December 12, 2013

Tom Sullivan, M.D.

How Will the Meaningful Use Stage 3 Delay Impact Providers and Stakeholders?

In light of CMS’s recent announcement that it has decided to delay the onset of Meaningful Use Stage 3 until 2017, the first question everyone seems to be asking has been: how does this affect providers and MU Stage 2? The short answer is there probably will not be many, if any, immediate or impactful changes for the great majority of providers in small to medium ambulatory clinical practices.
However, this is a qualified “win” for vendors, data analysts who work at the ONC and CMS, and selected large hospital based health systems. Hospital based systems, in addition to a large number of stakeholders across all of the affected industries, have advocated for a delay in the start of Stage 2 (which began in October of this year for hospitals) rather than just an extension. Stage 2 will still start in January for all other affected medical professionals such as physicians or eligible providers.
Over the past 6 to 12 months, major industry and professional organizations such as CHIME, the AHA, the AMA, the AAFP, the ACP, HIMSS, and MGMA have joined a large number of senators advising that CMS and the ONC delay Stage 2. Many providers have found it incredibly difficult to successfully implement Stage 1 requirements within their workflow without having productivity suffer. These providers are increasingly concerned about their practices’ abilities to efficiently adapt to the more technical and secure patient communication requirements of MU Stage 2.
Only three percent of vendors have successfully certified for Stage 2 as recently as October of this year, which reflects the sheer amount of time and effort that certification requires for the healthcare IT industry. Delaying Stage 3 until 2017 demonstrates that CMS wants to avoid any further issues going forward and wants to give the healthcare IT industry, among others, enough time for research and development to get Stage 3 right from the beginning. Both the IT industry and the analysts at CMS and the ONC will now have additional time to examine what is working and what is not. This will be most helpful for CMS itself as they determine how much more everyone will be “pushed” to adopt more stringent requirements that promote interoperability, the use and documentation of clinical quality measures and more secure, clinical communications particularly through the Direct Project protocols (especially with patients, not just with providers).
The delay in the onset of Stage 3 will help propel IT vendors into a stronger position of readiness. This will also help providers, as they will not have to face the potential of lost incentive money or worry about the possibility of penalties as their EMR systems attempt to satisfy CMS’s stringent requirements.
CMS has also announced that an additional option set of Meaningful Use Stage 3 certification standards will be developed in an effort to help keep Stage 3 responsive to the dilemmas providers encounter over the course of navigating Stage 2 of the program. According to their press release, CMS will release “proposed rulemaking (NPRM) for Stage 3 and corresponding ONC NPRM for the 2017 Edition of the ONC Standards and Certification Criteria…in the fall of 2014, which will outline further details for this proposed new timeline. The final rule with all requirements for Stage 3 would follow in the first half of 2015. All stakeholder comments will be reviewed and carefully considered before the release of the final rules.” Later in its press release, CMS notes that the ONC will be soliciting feedback from across the industry in order to formulate this second set of certification standards. CMS notes that its 2015 standards will not be mandatory and that any vendors or providers that have chosen to go with a 2014 certified product will not be penalized or forced to adapt their systems. This approach has met mixed reviews from CIOs and Health IT execs who feel that creating two sets of standards in consecutive years will be cause for confusion and frustration, and will not have the desired effect of making for a smooth transition in 2017.
Finally, one benefit of the delay, perhaps unintended by CMS, is that it allows room for competing priorities in small and large systems in 2014. These include the ICD-10 deadline in October, meeting the much stricter HIPAA Omnibus rule (which is already in effect), the PQRS quality reporting system requirements, and the new accounting changes and accommodations needed to meet the increased patient load from ACA staged rollouts.
On the bright side, it does appear that CMS is being much more sensitive and responsive to the general concerns of providers, hospitals, and the healthcare IT industry as it moves forward. This shows that CMS has been able to reflect on and their approach and make essential changes after receiving so much criticism for its handling of Meaningful Use Stage 2.

About Tom Sullivan, M.D.

Thomas E. Sullivan, M.D is a board-certified specialist in cardiology and internal medicine with over 40 years of clinical practice. He currently works for DrFirst and sees patients part-time in Massachusetts. His expertise in the application of information technology to health care has helped to create an international standard (ASTM) for the exchange of medical record information called the Continuity of Care Record (CCR). With AMA, he was founding chair of their e-Medicine Advisory Committee, worked with the Physician Consortium for Performance Improvement, represented the AMA and helped create the Physician EHR Coalition and is past chair of the AMA Council on Medical Service.