff Smith, Vice President of Public Policy at CHIME
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Jeff Smith, Vice President of Public Policy at CHIME

Top News

HHS Releases Proposed Rules for Meaningful Use Stage 3

Key Takeaway: Proposed rules outlining the third and final Stage of meaningful use (MU) were revealed last Friday. Among the many provisions offered by the Centers for Medicare and Medicaid Services (CMS) and the Office for the National Coordinator for Health (ONC) are plans to have one definition for MU beginning in 2018 and a certification program that is accessible to more types of health IT, beyond the requirements of MU. The rules did not include provisions to shorten the EHR reporting period in 2015, which is expected in a forthcoming notice of proposed rulemaking.

Why it Matters: As MU has come under increased fire from stakeholders and Congress, these rules seek to raise the bar on interoperability and patient engagement, while looking for ways to streamline and simplify program participation. Whether or not these proposed tactics will do this, remains to be seen. Health IT executives interested in helping CHIME develop a response to these rules should contact Leslie Krigstein.

Officials from the Department of Health and Human Services (HHS) unveiled their vision for MU Stage 3, including changes that support “efforts to increase simplicity and flexibility in the program while driving interoperability and a focus on patient outcomes in the meaningful use program,” CMS said. The proposed MU rule would establish a single reporting period for all providers based on the calendar year and require all hospitals to meet 18 measures across 8 objective areas and all eligible professionals to meet 17 measures across the same objective areas. Stage 3 will begin in 2017, but the proposed rule allows most providers the option to wait until 2018 to move from Stage 2 to Stage 3. Below is a snapshot of proposed objectives for Stage 3:

  • Protect ePHI
  • Perform a security risk analysis
  • eRx
  • > 80%
  • > 25% of hospital discharges medication orders query drug formulary
  • Clinical Decision Support
  • 5 CDS alerts
  • Enabled drug/drug; drug/allergy interaction
  • CPOE
  • 80% medication orders
  • 60% lab orders
  • 60% diagnostic
  • Patient Electronic Access to Health Information
  • Provide access w/in 24 hours (can be through API)
  • > 35% Education resources
  • Coordination of Care through Patient Engagement (meet 2 of 3)
  • > 25% View, Download or Transmit or > 25% use API to access their information
  • > 35% use secure messaging
  • > 15% PGHD is incorporated
  • Health Information Exchange
  • > 50% of ToC transmit electronic summary of care record (SoCR)
  • > 40% of ToC recipients incorporate SoCR into their EHR
  • > 80% of ToC perform “clinical information reconciliation”
  • Public Health
  • 6 measures; EPs choose 3 of measures 1-5; EHs choose 4 of measures 1-6

CHIME will form work groups to address questions and proposals related to the CMS and ONC rules. Interested members should contact Leslie Krigstein to learn more.

Legislation & Politics

Congressional Interest in MU Reform Continues in the House and Senate

Key Takeaway: During the Senate Health Education Labor and Pensions (HELP) Committee hearing last week Senate leaders called for a reboot of the Meaningful Use Program. Similarly, a bipartisan House letter made public last week suggested amendments to the Meaningful Use Program including the removal of the pass/fail approach.

Why It Matters: Under the leadership of Senator Lamar Alexander (R-TN), an original author of the “REBOOT” report, the Senate HELP Committee held their first hearing in six years on health information technology. At the close of the hearing, Chairman Alexander and Senator Sheldon Whitehouse (D-RI) reiterated the Committee’s bipartisan interest in reforming the Meaningful Use Program and ensuring the federal government’s health IT initiatives deliver on the promise better patient care. Chairman Alexander signaled an interest holding additional hearings with administration officials and additional industry stakeholders.

In the House, the cosponsors of the Flexibility in Health IT Reporting Act or “Flex-IT Act”, Congresswoman Renee Ellmers (R-NC-02) and Congressman Ron Kind (D-WI-3), penned a letter to HHS with their recommendations for the forthcoming flexibilities, including a 90-day reporting period in 2015, referenced in Deputy Administrator Conway’s January 29thblog post.

The letter called for each meaningful use stage to last three years instead of the current two and would remove the 365-day reporting period for the second and third year of each stage. In addition to the suggested removal of the pass/fail approach for meaningful use, the letter called for alignment of CMS quality reporting requirements. Further, the letter called on CMS to expand their hardship exemption categories, particularly cover organizations transitioning between EHR vendors.

The Flexibility in Health IT Reporting Act of 2015 (HR 270) now has 32 bipartisan cosponsors. 

SGR draft makes MU Participation a Factor in Medicare Reimbursement Formula

Key Takeaway: Lawmakers have released a draft bill for an overhaul of Medicare’s Sustainable Growth Rate (SGR) as the current patch expires on March 31st. If another patch or permanent solution is not in place before the end of March, doctors will face a 21.2 percent cut in Medicare reimbursements.

Why It Matters: The draft text, similar to what was passed by the House of Representatives in the 113th Congress, would sunset meaningful use penalties for physicians in 2018 and make participation in the EHR incentive program a component of the proposed merit-based incentive payment system (MIPS). The draft bill makes the use of federally certified electronic health records a requirement for providers in MIPS, a bonus-payment system meant to incentivize quality improvements by providers.

The so-called SGR Repeal and Medicare Provider Payment Modernization Act of 2015 outlines ways to improve fee-for-service Medicare and focus on quality instead of volume. Absent from the available draft is the discussion of how Congress plans to pay for the policy changes, with just the estimated cost for the repeal of the SGR at $174.5 billion. With the addition of a two year extension of the Children's Health Insurance Program (CHIP), the legislation’s cost rises to $213 billion, but only $70 billion would be paid for directly in an SGR bill to dismay of many fiscal conservatives.

The SGR reform package contains an interoperability provision noticeably different from that circulated among stakeholders earlier this month, despite also being authored by Representative Michael Burgess (R-TX-26). The interoperability language in the SGR bill would require the Secretary of Health and Human Services (HHS) to establish a set of metrics for determining the interoperability of all EHR systems certified through the Office of the National Coordinator (ONC) by July 1, 2016. Further, the draft requires HHS to determine by December 31, 2018, whether widespread interoperability of certified EHR systems has occurred. If by 2018 widespread interoperability is still a challenge, lawmakers recommend HHS reduce Medicare reimbursements for providers and hospitals not using certified EHRs and decertify EHR systems that are deemed interoperable.

As of last Friday, there has been no indication that a delay in the implementation of ICD-10 would be coupled with a “doc-fix” deal, temporary or permanent. However, CHIME continues to monitor the issue and we encourage members to contact their Congressional delegation if they support the October 1st implementation deadline here.


Edited by Gabriel Perna for style

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