CMS Publishes Final Rule for Meaningful Use Flexibility

Stage 2 of the Meaningful Use incentive program will be extended through 2016 for certain providers and Stage 3 will begin in 2017 for providers who first became meaningful users of electronic health records in 2011 or 2012 based on a final rule announced today by the Centers for Medicare & Medicaid Services.

The rule, set to be published Sept. 4 in the Federal Register, also allows eligible providers to use 2011 edition certified electronic health record technology (CEHRT), or a combination of 2011 and 2014 edition CEHRT to meet Meaningful Use for an EHR reporting period in 2014 for the Medicare and Medicaid EHR incentive programs. Eligible professionals (EPs), eligible hospitals (EHs) and critical access hospitals must use the 2014 edition CEHRT in 2015.

“We listened to stakeholder feedback and provided CEHRT flexibility for 2014 to help ensure providers can continue to participate in the EHR Incentive Programs forward,” CMS Administrator Marilyn Tavenner said in an announcement. “We were excited to see that there is overwhelming support for this change.”

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In the rule, CMS states that commenters for its proposed rule, released in May, wanted clarification of how the edition of CEHRT would dictate the stage of Meaningful Use under the CEHRT options.

“Commenters questioned whether the options for the use of CEHRT extended to allowing for options for measure selection,” CMS stated. “A few commenters suggested that we allow additional options for the use of CEHRT regardless of the edition of CEHRT the provider has implemented. These options included: allowing providers to attest to Stage 2 with exclusion of one or more core objectives; allowing providers to report on either Stage 1 or 2, using either the 2011 or 2014 edition CEHRT; allowing providers to choose between 2014 Stage 1 objectives and measures and the 2013 Stage 1 objectives and measures; and allowing providers to report on any version of CQMs.”

To that end, CMS said it recognizes that impacted providers will require “multiple factors” to determine options for which they’ll be eligible.

“While we understand it may be cumbersome for providers to use a combination of 2011 and 2014 edition CEHRT to meet Meaningful Use in 2014, we expect the benefit of ultimately demonstrating Meaningful Use outweighs the complexity of using two CEHRT editions,” CMS said.

Furthermore, CMS said that it does not specify:

  • Whether a provider must use 2011 edition CEHRT or 2014 edition CEHRT for a certain amount of time during the EHR reporting period,
  • Whether a certain amount of modules in one CEHRT edition or another is required
  • Whether a certain number of provider settings must have one CEHRT edition over another

“We expect there will be significant variations among practices based on the type of software used, the complexity of a provider’s total systems and the overall implementation timeline for 2014 edition CEHRT installation,” CMS said.

Russell Branzell, president and CEO of the College of Healthcare Information Management Executives, expressed disappointment with the rule for requiring 365-days of EHR reporting in 2015 in a statement emailed to FierceHealthIT.

“This single provision has severely muted the positive impacts of this final rule. Further, it has all but ensured that industry struggles will continue well beyond 2014,” Branzell said. “Roughly 50 percent of EHs and CAHs were scheduled to meet Stage 2 requirements this year and nearly 85 percent of EHs and CAHs will be required to meet Stage 2 requirements in 2015. Most hospitals who take advantage of new pathways made possible through this final rule will not be in a position to meet Stage 2 requirements beginning Oct. 1, 2014. This means that penalties avoided in 2014 will come in 2015, and millions of dollars will be lost due to misguided government timelines. … Now the very future of Meaningful Use is in question.”

To learn more:
– here’s the CMS announcement
– here’s the final rule (.pdf)