CMS Expands Medicare EHR "Meaningful Use" Hardship Exception to Cover Vendor Issues

Medicare eligible professionals and eligible hospitals that are not “meaningful users” of certified electronic health record (EHR) technology will be subject to payment adjustments under the Medicare EHR Incentive Programs beginning on October 1, 2014 for hospitals and on January 1, 2015 for eligible professionals. Eligible professionals and hospitals may be exempt from payment adjustment, however, if demonstrating meaningful use would result in a significant hardship. CMS recently released the hardship exception applications, which outline the specific circumstances that CMS has determined pose a significant barrier to achieving meaningful use. Of particular interest, CMS has added an exception category for “2014 EHR Vendor Issues,” to cover circumstances under which the professional’s or hospital’s EHR vendor was unable to obtain 2014 certification, or the eligible professional or hospital was unable to implement meaningful use due to 2014 EHR certification delays. The hardship application is due by April 1, 2014 for eligible hospitals, and by July 1, 2014 for eligible professionals. Important to certain specialists, the application for eligible professionals states that physicians classified in the Medicare Provider Enrollment, Chain and Ownership System (PECOS) with a primary area of practice of Diagnostic Radiology (30), Nuclear Medicine (36), Interventional Radiology (94), Anesthesiology(05), or Pathology (22) are automatically exempt from the 2015 payment adjustment and are not required to complete the exception application.

CMS Blog Post Announces Delay in Electronic Health Record (EHR) Incentive Program "Stage 3" Meaningful Use Start

On December 6, 2013, CMS announced its intention to push back implementation of the Stage 3 meaningful use criteria for the Medicare and Medicaid EHR Incentive Programs. Under the new timeline, Stage 2 will be extended through 2016 and Stage 3 will begin in 2017 (instead of 2016) for those providers that have completed at least two years in Stage 2. By way of background, under Stage 1 (which began in 2011), the “meaningful use” criteria focus on capturing and sharing data. Stage 2 meaningful use criteria focus on exchange of clinically relevant information between providers and promote patients’ secure online access to their health information. Under Stage 3, meaningful use will include demonstrating improvement in quality of health care. CMS intends to release a proposed rule for Stage 3 in the fall of 2014, with a final rule to follow in the first half of 2015. The blog post also outlines a related Office of the National Coordinator for Health Information Technology (ONC) plan to allow for more frequent updates of certification criteria under the ONC HIT Certification Program.

CMS Call on Meaningful Use Stage 1 & 2 (Jan. 16)

CMS is hosting a national provider call on January 16, 2013 on Meaningful Use requirements under the Medicare and Medicaid Electronic Health Record Incentive Programs. The target audience is hospitals, critical access hospitals, and professionals eligible for incentives. Registration is required. 

ONC Invites Comments on Stage 3 Meaningful Use Policy

The Office of the National Coordinator for Health Information Technology (ONC) has issued a Request for Comment (RFC) on Stage 3 meaningful use recommendations, which will “target a collaborative model of care with shared responsibility and accountability.” In releasing the RFC, the ONC acknowledges “today’s challenges in setting up data exchanges,” but recommends that Stage 3, which takes effect in 2016, represents “the time to begin to transition from a setting-specific focus to a collaborative, patient- and family- centric approach.” The 37-page RFC highlights three broad areas: Meaningful Use Objectives and Measures; Quality Measures; and Privacy and Security.  The comment deadline is January 14, 2013.  After the comment period, the ONC Health Information Technology Policy Committee intends to hold public meetings on development of the Stage 3 policy.

November Congressional Health Policy Hearings

On November 14, 2012, the House Science, Space, and Technology Committee is holding a hearing entitled “Is 'Meaningful Use' Delivering Meaningful Results -- An Examination of Health Information Technology Standards and Interoperability.”  Two hearings are scheduled to examine the recent outbreak of fungal meningitis: a November 14 House Energy and Commerce Oversight Subcommittee hearing on "The Fungal Meningitis Outbreak: Could It Have Been Prevented?"  and a November 15 Senate Health, Education, Labor, and Pensions Committee hearing entitled “Pharmacy Compounding: Implications of the 2012 Meningitis Outbreak.”

CMS Publishes Corrections to FY 2013 IPPS, EHR Incentive Program Final Rules

On October 29, 2012, CMS published additional corrections to its August 31, 2012 final FY 2013 Medicare inpatient prospective payment system (IPPS) rule. The corrections address the achievement thresholds and benchmark values presented in the Clinical Process of Care measures section of the final performance standards for the FY 2015 Hospital Value-Based Purchasing Program table.  In addition, CMS has published a notice correcting technical and typographical errors in the September 4, 2012 final rule specifying the “Stage 2” meaningful use criteria that eligible professionals, eligible hospitals, and critical access hospitals must meet in order to qualify for Medicare and/or Medicaid electronic health record (EHR) incentive payments.

