On Oct. 6, after many months of anticipation, the Centers for Medicare & Medicaid Services and the Office of the National Coordinator for Health IT published the 2015 Meaningful Use final rule. This long-awaited document, weighing in at almost 800 pages, contains some major changes to the Meaningful Use program beginning this year. By the time you read this, you’ll no doubt have heard about the major aspects of the changes. Regardless, we thought it would be useful to focus our lens on the new rules and consider how they will translate from the legislature into the real world.
What’s new?
Contrary to its name, the electronic health record incentive program has been considered hardly “meaningful” by physicians struggling to meet the objectives. Up to this point, it’s seemingly been more about busywork and aimless button-clicking than meaningful work. The 2015 final rule seeks to finally change that. In the press release accompanying the announcement, Dr. Patrick Conway, CMS Deputy Administrator, offered the following:
“We have a shared goal of electronic health records helping physicians, clinicians, and hospitals to deliver better care, smarter spending, and healthier people. We eliminated unnecessary requirements, simplified and increased flexibility for those that remain, and focused on interoperability, information exchange, and patient engagement.”
Expanding on his comments, we’ll first point out the change in length of the meaningful use reporting period. In 2015, it has been shortened to 90 days, regardless of stage. For most, this will elicit a huge sigh of relief, as providers now have the option to choose any continuous 90-day period within 2015 instead of being forced to report for the full year. This fundamental change adds tremendous flexibility to the program, as it eliminates the do-or-die scenario of full-year reporting and allows providers to retrospectively select an optimal attestation period.
Next is the streamlining of the required measures. From 20 measures, the list has been brought down to 10: 9 core objectives and 1 public health objective. In doing this, the CMS sought to remove the “checkbox processes” that have become a much-maligned hallmark of meaningful use. The agency also made an attempt to remove measures considered redundant, duplicative, or topped-out (such as demographic and vital sign documentation). Finally, the CMS essentially removed the core and menu structure and consolidated all measures, so that all providers are working off the same playbook, regardless of stage.
Third, and perhaps most interestingly, is the focus of the remaining objectives. As Dr. Conway related, the measures that the CMS has chosen to retain aim very clearly at a few key goals, with data-sharing principal among them. In fact, more than half the measures rely on information exchange. CMS has admitted that efforts thus far have not produced the kind of transformational interoperability intended, but that ultimately this is the direction EHRs need to take if they are to fulfill their true promise. Although we tend to agree (and we will be writing in greater detail about this in future columns), we feel it’s important to note that this will continue to be challenging for providers and vendors. Until data standards are universally adopted by EHR vendors, health care providers will be forced to bear the burden of imperfect interoperability.
Fortunately, one area in which the burden on physicians has been lightened is patient participation in meaningful use. The CMS has realized the impracticality of measures that rely completely on patients for success and removed the compliance thresholds for secure electronic messages and electronic portal usage. These tools need to be made available to patients, but providers are no longer held responsible for whether or not a certain percentage of patients choose to use them. In 2015, only one patient needs to “view, download, or transmit” information through a patient portal, and secure email capability only needs to be enabled, even if no one opts to use it.
Finally, the CMS is clear to point out that it sympathizes with those who have been unsuccessful in attaining meaningful use, encouraging them to submit requests for hardship exceptions “through the existing request process.” Unfortunately, this process is fairly narrow in scope and really only applies in cases of vendor delays or significant unforeseen consequences (such as bankruptcy, fire, or natural disasters). Still, there is no penalty in applying for an exception even if it is not granted, so, while CMS plans to grant only a limited number of exceptions, we would echo the encouragement to apply if needed.
What’s next?
The 2015 final rule is yet another step in laying groundwork for Meaningful Use stage III, which will be optional in 2017 and mandatory in 2018. The delay offers providers and vendors additional time to adapt and comply with the new regulations, while hopefully adding simplicity and flexibility to the process. Ultimately, this also better aligns reporting Meaningful Use with other incentive programs, all of which will be eventually consolidated under MIPS, the Merit-based Incentive Payment System (we’ll have more on this in a later column, but we want you to know that it is a new system of value-based reimbursement that will sunset the Meaningful Use payment adjustment at the end of calendar year 2018).