Meaningful Use Stage 2 Reprieve Helps Anesthesia Practices
Under CMS’ current Medicare and Medicaid electronic health record (EHR) incentive program regulations, eligible professionals (EPs) must use 2014 edition certified EHR technology (CEHRT) to demonstrate meaningful use for either Stage 1 or Stage 2 in 2014. Many EHR vendors have not yet met the criteria to obtain certification for the 2014 edition, or they have too large a backlog of installations to comply with the timeline, however. On May 20th, CMS issued a proposed rule that would push back the deadlines for implementation of 2014 edition systems for the Medicare program.
The proposed rule offers EPs substantial flexibility in selecting meaningful use criteria from 2011, 2013 and/or 2014 to attest for Stages 1 or 2 in 2014. An EP who cannot fully implement 2014 criteria this year can attest using 2011 criteria (including enhanced criteria under a 2013 upgrade of the 2011 edition). Thus, EPs (1) would be able to use 2011 edition CEHRT for either Stage 1 or Stage 2, (2) would have the option to attest to the 2013 definition of meaningful use core and menu objectives, and (3) could use the 2013 definitions of the clinical quality measures (CQMs). This special rule is valid only for the 2014 reporting year.
As a reminder, the Medicare and Medicaid EHR Incentive Programs include three stages with increasing requirements for participation. The number of “objectives” and CQMs that must be reported increase from one stage to the next. The requirements for Stage 1 and Stage 2 are shown below:
Details on the core objectives, menu set objectives and CQMs are posted on the CMS EHR Incentive Program website.
EPs report each stage for two or three years, depending on when they begin and on the expected finalization of CMS’ proposal to extend Stage 2 through 2016. After meeting the Stage 1 requirements, EPs then have to meet Stage 2 requirements for at least two years: the proposed rule formalizes CMS’ intention, announced last December, to add a third year to Stage 2 in 2016 and to delay the start of Stage 3 to 2017.
All providers begin participating by meeting the Stage 1 requirements for a 90-day period in their first year of meaningful use. Normally EPs must report for a full calendar year in their second year of meaningful use. Calendar year 2014 is an exception to this principle: all EPs need only report for one 3-month period. EPs who are not able to demonstrate meaningful use in 2014 will be subject to a one percent payment cut in 2016.
The following table from the CMS press office, Press release: CMS rule to help providers make use of Certified EHR Technology, May 20, 2014, shows the proposed options for using 2011 edition CEHRT, 2014 edition CEHRT, or a combination of the two:
Providers who choose one of the three options in the table would be required to attest that they were unable to implement fully 2014 edition CEHRT because of availability or implementation delays.
Beginning in 2015, all EPs would have to report using 2014 edition CEHRT. “We are proposing this change for 2014 only,” the proposed rule states. “We will maintain the existing policy that all providers must use 2014 Edition CEHRT for the EHR reporting periods in CY 2015, FY 2015, and in subsequent years or until new certification requirements are adopted in subsequent rulemaking. We strongly recommend eligible professionals … that have not yet purchased EHR technology to obtain 2014 Edition CEHRT as these providers will still need to use 2014 Edition CEHRT for their EHR reporting period in 2015.”
It is extremely likely that the proposed rule will be finalized—many provider and healthcare industry organizations had urged CMS to increase the EHR incentive program’s flexibility, while there appears to be no opposition at all. Although anesthesiologists benefit from an automatic hardship exemption that will protect them against payment cuts next year if they fail to attest to meeting the meaningful use requirements by October 1, 2014, the delay in the deadlines for implementation of 2014 edition CEHRT would permit them to earn an incentive payment based on 2011 edition systems and the 2013 Stage 1 requirements.
As we stated in our May 12th Alert Meaningful Use of Electronic Health Records by Anesthesiologists and Pain Physicians – 2014, “Practices deploying ABC’s F1RSTUseTM technology should note that it has received 2014 certification, which means that it satisfies certain new functional criteria known as the ‘2014 Edition’ software standards.” Even those practices running F1RSTUse or other 2014 edition CEHRT, if they were scheduled to demonstrate Stage 2 in 2014, would benefit from the proposed rule since they could continue to attest to Stage 1 objectives and measures. All in all, the proposed rule is a welcome reprieve. We hope and expect that it will be finalized.