Tag: Meaningful Use

Texas docs plead for relief from ‘meaningful abuse’ of Meaningful Use

The Texas Medical Association wants Congress to intervene and make changes to the federal electronic health-record incentive payment Meaningful Use program it’s calling “meaningful abuse.”

The group says stage 3 of the program meant to get physicians using EHRs could jeopardize Medicare doc payment rules.

The TMA, the largest state medical association in the country, wants Congress to lift what it’s describing as the $31.6 billion program’s “convoluted and tedious” meaningful-use requirements.

In a letter Texas’ two U.S. senators, John Cornyn, and Ted Cruz, and to the Texas delegates to the House of Representatives, TMA President Dr. Tom Garcia asked legislators to co-sponsor two bills to alter the meaningful-use landscape.

One is the Flex-IT 2 Act by Rep. Renee Ellmers, (R-N.C.), which would delay Stage 3 meaningful-use rules until at least Jan. 1, 2017. The other is the Transparent Ratings on Usability and Security to Transform Information Technology, or TRUST IT Act by Sens. Bill Cassidy (R-La.) and Sheldon Whitehouse (D-R.I.) which is aimed at ensuring health IT systems perform better in the field.

“We believe Congress must enact legislation that provides positive incentives for physicians to acquire and maintain health information technology,” Garcia wrote. “Until electronic health records truly add value to medical care and can seamlessly interact with other systems, we want Congress to reform the program and eliminate federal mandates that compel physicians to engage in unnecessary activities and reporting.”

The TMA went on to stress that numerous other organizations and individuals are protesting the implementation of Stage 3.

“EHR State of Mind,” a video by physician-rapper Dr. Zubin Damania has drawn nearly 200,000, according to the medical society. The TMA also pointed to a town hall event hosted by the American Medical Association and the Medical Association of Georgia which concluded that EHRs could be helpful, but that government regulations like meaningful use have made them almost unusable.

“Help us put real meaning back into medical practice,” Garcia wrote.

CMS releases final rule on Meaningful Use for 2015

The Centers for Medicare & Medicaid Services (CMS) released final Meaningful Use rules that simplify requirements and add new flexibilities for providers to make, electronic health information available when and where it matters most and for health care providers and consumers to be able to readily, safely, and securely exchange that information. The final rules for 2015 Edition Health IT Certification Criteria (2015 Edition) and final rules with comment period for the Medicare and Medicaid Electronic Health Records (EHRs) Incentive Programs will help continue to move the health care industry from a paper-based system, where a doctor’s hand-writing had to be interpreted and patient files could be misplaced.

CMS heard from physicians and other providers about the challenges and burdens they face making this technology work well for their individual practices and for their patients. In recognition of these concerns, the final regulations make significant changes to current requirements by easing the reporting burden for providers, supporting interoperability, and improving patient outcomes. CMS is also encouraging providers to apply for exemptions if they had difficulty with or needed to switch their EHR vendor or experienced challenges due to the timing of the rules and EHR implementation. Additionally, the new rules will enable the development of user-friendly technology, allowing individuals easier access to their information so they can be engaged and empowered in their care.

Overview of Rule Provisions

CMS reviewed and considered more than 2,500 comments on the two proposed rules to create the final policies, with the opportunity for additional comment, for participation in the EHR Incentive Programs.  In recognition of the issues raised, CMMS made significant changes to ease reporting burden for all providers, supporting health information exchange, and improving patient outcomes. For example, the regulations:

  • Shift the paradigm so health IT becomes a tool for care improvement, not an end in itself.
  • Provide simplicity and flexibility so that providers can choose measures that use in their practices and report progress that are most meaningful to their practice.
  • Give providers and state Medicaid agencies more time – 27 months, until January 1, 2018 – to comply with the new requirements and prepare for the next set of system improvements.
  • Give developers more time to create the next advancements in technology that will be easier to use and more appropriate to new models of care and access to data by consumers.
  • Support provider exchange of health information and a more useful interoperable infrastructure for information exchange between providers and with patients
  • Give developers more time to create the next advancements in technology that will be easier to use and more appropriate to new models of care and access to data by consumers.
  • Address health information blocking and interoperability between providers and with patients.

For the EHR Incentive Programs in 2015 through 2017, major provisions include:

  • 10 objectives for eligible professionals including one public health reporting objective, down from 18 total objectives in prior stages.
  • 9 objectives for eligible hospitals and critical access hospitals (CAHs) including one public health reporting objective, down from 20 total objectives in prior stages.
  • Clinical Quality Measures (CQM) reporting for both eligible professionals (EPs) and eligible hospitals/CAHs remains as previously finalized.

CMS evaluated the current programs and identified areas where modifications could be made to align with the long-term vision and goals for Stage 3. CMS restructured the objectives and measures of the EHR Incentive Programs in 2015 through 2017 to align with Stage 3, and modified “patient action” measures in Stage 2 objectives.  These changes recognize the progress providers have made and realign with long term goals.

