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October 13, 2015



AAOS Disappointed in Release of Meaningful Use Stage 3 Final Rules

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AAOS Disappointed in Release of Meaningful Use Stage 3 Final Rules

On October 6, 2015, the Centers for Medicare and Medicaid Services (CMS) released the final rule for Stage 3 of its meaningful use (MU) program for electronic health records (EHRs). AAOS, together with a multitude of other health care groups, had urged the administration to pause MU Stage 3 and reevaluate the program in light of recent changes to Medicare (read a recent letter to HHS here). EHRs are an essential foundation for the implementation of the Merit-Based Incentive Payment System (MIPS) program and Alternative Payment Models (APMs), and health information technology (HIT) generally is a fundamental component to improving our nation’s health care system. However, while approximately 80 percent of physicians are utilizing EHRs, less than 20 percent of physicians have successfully participated in MU Stage 2. The current HIT infrastructure does not provide for efficient electronic exchange of patient information and the MU program’s ambitious and prescriptive timetables hinder – instead of help – physicians’ abilities to provide quality care to their patients.

“We are disappointed that CMS did not listen to stakeholders and members of Congress who urged them to delay rulemaking for Stage 3 so that it would better align with the MIPS program and allow adequate time to prepare,” stated Thomas C. Barber, MD, Chair of the AAOS Council on Advocacy. “We certainly appreciate the recognition of concerns and added flexibility in the program, but rather than push forward with the next stage of meaningful use, CMS should first focus their attention on ensuring that providers can easily and efficiently share health information to support care delivery and new models of care. We will continue to advocate for meaningful use requirements that better align with upcoming programs, increase specialty specific quality measures, encourage interoperability, and expand hardship exemptions.”

  AAOS members took to Capitol Hill October 7th to express concerns with meaningful use program and release of Stage 3 rule.

“The AAOS represents over 18,000 board-certified orthopaedic surgeons and has been a committed partner to CMS in the adoption of electronic health records and the meaningful use program,” wrote David D. Teuscher, MD, President of AAOS, in an earlier comment to CMS. “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. Challenges remain despite our desire to adopt EHR technology. The amount of time orthopaedic surgeons would spend trying to meet the proposed Stage 3 objectives would ultimately result in less time treating patients, thereby reducing patients’ access to care.”

Members of Congress expressed similar frustration. More than 100 legislators joined Reps. Tom Price, Renee Ellmers, and David Scott asking for a delay to align meaningful use with the forthcoming MIPS program, among other reasons. Read the congressional letter online here. Additionally, Senator Lamar Alexander (R-TN) had repeatedly suggested a Stage 3 delay. Read more in Advocacy Now online here and here.

“The administration has a tin ear,” stated Alexander after the release of the rules. “We asked: ‘Why spend a year modifying rushed up mistakes? Why not spend a year getting it right in the first place?’ They listened but they did not hear. They’ve missed a golden opportunity to develop bipartisan support in Congress and throughout the country for an electronic health records system that would genuinely help patients. Instead, they’ve rushed ahead with a rule against the advice of some of the nation’s leading medical institutions and physicians. Congress will carefully review this rule and has the option of fixing it through legislation or overturning it through the Congressional Review Act.”

CMS at the same time released a rule that finalizes modifications to Stages 1 and 2. Read more about the modifications in an earlier Advocacy Now article here.

About the Rules

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. All returning participant must use the EHR reporting period of a full calendar year in 2016, 2017 and 2018.

Read more online here.