CMS Releases Notice of Proposed Rule Changes for Meaningful Use for 2015. These changes impact providers who are at Stage 1 and on Stage 2.
The most talked about provision of this notice is the 90 day period for attesting for Meaningful Use in 2015. Based upon the rule, all providers new and existing; Stage 1 and Stage 2, would utilize any continuous 90 day period during calendar year 2015 to attest for Meaningful Use. Providers who are in their second year of Meaningful Use and beyond would not be able to attest until January 1, 2016 even if they complete their 90 day period prior to the end of 2015. All providers would have until February 29, 2016 to attest for 2015. Providers who are new to Meaningful Use would be able to avoid a penalty in 2016 by attesting prior to February 29, 2015, these individuals may experience a payment adjustment early in 2016, but upon successful attestation, all claims for 2016 would be reprocessed and the payment adjustment would be reversed.
There are also a number of significant changes to both Stage 1 and Stage 2 of Meaningful use to more closely align these stages with the proposed Stage 3 requirements. These changes should be very welcome by the provider community. The more difficult aspects of Stage 2 are those measures that require patient action. Specifically the requirement that 5% of patients view, download or transmit their health information and that 5% of patients send a secure message to the provider. Both of these measures have been modified to reflect the difficulty that has been created by these measures. The rule proposes that only one (1) patient view, download or transmit their health information during the Meaningful Use period, and that the provider demonstrate that the ability for patients to send secure messages is active and functional. This change is significant in that it enables providers with patient populations that are not computer savvy to easily meet these two patient engagement measures. Many providers who have previously stated that they do not intend to meet Meaningful Use in 2015 may now reconsider their plans.
The requirement for completing or reviewing the HIPAA Security Risk Analysis has been clarified and it is clear that this process cannot have been done in the previous calendar year. Additional options have been proposed for electronic transmission of the Summary of Care document when transitioning a patient from one care setting to another (for example a referral).
The public health reporting measures have been restructured. Eligible providers at Stage 1 must meet 1 of 5 of the public health reporting measures or demonstrate that they are excluded from all 5 measures. Eligible providers at Stage 2 must meet 2 of these measures. Meeting the measure is demonstrating that you are actively engaged with a public health reporting program. This can be having registered to report and waiting for the account to be activated, in the process of testing the submission of information or actively submitting data to a public health registry.
A number of measures have been eliminated from both Meaningful Use as they have topped out, become redundant, or duplicative with other measures that have been retained as part of meaningful use. A measure has topped out is one that has a strong statistical likelihood that the functions of the measures and processes behind them would continue even without a requirement to report the results. The measures that have been removed from Meaningful Use include:
• Record Demographics
• Record Vital Signs
• Record Smoking Status
• Clinical Summaries
• Structured Lab Results
• Patient List
• Patient Reminders
• Electronic Notes
• Imaging Results
• Family Health History
Some of these measures are part of both Stage 1 and Stage 2, others are specific to Stage 2. Here we see that providers have been relieved of some of the measures that have been considered ‘busy work’ and providers did not see how meeting these measures contributed to the quality of care that was provided (for example Patient Demographics). Other measures that been removed are measures that presented technical difficulties with incorporating the data into the Certified EHR Systems including Structured Lab Results and Imaging Results.
The structure of Meaningful Use has also changed. There are no longer core and menu items. All items are core items, and many of these core items still contain a provision for exclusions under the appropriate circumstances.
With these proposed changes, there may be a shift in the perception of Meaningful Use among many in the provider community. It is much easier to correlate many of the retained measures with processes that can have a positive impact on quality of care and outcomes.
The proposed changes are scheduled to be published in the Federal Register on April 15. There will then be a 60 day comment period where various stakeholders can submit comments on the proposed rule change. After the comment period closes, the comments will be reviewed and a final rule will be published. It is reasonable to expect the final rule to be published sometime after September 1, 2015.
In all probability the proposed rule will be finalized with the changes outlined intact, but until the final rule is published the changes are not official. In the meantime, if you have not yet obtained accounts with your local or state public health reporting programs, now is the time. Without the attempt to obtain these accounts, you are likely to have difficulty in meeting the public health reporting measures.