For Stage 3 of the EHR Incentive Programs in 2017 and subsequent years, major provisions include:

  • 8 objectives for eligible professionals, eligible hospitals, and CAHs:  In Stage 3, more than 60 percent of the proposed measures require interoperability, up from 33 percent in Stage 2.
  • Public health reporting with flexible options for measure selection.
  • CQM reporting aligned with the CMS quality reporting programs.
  • Finalize the use of application program interfaces (APIs) that enable the development of new functionalities to build bridges across systems and provide increased data access. This will help patients have unprecedented access to their own health records, empowering individuals to make key health decisions.

The Stage 3 requirements are optional in 2017. Providers who choose to begin Stage 3 in 2017 will have a 90-day reporting period. All providers will be required to comply with Stage 3 requirements beginning in 2018 using EHR technology certified to the 2015 Edition. Objectives and measures for Stage 3 include increased thresholds, advanced use of health information exchange functionality, and an overall focus on continuous quality improvement.

In addition, the final rule adopts flexible reporting periods that are aligned with other programs to reduce burden, including moving from fiscal year to calendar year reporting for all providers beginning in 2015, and offering a 90-day reporting period in 2015 for all providers, for new participants in 2016 and 2017, and for any provider moving to Stage 3 in 2017.

As part of today’s regulations, CMS announced a 60-day public comment period to facilitate additional feedback about Stage 3 of the EHR Incentive Programs going forward, in particular with the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which established the Merit-based Incentive Payment System (MIPS) and consolidates certain aspects of a number of quality measurement and federal incentive programs into one more efficient framework. We will use this feedback to inform future policy developments for the EHR Incentive Programs, as well as consider it during rulemaking to implement MACRA, which we expect to release in the spring of 2016.

AMA: Physicians Still Watching and Waiting for 2015 Meaningful Use Program Requirements

Because the Centers for Medicare and Medicaid Services (CMS) has yet to issue the so-called “modification rule” for the electronic health record (EHR) Meaningful Use program for 2015, the AMA is calling on the agency to create an automatic hardship exemption for physicians who did not have the opportunity to report successfully this year.

In April, CMS proposed modifications to stages 1 & 2 of the program that reduced the reporting period from a full calendar year to 90 days. Stakeholders believed this was necessary since many physicians could not update systems, change products, or accommodate Internet outages or other disruptions under a 365-day reporting program.

“The AMA welcomed and supported the proposed changes, but it’s now Oct. 1 and CMS has left physicians without any guidance or assurances that they will be capable of meeting program requirements before the end of the year,” said AMA President Steven J. Stack, M.D. “The AMA has regularly stressed that CMS must finalize Meaningful Use modifications well ahead of Oct. 1 to provide the time that physicians need to plan for and accommodate these changes, yet CMS has continued to delay finalizing this rule. As a result, many physicians who were counting on this flexibility will be subject to financial penalties under the rules currently in place. The AMA is asking CMS to create an automatic hardship exemption as soon as possible so that physicians are not penalized for regulatory delays that are outside their control.”

Previous AMA efforts to shape the Meaningful Use program can be found at AMA Wire. For additional information visit BreaktheRedTape.org, or join the discussion on Twitter using #FixEHR.

Certified EHR Technology Use Reaches 74% of Physicians

New data published by the Office of the National Coordinator for Health Information Technology shows high levels of office-based physician EHR use of certified EHR technology (CEHRT) and even greater EHR adoption numbers in 2014.

The most recent ONC brief puts the percentage of office-based physician CEHRT users at 74 percent as compared to 51 percent using a basic EHR and a total of 83 percent using any type of EHR technology.

Of those physician EHR users with CEHRTs, more than half (56%) have plans to participate in the EHR Incentive Programs although one-third that number (18%) have no plans or remain unsure as to their participation in meaningful use.

As for the basic EHR functionalities being used by office-based physicians, the figures hovered around 80 percent with the exception of viewing imaging results. Less than two-thirds of office-based physician EHR users reported have the ability to view imaging results electronically, 25-percentage points fewer than the most common computerized functionalities of recording demographic information (86%) and computerized prescription order entry (85%). Other functionalities topping the 80-percent mark were:

  • Recording patient’s medications and allergies (84%)
  • Recording clinical notes (83%)
  • Recording patient problem lists (82%)

Based on specialty, primary care physicians reported the highest rates of EHR adoption across all types of EHR technology — 87 percent. Medical specialists and surgical specialists were not too far behind at 80 percent and 78 percent, respectively, and equal in terms of physician CEHRT users (70%).

Generally an indicator of EHR adoption, practice size proved to be a significant differentiator in 2014 for office-based physician EHR adoption.

Solo practitioners reported the lowest percent of EHR adoption across the board, at a total of 64 percent for all EHR technology and 55 percent for CEHRT. The highest percentage of EHR adoption was reported by practices of 11 or more physicians, 97 percent of which had adopted EHR technology of any type and 86 percent of CEHRT. Sandwiched between these two sets of physicians were 6-10 physician practices and 2-5 physician practices.

