CMS Issues Final Rule on Timelines and “Flexibility” in Certified EHR Technology for 2014

Published on
Tuesday, September 2nd, 2014
Author: Brian Ahier

CMS and ONC issued a final rule under which providers in the Medicare and Medicaid EHR Incentive Program can meet Meaningful Use (MU) in 2014 using 2011 or 2014 Edition certified EHR technology (CEHRT), or a combination, with flexibility to attest to either Stage 1 or 2 objectives and measures if they faced delays in 2014 Edition CEHRs’ availability. Furthermore, as proposed, CMS finalizes the delay of Stage 3 of MU until 2017. Stage 2 now extends through 2016 for eligible professionals and hospitals who began the program in 2011 or 2012.

The chart below outlines the 2014 options now available to providers, including if they were slated to demonstrate Stage 1 or Stage 2 in 2014, based on the Edition of CEHRT they are using. Among the examples, a provider scheduled to attest to Stage 2 in 2014 who is using 2014 Edition CEHR technology can attest to 2014 Stage 1 objectives and measures, provided they “could not fully implement 2014 Edition CEHRT for the EHR reporting period in 2014 due to delays in 2014 Edition CEHRT availability,” or Stage 2 objectives and measures. The agency specifies that “all eligible professionals, eligible hospitals, and CAHs are required to use the 2014 Edition CEHRT in 2015.”

CMS elaborates on what is meant by “not able to fully implement [2014 Edition CEHRT]” and “delays in 2014 Edition CEHRT availability,” the criteria for leveraging the flexibility for using the varying options for CEHRT outlined for 2014. For instance, the agency notes that it “stress[es] the delay in 2014 Edition CEHRT availability must be attributable to the issues related to software development, certification, implementation, testing, or release of the product by the EHR vendor which affected 2014 CEHRT availability, which then results in the inability for a provider to fully implement 2014 Edition CEHRT.” On inability to fully implement, it says “this area where we intended to provide the broadest application” and, on p. 42, notes several examples that would not be permissible instances, adding “we believe that beginning with what is not permissible, rather than what is, represents a far smaller set of circumstances that will both quell providers’ concerns about audits and provide additional parameters on the use of the CEHRT options generally.”

The agency says that in finalizing the rule, “we have heard [providers’] concerns over the challenges of successfully implementing 2014 Edition CEHRT in time for an EHR reporting period in 2014.” Citing widespread reports of “EHR development and implementation delays,” CMS says it disagrees with stakeholders who commented that the changes “somehow give providers that waited until the last minute a ‘free pass’, or punish those providers who were early adopters.” Additionally, the final rule:

  • Finalizes revisions for the Stage 2 MU objective for hospitals to providing “electronic laboratory results to ambulatory providers; to correct the regulation text for the measures associated with the objective for hospitals to provide patients the ability to view online, download, and transmit information about a hospital admission; and to set a case number threshold exemption for CQM reporting applicable for eligible hospitals and critical access hospitals (CAHs) beginning with FY 2013”;
  • Formally adopts the Data Element Catalog and the Quality Reporting Document Architecture Category III standards with updated versions of these standards.

The College of Healthcare Information Management Executives (CHIME) head Russell Branzell, FCHIME, CHCIO, expressed very strong disappointment with the finalized requirement of a 365-day reporting period in 2015 saying, “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.

Roughly 50% of EHs and CAHs were scheduled to meet Stage 2 requirements this year and nearly 85% 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 October 1, 2014.”

He further stated, “Now, the very future of Meaningful Use is in question.”

The rule is scheduled to be published in the Federal Register on September 4, 2014 HERE. The final rule takes effect on Oct. 1, 2014.

Medicity will continue to support our clients in meeting the measures and objectives of the EHR Incentive Program. We will support all of the approaches which are now available through the new flexibility provided by CMS and the ONC. If you have any questions on how this new rule might impact you feel free to reach out and let us help you.

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