This week, CMS issued a final rule granting providers the flexibility in meaningful use attestation the agency had originally proposed back in May and finalizing the extension of stage 2 through 2016 for providers that started attesting in 2011 or 2012.
Here are 10 things to know about the final rule.
1. The rule finalizes the proposed attestation flexibility for providers that were unable to implement 2014 CEHRT in time to successfully attest due to vendor delays. These providers will be able to use 2011 Edition CEHRT or a combination of 2011 and 2014 Edition to attest to either stage 1 or stage 2. They will also be able to attest to meaningful use under the 2013 reporting year definition and use 2013's clinical quality measures.
2. This flexibility was proposed and finalized based on feedback from providers, according to CMS Administrator Marilyn Tavenner. When the rule was proposed, National Coordinator for Health IT Karen DeSalvo, MD, said "the steps we are taking today will give new options to those who, through no fault of their own, have been unable to get the new 2014 Edition technology, including those at high risk, such as smaller providers and rural hospitals."
3. However, the final rule comes after hospitals had to make a decision about meaningful use attestation for the 2014 reporting period. The rule was proposed in May but the last 90-day reporting period began July 1, meaning hospitals either had to act on faith the proposal would be finalized or forge ahead with using 2014 CEHRT for attestation. "We have to be done [with the three-month attestation period] by Oct. 1, and the comment period will last until July 20 — you see the problem," Mark Odom, CIO of St. Bernards Healthcare in Jonesboro, Ark., told Becker's Hospital Review in May. "So we have to push forward [with stage 2], if only to find out we didn't need to…we can't afford not to attest."
4. The final rule does arrive in time to affect decisions at integrated delivery systems that include physicians, as the last 90-day period for physician attestation, scheduled by the calendar and not fiscal year, doesn't start until Oct. 1. The physician attestation calendar is one of the reasons Joseph Traub, MD, vice president and medical director of information services at Scripps Health in San Diego, had written to CMS during the public comment period to urge the finalization of the proposed flexibility, to "avoid further strain" on the IDS.
5. All providers will be required to use 2014 CEHRT in 2015, according to the final rule. Additionally, providers that received their first meaningful use payments prior to 2014 will be required to move on to stage 2 in 2015.
6. The rule also finalizes the extension of meaningful use stage 2 through 2016, meaning providers that received their first payment in 2011 or 2012 will start stage 3 in 2017 instead of 2016. Providers that received their first payments in 2013 will also move on to stage 3 in 2017 as previously scheduled.
7. Despite industry urging, the final rule also solidifies a 365-day reporting period for 2015. A number of hospitals, like Floyd Medical Center in Rome, Ga., asked CMS to continue the 90-day reporting period into 2015, anticipating the challenges that have made stage 2 difficult to reach will continue into next year. "We had vendor delays with the upgrade to our 2014 CEHRT and delays in the implementation of our patient portal," wrote Floyd Medical Center CIO Jeff Buda. "As a result, it has been difficult to reach the 5 percent patient adoption rate. For electronic transmission of the transition of care record, our vendor is still testing changes to allow this to happen successfully. We need more time in fiscal year 2015 for these stage 2 requirements to be completed successfully so that patient care quality and safety do not suffer."
8. The year-long reporting period for 2015 is one of the main complaints among stakeholders about the new rule. "Roughly 50 percent of eligible hospitals and critical access hospitals 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," said CHIME CEO Russ Branzell. "Most hospitals that 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."
9. Struggles in meeting stage 2 requirements are not all about vendor delays — a major sticking point has been the transition of care requirement that necessitates data exchange with other providers. Many hospitals' referring partners do not yet have the necessary technology to receive these transmissions. An addition to the final rule means providers unable to meet the transitions of care requirement due to others' technological capabilities also experienced "vendor delays" and are eligible for the new flexibility. "Therefore, we consider the inability to fully implement to extend to those providers for the summary of care document measure at 42 CFR 495.6 (d)(14)(ii)(B) for EPs and (l)(11)(ii)(B) for eligible hospitals and CAHs," according to the rule. "A referring provider under this circumstance may attest to the 2014 stage 1 objectives and measures for the EHR reporting period in 2014."
10. However, providers struggling with meaningful use stage 2 that did not experience vendor delays and that do not qualify for the exception above will not be allowed to take advantage of the new flexibility. "We stress that other issues related to objectives and measures, such as a failure to meet a measure threshold, or failure to conduct the activities required to meet a measure, will not be considered a suitable basis to use the CEHRT options outlined in this final rule."
More articles on meaningful use:
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