A rather ambiguous finding in the report deals with physician EHR adoption by practice setting:

  • 98 percent of physicians in community health centers had adopted EHR technology; 76 percent CEHRT
  • 44 percent of physicians in community health centers and physician or group-owned practices were using all Basic EHR functionalities
  • Physicians in physician- or group-owned practices reported the lowest EHR adoption rates across all EHR types
  • HMO-owned or other healthcare corporation-owned physician practices reported the highest adoption rates of certified EHRs at 87%

“These findings may be related to the fact that the Basic EHR definition includes functionalities that apply primarily to certain physician specialties and may not be broadly applicable across the care continuum,” the ONC report states.

ONC: Rate of EHR Replacements Among Providers Up Significantly

The percentage of eligible professionals and hospitals that undertook complete electronic health record (EHR) replacement quadrupled between meaningful use program years 2013 and 2014, according to new data from the Office of the National Coordinator for Health IT, Health Data Management reports.

Under the 2009 economic stimulus package, providers who demonstrate meaningful use of certified EHRs can qualify for Medicaid and Medicare incentive payments.

The data were presented during a Health IT Policy Committee meeting on Wednesday (Slabodkin, Health Data Management, 9/10).

Details of EHR Replacement Data

According to the data, the rate of EHR replacement between the 2013 program year and the 2014 program year increased from:

  • 2% to 8% among eligible professionals; and
  • 0% to 4% among eligible hospitals (Murphy, EHR Intelligence, 9/10).

Specifically, to attest to the 2014 program year, the data show:

  • 10% of eligible professionals switched vendors; and
  • 12% of eligible hospitals switched vendors (Health Data Management, 9/10).

However, the data show the majority of meaningful use participants — 90% of eligible professionals and 88% of eligible hospitals — obtained 2014 Certified EHR Technology to attest to the meaningful use program from their current vendor (ONC data, 9/9).

Dustin Charles, a public health analyst at ONC, said it was unclear why eligible professionals and hospitals decided to change EHRs, noting, “There are many reasons why providers would want to change their own vendor.” He added that ONC “would like to look more into those who did switch and understand what’s going on.”

According to Health Data Management, industry analysts said it was not surprising that EHR replacement has increased.

Michelle Holmes, a principal at ECG Management Consultants, said she expects the rate to continue to rise, noting that providers often replace their EHRs for three reasons:

  • Dissatisfaction with current systems;
  • Implementation of an integrated/single database strategy; and
  • Situational changes, including mergers and acquisitions (Health Data Management, 9/10).

 

ONC Terminates EHR Certifications for Two EHR Products

One EHR vendor has had the certifications for two versions of its EHR technology revoked, the Office of the National Coordinator announced Wednesday.

Platinum Health Information Systems no longer has EHR certifications for a couple versions of SkyCare 4.2 terminated for “failure to respond and participate in routine surveillance requests” by ONC Authorized Certification Body (ONC-ACB) InfoGard Laboratories Inc.

“We take our responsibility to provide appropriate oversight of certified EHR products seriously and have every expectation that users will have systems that meet the technological capabilities and requirements adopted by Health and Human Services and will take action accordingly,” National Coordinator Karen DeSalvo, MD, MSc, MPH.

In the announcement, ONC explained the events leading up to the EHR certification termination:

As a required activity in the ONC Health IT Certification Program and according to standards to which the ONC-ACBs are accredited, InfoGard proactively initiated surveillance activities with Platinum Health. Despite InfoGard’s good faith efforts, Platinum Health did not respond to InfoGard’s surveillance requests and, consequently, was no longer compliant with certification requirements.

The fallout from revoking two EHR certifications means that a number of eligible professionals having attested to meaningful requirements previously with this formerly certified EHR technology must go through the EHR replacement process in order to participate in the EHR Incentive Programs going forward:

To date, forty-eight eligible professionals attested to meeting the Stage 1 requirements of the Medicare EHR Incentive Program using SkyCare EHR products. Although these attestations were made while the products were certified, these providers will need to transition to other certified EHR technology products to continue to participate in the Medicare EHR Incentive Program. Providers who are currently using the SkyCare EHR products can apply for a hardship exception from the meaningful use payment adjustments under the Medicare EHR program as they transition to new certified EHR technology. For more information about applying for a hardship exception, providers should visit CMS.gov.

Back in 2013, InfoGard played a similar role in the EHR certification termination of EHRMagic-Ambulatory and EHRMagic-Inpatient. That announcement contained implications of customer complaints necessitating follow-up surveillance.

“We and our certification bodies take complaints and our follow-up seriously. By revoking the certification of these EHR products, we are making sure that certified electronic health record products meet the requirements to protect patients and providers,” former National Coordinator Farzad Mostashari, MD, ScM said at the time. “Because EHRMagic was unable to show that their EHR products met ONC’s certification requirements, their EHRs will no longer be certified under the ONC HIT Certification Program.”

Surveillance is a feature of EHR certification that ONC intends to increase as part of its proposed rule for 2015 Edition health IT certification. Added surveillance could mean subsequent EHR certification terminations for EHR vendors falling short of the standards set and maintained by the federal agency on a near annual basis.


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