Will the Stage 3 Meaningful Use Requirements Be an Improvement for Anesthesiologists and Pain Physicians?

Let us begin with the basic answer to the question in the title of this Alert:  anesthesiologists continue to benefit from a specialty-based exemption from the Electronic Health Record (EHR) Incentive Program’s “meaningful use” (MU) requirements, so only those who are have chosen to earn the incentive will be affected directly by the new Stage 3 rules.  Pain physicians may be affected, unless their practice meets the EHR program definition of “hospital-based” or they have been granted a hardship exception (see Alert dated February 16, 2015).

The Stage 3 changes to the MU requirements, as described in a proposed rule issued on March 20, are part of what CMS calls its “broader efforts to increase simplicity and flexibility in the program while driving interoperability and a focus on patient outcomes in the meaningful use program.”  The most significant of the changes that would be implemented beginning in 2017, if the Stage 3 rule is finalized as proposed, are the following:

• give EPs the option of starting Stage 3 of meaningful use in 2017.  All EPs would be required to be in Stage 3 by 2018, regardless of what stage they were at previously;
• define the full calendar year as the EHR reporting period beginning in 2017, aligning EPs and hospitals, and eliminate the limited EHR reporting period of any continuous 90 days for EPs demonstrating MU for the first time; and, most important,
• replace all existing objectives and measures and reduce the overall number of objectives to the following eight, which would apply to EPs and hospitals alike, regardless of the stage they were at in the prior reporting period.  The Stage 3 objectives, and their associated measures are as follows:

While the first several of the proposed Stage 3 objectives are unchanged or only slightly changed from Stage 2, the patient electronic access, “coordination of care through patient engagement” and HIE objectives include higher thresholds as well as new requirements and would pose challenges to most physicians, not just to anesthesiologists.  For example, EPs would be required to communicate via EHR with patients (or with the patients’ authorized representatives) about clinical care and not just about appointments or insurance information.  Simply convincing patients to sign up to access their EHRs has been very difficult for many practices.

The government will be receiving comments on the proposed rule through May 29, 2015, as well as on a companion rule The Office of the National Coordinator also released a companion rule released by the Office of the National Coordinator that proposes vendor certification criteria and required standards and implementation specifications for EHR technology.  A significant volume of comments is expected.  The American Hospital Association has stated that “The release of [the proposed] rule demonstrates that [CMS] continues to create policies for the future without fixing the problems the program faces today,” and that “It is difficult to understand the rush to raise the bar yet again, when only 35% of hospitals and a small fraction of physicians have met the Stage 2 requirements.” (Tahir D. CMS issues draft Stage 3 rules for EHR incentive program.  Modern Healthcare, March 20, 2015.)  The American College of Cardiology has voiced its concerns over requiring all physicians, even first-time participants, to report for a full calendar year, as well as proposals to require all participants to immediately begin participation in Stage 3 starting in 2018, rather than allowing participants to proceed through the Stages in a progressive fashion.

We would expect quite a few changes to Stage 3 before it is implemented in 2017 and 2018.  In the shorter term, CMS is expected to release another rule that is expected to add some reporting flexibility and to shorten the 2015 Stage 2 reporting period to 90 days.  We will keep our readers informed, as always.