Catherine Boudreaux, MPP, and Elizabeth Fassbender

In a move welcomed by many healthcare providers, the Centers for Medicare & Medicaid Services (CMS) last month released a proposed rule that would ease some of the reporting burdens and give more flexibility to hospitals, office-based physicians, and other eligible professionals attempting to meet federal targets for meaningful use of electronic health records (EHR) for 2015 through 2017.

CMS called the proposed rule “a critical step forward in helping to support the long-term goals of delivery system reform; especially those goals of a nationwide interoperable learning health system and patient-centered care.” The changes follow a December 2014 declaration that approximately 257,000 healthcare professionals would be affected by penalties for failing to meet meaningful use requirements.

Shorter reporting period
The primary changes revolve around a proposal to eliminate the requirement for a full year of meaningful use in 2015 and standardize the 2015 reporting period for the EHR incentive-payment program to 90 consecutive days. All participating providers who demonstrate meaningful use for the first time in 2016 can use any continuous 90-day reporting period during the year. All returning participants would have a full calendar year reporting period in 2016.

Finally, all participants—new and existing—would have a full calendar year reporting period in 2017, except for those attesting for Medicaid for the first time. This proposed change comes after Rep. Renee Ellmers (R-N.C.) introduced H.R. 270, The Flex-It Act, which would have required CMS to make the same alterations. The American Association of Orthopaedic Surgeons (AAOS) supported Rep. Ellmers’ efforts when she introduced similar legislation in late 2014 and its reintroduction in 2015.

“We strongly believe that Meaningful Use requirements should be established through phased implementation with sufficient incentives over several years, rather than a single, hard deadline with non-adoption penalties,” wrote Frederick M. Azar, MD, AAOS past president. “Requiring physicians to report a full year of Meaningful Use in 2015 is contrary to the intent of the program and may cause physicians who are in compliance to miss out on eligibility. We therefore applaud your efforts to relax this reporting requirement by shrinking the reporting period from a full calendar year to any three-month period.”

Relaxed technology requirement
In addition, CMS plans to eliminate the current requirement that eligible providers have 5 percent of their patients use technology to electronically download, view, and transmit their medical records. Instead, the proposed rule would reduce that requirement to having a single patient download, view and transmit records.

Patient groups have expressed anger over this particular proposal, stating that patients want access to their records and are able to download them through smartphones. However, providers argue that the way the EHR presents the records makes understanding the information difficult for patients. Patients may have little reason to log into a patient portal, potentially costing providers additional penalties.

Additional changes
CMS also proposed changing the reporting year for hospitals to the calendar year, to match the reporting period used by physicians and other eligible professionals. This change will enable and encourage hospitals and physicians to work more closely with each other.

The proposed rule also makes the following alterations to the program:

• changing Secure Electronic Messaging from a percentage-based measure to a yes-no measure based on whether the messaging capability is “functionally fully enabled”
• consolidating all public health reporting objectives into a single objective with measure options following the structure of the Stage 3 public health reporting objective
• making the hospital electronic prescribing objective mandatory, with exclusions possible for certain hospitals

Beginning in 2015, the following objectives and measures are considered redundant, duplicate or “topped-out,” meaning they have substantially been adopted and attestation is no longer required:

• for eligible professionals: record demographics, vital signs, and smoking status; clinical summaries, structured lab results, patient list, patient reminders, summary of care (Measure 1–Any Method and Measure 3–Test), electronic notes, imaging results, and family health history
• for hospitals: record demographics, vital signs and smoking status; structured lab results, patient list, summary of care (Measure 1–Any Method and Measure 3–Test), eMAR, advanced directives, electronic notes, imaging results, family health history, and structured labs to ambulatory providers

According to CMS, as of March 1, 2015, more than 525,000 providers have registered to participate in the Medicare and Medicaid EHR Incentive Programs. In addition, more than 438,000 eligible professionals, eligible hospitals, and critical access hospitals (CAHs) have received an EHR incentive payment. As of the end of 2014, 95 percent of eligible hospitals and CAHs, and more than 62 percent of eligible professionals have successfully demonstrated meaningful use of certified EHR technology.

Meaningful Use Stage 3 announcement
In a separate announcement, CMS released draft regulations to add a third and final stage to the meaningful use program. The new rule maintains current payment adjustments and hardship exemptions, and in most instances, all physicians and other eligible professionals will be required to conform to the rules by 2018, regardless of the level of their previous participation. According to CMS, however, these proposed rules will give providers additional flexibility, make the program simpler, drive interoperability among EHRs, and increase the focus on patient outcomes to improve care.

The scope of the proposed rule is limited to the requirements and criteria for meaningful use in 2017 and subsequent years.

AAOS response
Although the AAOS shares the goal of having physicians use health information technology in a meaningful way, it has aggressively and continually urged CMS to consider the reporting difficulties associated with these programs. AAOS believes that some meaningful use policies could “threaten to put small and solo practitioners out of business, while simultaneously reducing access to care.”

AAOS has submitted comments to the Office of the National Coordinator for Health Information Technology at the Department of Health and Human Services highlighting the complexity and expense of implementation of EHR systems in orthopaedic offices. “As specialty physicians, we face unique technology challenges, ranging from certification issues to collection of appropriate data, as well as the larger issues impacting all physicians such as interoperability and cost,” the letter stated. Specific suggestions AAOS made included development of quality measures for orthopaedic surgery that can be used in the meaningful use definitions and refinement of the meaningful use criteria to better reflect the unique characteristics of surgical specialty practices.

AAOS will be submitting comments on the proposed rule. A final rule will be drafted after the 60-day comment period and could be issued sometime this summer.

Elizabeth Fassbender is the communications specialist and Catherine Boudreaux is the senior manager, government relations, in the AAOS office of government relations.