With the release of the Meaningful Use Stage 3 proposed rule on March 30, CMS is attempting to reduce complexity and increase uniformity within the electronic health record EHR Incentive Programs by reducing the myriad of choices currently available. CMS intends Stage 3 to be the third and final stage of meaningful use; it would bring a revised, unitary set of required objectives and measures to accomplish meaningful use, corresponding updates to EHR technology and a single, universal reporting period. Stage 3 is proposed to take effect as an option for 2017 and a requirement for 2018 and beyond.
Considering that this last stage of meaningful use is likely to be with us for the long term, now is the time to submit your comments, changes and concerns before the comment period closes on May 29, 2015.
A Single Set of Objectives and Measures
Under the proposed rules, Stage 3 would establish a single set of objectives and measures for all program participants, regardless of years of prior participation. Currently, participants begin by meeting the Stage 1 criteria and then progress to the more stringent Stage 2 criteria on an established timeline. Under the proposed approach, Stage 1 and Stage 2 would be eliminated and replaced by the single set of Stage 3 requirements that would apply across the board.
During the 2017 transition year, this set of objectives and their corresponding measures would be optional for all providers to demonstrate meaningful use. Beginning in 2018 and for all subsequent years, meeting these objectives would be required to achieve meaningful use.
Alignment of EHR Reporting Periods Means Loss of 90-Day Reporting Period for First-Time Meaningful Users
Under the proposed rules, all providers would report on a calendar year basis beginning in 2017. The move to a single EHR reporting period would eliminate the current 90-day reporting period for providers demonstrating meaningful use for first time. Eligible professionals, hospitals and critical access hospitals (CAHs) participating in the Medicare program would no longer have a shorter, initial time period to achieve meaningful use. Instead, they would need to be using certified EHR technology and meeting all of the objectives as of January 1 and continuing throughout the entire year.
While this change may simplify the regulations, it also means that providers beginning the drive to meaningful use cannot qualify in an initial partial year of using certified EHR technology. As a practical matter, it will delay a provider from accomplishing meaningful use until the first full calendar year following implementation of certified EHR technology. There is an exception, however, for Medicaid providers demonstrating meaningful use for first time, and they would still be able to attest based on a 90-day reporting period.
Shifting to a calendar year reporting period would also impact eligible hospitals and CAHs, which would no longer use the federal fiscal year as their reporting period. As hospitals and CAHs transition from the 2016 federal fiscal year to the 2017 calendar year, there would be a reporting gap for the 3-month quarter from October through December 2016. Hospitals and CAHs would not be required to report on objectives and measures during this time period, but they may be required to include this data in clinical quality measure (CQM) reporting. Eligible professionals are already reporting on a calendar year basis.
Objectives and Measures Linked to Updated Certified EHR Technology
Consistent with earlier rulemaking, this latest CMS rule for demonstrating meaningful use would closely track required capabilities, specifications and standards for certified EHR technology. To qualify as a meaningful user, a health care provider must meet all of the objectives using certified EHR technology. Currently, providers must use an EHR that has been certified to meet the 2014 Edition of criteria, standards and specifications for EHR promulgated by ONC.
During the 2017 year – the last year a provider could attest to Stage 1 or Stage 2 to achieve meaningful use – providers could use either 2014 Edition certified EHR technology or 2015 Edition certified EHR technology to attest to the objectives and measures of either of those stages.
All providers would be required to use 2015 Edition certified EHR technology beginning in 2018.
Deadline for Public Comments
Public comments must be submitted by May 29, 2015 and can be submitted anonymously through counsel.
