Rock and a hard place sign outdoors

Stage 2 Meaningful Use: Of Rocks, Hard Places, and Rising Waters

8 Oct 2014

Healthcare providers are caught between the rock of pending “Meaningful Use” requirements and the hard place of a shortage in electronic health records (EHR) products to comply with them.

The Centers for Medicare & Medicaid Services (CMS) has extended the deadline for meeting Stage 2 Meaningful Use (MU) requirements and delayed the start of Stage 3.

In Stage 2, hospital administrators must adopt EHR systems certified for use in Stage 2 and attest to meeting the program’s 16 core objectives, and half of its six menu objectives, to qualify for incentives under Medicare and Medicaid.

The Healthcare Information and Management Systems Society (HIMMS) and the American Hospital Association have expressed concern over the scant availability of health information technology products that are certified for 2014 by the Office of the National Coordinator for Health Information Technology (ONC).

Providers are looking at more than switching out software programs. They must install entirely new EHR systems that meet ONC certification standards or face potential Medicare reimbursement penalties for noncompliance with the MU requirements. The ONC is sanguine about the ability of software developers to update EHR technology in time for providers to avail themselves and avoid looming penalties.

In January, the ONC said that 80 percent of hospitals meeting Stage 1 requirements used a 2014 certified EHR vendor. But the same data revealed that less than 60 percent of all providers are working on a system made by a 2014 certified vendor.

Dropping Out

Will these obstacles push more healthcare providers and hospitals to abandon the Meaningful Use program altogether?

According to CMS, roughly 10,000 health-care providers abandoned the Meaningful Use program between 2011 and 2012, thanks to its complexity.

But the consequences for doing so grow more dire as we move forward.

Providers that don’t meet MU requirements by 2015 will face a 1 percent Medicare reimbursement cut, starting in 2016. The penalty increases by 1 percent each subsequent year that criteria are not met.

Integral to the ACA, President George W. Bush actually started what became the federal government’s MU program promoting the use of electronic health records.

Funding for MU was provided through the HITECH Act, which was part of President Obama’s 2009 stimulus program and clearly not a “shovel ready” choice.

MU, in the end, is an electronic health records incentive program that has doled out $23 billion in federal monies, and counting. Some $14.3 billion went to hospitals. Medicare providers have received approximately $5.5 billion, Medicaid just under $3 billion.

Available Money

The cap on what providers can get from the Medicare MU program is $12,000 for 2014. Those who met Stage 2 criteria in 2013 received $15,000.

In 2015, the same year Medicare reimbursement penalties kick in for noncompliance, the highest MU Medicare incentive payment available for providers will be $8,000.

Getting ahead of the curve on these requirements pays — literally. It has been suggested that a gap may emerge between larger, more sophisticated entities, with resources, which can handle the demands of Meaningful Use, and those that can’t. Stage 3 requirements, this line of thinking goes, will widen that gap.

This final phase doesn’t take effect until 2018, but the groundwork is being laid in 2014, as CMS begins crunching data from Stages 1 and 2. These results will inform Stage 3 parameters and particulars.

Under Stage 2, providers will be required to provide electronic access to at least 10 percent of their patients. It is that data CMS will use, and is hoping providers do, too. For that to transpire in hospitals, a cultural change among the physicians they collaborate with is required. Hospital executives have said that changing technology is one thing, but that getting doctors to help them meet MU requirements is another.  The program’s dictates replace long-established methods practiced by a profession that may be short on the IT literacy necessary to do the job.

For smaller outfits and private practitioners, it may be less a matter of culture change than a simple challenge to sink or swim in the ACO waters rising around them.

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