CMS releases Stage 3 Meaningful Use rules

Fewer than half of physicians have met Stage 2 Meaningful Use requirements and, despite a promise to add flexibility to reporting requirements in 2015, the Centers for Medicare & Medicaid Services (CMS) has released a proposed rule for Stage 3 of the Medicare and Medicaid Electronic Health Record Incentive Program that some stakeholders say is anything but flexible.

“The release of [this] rule demonstrates that the agency continues to create policies for the future without fixing the problems the program faces today,” says Linda E. Fishman, senior vice president of public policy analysis and development for the American Hospital Association (AHA). “In January, CMS promised to provide much-needed flexibility for the 2015 reporting year, which is almost half over. Instead, CMS released Stage 3 rules that pile additional requirements onto providers.

“It is difficult to understand the rush to raise the bar yet again, when only 35% of hospitals and a small fraction of physicians have met the Stage 2 requirements,” Fishman adds.

CMS’s Meaningful Use Stage 3 rule sets out new criteria providers must meet to qualify for Medicaid EHR incentive payments and Medicare payment adjustments based on program performance starting in payment year 2018. Many aspects of the new rule focus on using electronic health records and eliminating outdated requirements.

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“This Stage 3 proposed rule…helps simplify the meaningful use program, advances the use of health IT toward our vision for improving health delivery, and further aligns the program with other quality and value programs,” says Patrick Conway, MD, MSc, CMS acting principal deputy administrator and chief medical officer. “And, in an effort to make reporting easier for health care providers, we will be proposing a new meaningful use reporting deadline soon.”

In 2017, providers will still have the option of attesting to Stage 1 or Stage 2 of Meaningful Use. Starting in 2018, however, the new rule would require that all providers attest to Stage 3 Meaningful Use, regardless of which stage they were in before. And while the proposed rule doesn’t take effect until 2017 and beyond, it includes some lofty goals, such as a requirement to “actively engage” a quarter of hospital or emergency department discharges through electronic records, and another requirement to create a summary of care for more than half of transitions of care or referrals.

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The proposed rule also increases the percentage of patients who engage by viewing their health records on their own from 5% to 25%, plus another 5% to 25% increase in the rate of secure messaging. Additionally, providers would be required to capture patient-generated health data from 15% of their patients by collecting information from devices such as Fitbits.

NEXT: CMS considering seperate meaningful use rule on providers

The proposed rule also increases the demands on computerized physician orders, with electronic prescription requirements increasing from 60% in Stage 2 to 80% in Stage 3.

The wording of the proposed rule makes it apparent that even CMS believes the goals it sets out are out of reach for some. According to the proposed rule, physicians who fail to meet the Stage 3 requirements are expected to pay between $500 million in Medicare penalties between 2018 and 2020; all hospitals are expected to be in compliance by 2018. That is in addition to the cost to meet the requirements.

CMS says that it expects it will cost physicians $54,000 to upgrade their systems to meet the requirements, plus $10,000 annually in maintenance costs. Hospitals face $5 million in initial upgrade costs plus $1 million annually for maintenance.

Conway says CMS is also considering a separate meaningful use rule that would reduce reporting burdens on providers and address concerns regarding software implementation. The new rule is expected in the spring of 2015, and is expected to reduce the 2015 reporting period from one year to 90 days, among other provisions.

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Along with the meaningful use proposals, the Office of the National Coordinator for Health Information Technology (ONC) released its 2015 Edition of Health IT Certification Criteria. ONC said in a statement that its rules are part of a larger effort across the Department of Health and Human Services (HHS) to deliver better care and a better cost and create a healthier nation by improving interoperability.

“ONC’s proposed rule will be an integral component in the shared nationwide effort to achieve an interoperable health system,” says Karen DeSalvo, MD, MPH, MSc, national coordinator for health IT. “The certification criteria we have proposed in the 2015 Edition will help achieve that vision through provisions that consider the range of health IT users and uses across the care continuum, including those focused on interoperable standards, data portability, improved transparency, privacy and security capabilities, and increased oversight through ONC’s Health IT Certification Program.”

The Stage 3 proposed rule can be found online at the federal register. The comment period ending May 29, 2015.

The 2015 Edition proposed rule can also be viewed online and has a comment period ending on May 29, 2015. The ONC rule has a comment period ending on June 30, 2015.