Last week, during a Senate Health, Education, Labor & Pensions (HELP) Committee hearing, Sen. Lamar Alexander (R-TN), chair of the committee, said that he has requested that the U.S. Department of Health and Human Services (HHS) delay Stage 3 of the meaningful use program. Alexander's announcement, which followed a HELP committee hearing on information blocking and electronic health record (EHR) interoperability, came from what he said is based on conversations he has been having with providers.
"My instinct is to say to Secretary [Sylvia Mathews] Burwell, 'Let's not go backward on electronic health records,'" Alexander said in the hearing, as reported by FierceEMR. "But let's not impose on physicians and hospitals a system that doesn't work and which they spend most of their time dreading." Alexander, who has long been concerned with issues related to EHRs and meaningful use, did specify that he wants to slow down implementation of federal rules, not stop progress altogether, to ensure EHR implementation is done right the first time.
Indeed, since the release of the Stage 3 rule in March, which is set to begin in 2017, provider groups around the country have questioned the logic behind the proposed mandate. Among the most common complaints include dissatisfaction regarding the number of patient action thresholds for the care coordination objectives. Specifically, the College for Healthcare Information Management Executives (CHIME) has called to reduce the view, download or transmit requirement from 25 percent to five percent, reduce the number of measures in multi-measure objectives, and allow paper-based means to achieve measure thresholds. “And with so few providers having demonstrated Stage 2 capabilities, we question the underlying feasibility of many requirements and question the logic of building on deficient measures,” CHIME wrote in a May letter to Andy Slavitt, Acting Administrator for the Centers for Medicare and Medicaid Services (CMS). CHIME called the sum of all Stage 3 proposals “unworkable.”
What’s more, as Leslie Kriegstein, interim vice president of public policy at CHIME said in this week’s “Washington Debrief,” Calls for Stage 3 rulemaking delays are not limited to the Senate. Last week, Congresswoman Renee Ellmers (R-NC-02) announced a forthcoming bill to reform the meaningful use program that among other provisions would delay rulemaking on Stage 3. Further, Congressman Tom Price (R-GA-06), who hosted a town hall meeting with the American Medical Association last week to discuss physician challenges with EHRs, expressed concern during a Ways and Means Committee hearing last week about CMS’ intent to move forward with Stage 3 rulemaking without the proper metrics indicating provider success in Stage 2.
In an interview, Kriegstein reiterated to me that the provider community has thus far been in unison for a Stage 3 delay. “We think that given the low participation numbers so far with Stage 2, another program year to get proper metrics will be very worthwhile,” she said, referring to the only 11 percent of providers that have attested to Stage 2 thus far, as per March CMS data.
Moreover, Kriegstein also mentioned how the new physician payment program, the Merit-based Incentive Payment System, or MIPS, set to begin in 2019, rolls meaningful use into it; the EHR incentive program would account for 25 percent of the total MIPS score, which could significantly impact incentives for provider organizations. The MIPS program sunsets penalties for meaningful use by 2019 as well.
Another piece in the Stage 3 delay puzzle is that Karen DeSalvo, M.D., who has been serving as National Coordinator for Health IT and leading the Office of the National Coordinator for Health IT (ONC), has been nominated to be Assistant Secretary for Health at HHS. Kriegstein noted that when DeSalvo was nominated for this position, Sen. Alexander insisted that the two of them still work together on the EHR program, and more generally, health IT-related issues. “There has been an ongoing conversation between the two of them, and that level of interaction is out of the ordinary,” she said, adding that DeSalvo will also need Alexander’s blessing for her HHS nomination, perhaps further muddying the waters. However, during the hearing last week, Alexander said, "[A] hospital told me that Stage 1 and Stage 2 worked 'okay,' but they were 'terrified' by Stage 3,” as reported by several members of the health IT media.
As such, there is no doubt that there are numerous moving parts and various factors to consider when it comes to a possible delay to Stage 3. As far as the possible impact of all these calls for action, Kriegstein noted that up first, CMS has to address meaningful use modifications from 2015-2017 that it laid out earlier this year, which among other things, includes a flexible 90-day reporting period as opposed to a 365-day one. "We are urging CMS to get the modification rules out there," she said.
Kriegstein estimated that should happen sometime in September, with the Stage 3 final rule to be released later in 2015. “I’m not sold on a Stage 3 delay,” she said. “Just because the committee makes recommendations doesn’t mean that the agency has to follow them.”