CMS Issues Final "Stage 2" Medicare/Medicaid Electronic Health Record (EHR) Incentive Program Rules, EHR Certification Standards

On September 4, 2012, CMS published a final rule specifying the “Stage 2” meaningful use criteria that eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) must meet in order to qualify for Medicare and/or Medicaid EHR incentive payments. By way of background, under Stage 1 (which began in 2011), “meaningful use” consists of transferring data to EHRs and being able to share information such as electronic copies and visit summaries for patients (note that certain Stage 1 criteria are modified under the Stage 2 final rule). Stage 2 meaningful use criteria, which are the focus of this final rule, seek to increase the exchange of clinically relevant information between providers and promote patients’ secure online access to their health information. With regard to timing, the final rule provides that any provider who first attested to Stage 1 criteria in 2011 will have until 2014 to attest to Stage 2 criteria (instead of 2013 as provided under the Stage 1 final rule). The final rule also specifies Medicare payment adjustments that will apply beginning in 2015 for covered professional services and hospital services provided by EPs, eligible hospitals, and CAHs failing to demonstrate meaningful use of certified EHR technology and other program participation requirements according to the applicable schedule. CMS adopted certain hardship exceptions to the payment adjustments related to: availability of internet access or barriers to obtaining information technology infrastructure; newly practicing EPs who would not otherwise be able to avoid payment adjustments; unforeseen circumstances such as natural disasters; and certain scope of practice issues, such as lack of face-to-face or telemedicine interaction with patients or lack of control over the availability of Certified EHR Technology at their practice location, to recognize certain barriers concentrated among specialties such as anesthesiology, radiology, and pathology. Looking ahead to Stage 3, under which “meaningful use” will include demonstrating improvement in quality of health care, CMS states in the preamble to the rule that it intends to finalize Stage 3 criteria through rulemaking in 2014, with Stage 3 starting in 2016.

Also on September 4, HHS published a final certification criteria rule establishing the technical capabilities and related standards and implementation specifications that Certified EHR Technology will need to include, at a minimum, to support the achievement of “meaningful use” by EPs, eligible hospitals, and CAHs under the Medicare and Medicaid EHR incentive programs beginning with the 2014 EHR reporting periods. The final rule also makes changes to the permanent certification program for health information technology, including changing the program’s name to the ONC HIT Certification Program. The rule is effective October 4, 2012.

CMS Call: Stage 2 Requirements for the Medicare/Medicaid EHR Incentive Programs (Sept. 13)

On September 13, 2013, CMS is hosting a call on the agency’s September 4, 2012 final rule on Stage 2 EHR requirements and other changes to the EHR Incentive Programs.

CMS/ONC Call: Using Certified EHR Technology to Meet Meaningful Use (June 27)

CMS and ONC are holding a joint National Provider Call on June 27, 2012 to provide information to eligible professionals (EPs) and eligible hospitals on the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. The program also will discuss the use of certified EHR technology to meet the meaningful use standard. Advance registration is required.

CMS Releases Data on Medicare EHR Incentive Program Payment Recipients

CMS has posted the names and addresses of Medicare eligible professionals (EPs), eligible hospitals, and critical access hospitals that have successfully demonstrated meaningful use and received a payment as of March 2012 under the Medicare Electronic Health Record (EHR) Incentive Program. CMS has made more than $2.3 billion in Medicare EHR Incentive Program payments between May 2011 and the end of March 2012.

New ONC Health IT Resources

The HHS Office of the National Coordinator for Health Information Technology (ONC) has released a “Guide to Privacy and Security of Health Information,” which is designed to help practitioners, staff, and other professionals better understand the role privacy and security play in the use of electronic health records (EHRs) and Meaningful Use. In addition, the ONC has announced the launch of its “Health IT Dashboard,” a compilation of information about ONC strategy, health care innovation grants programs, and data on adoption of health information technology.

Stage 2 Electronic Health Record (EHR) Meaningful Use Proposed Rules Released

On February 23, 2012, CMS released a proposed rule to specify the Stage 2 criteria that eligible professionals (EPs), eligible hospitals, and critical access hospitals must meet in order to qualify for Medicare and/or Medicaid electronic health record (EHR) incentive payments under the Health Information Technology for Economic and Clinical Health (HITECH) Act.  By way of background, a July 28, 2010 final CMS rule establishing meaningful use requirements for the Medicare and Medicaid EHR Incentive Programs set forth three implementation stages, with each stage requiring increasing use of EHRs and electronic information exchange. Under Stage 1, which began in 2011 and is the starting point for all providers, "meaningful use" consists of transferring data to EHRs and being able to share information such as electronic copies and visit summaries for patients (note that certain Stage 1 criteria would be modified under the proposed rule). Stage 2 meaningful use criteria, which are the focus of the proposed rule, seek to increase the electronic capturing of health information in a structured format, as well as increasing the exchange of clinically relevant information between providers of care at care transitions. The proposed rule also includes new Stage 2 objectives with greater applicability to specialty providers, such as the ability to make imaging results and information accessible through certified EHR technology and the capacity to report information to patient registries. As the Obama Administration announced in November 2011, under the proposed rule, any provider who first attested to Stage 1 criteria in 2011 will have until 2014 to begin using Stage 2 criteria (instead of 2013 as provided under the 2010 rule). Under Stage 3, which CMS expects to implement in 2016, "meaningful use" includes demonstrating improvement in quality of health care. The proposed rule also specifies Medicare payment adjustments that would apply beginning in 2015 if covered providers fail to demonstrate meaningful use of certified EHR technology and other program participation requirements according to CMS timelines. CMS is proposing exceptions to the payment adjustments related to: availability of internet access or barriers to obtaining information technology infrastructure; newly practicing EPs who would not otherwise be able to avoid payment adjustments; and unforeseen circumstances such as natural disasters. The proposed rule is scheduled to be published March 7, 2012, and comments will be accepted for 60 days after publication.

In a related development, the HHS Office of the National Coordinator for Health Information Technology (ONC) has issued a proposed rule that details the capabilities and related standards and implementation specifications that certified EHR technology will need to include to, at a minimum, support “meaningful use” by eligible health care providers beginning with the 2014 EHR reporting periods. The rule also proposes revisions to the permanent certification program for health information technology, which includes changing the name of the program to the "ONC HIT Certification Program.” The official version will be published on March 7, 2012. Comments will be accepted for 60 days after publication.

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