On March 20, the Centers for Medicare & Medicaid Services (CMS) released its proposed rule (Proposed Rule) for implementing Stage 3 of the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs (Programs). CMS proposes a number of important changes to the Programs that will affect all providers receiving payments from Medicare and Medicaid starting in 2018. The same day, the Office of the National Coordinator for Health Information Technology released its proposed certification criteria for EHR technology (2015 Edition CEHRT). This alert describes several notable changes to the Programs.

CMS proposes to abandon the concept of stages in 2018. Under the Proposed Rule, all providers would be required to attest to Stage 3 beginning in 2018 using 2015 Edition CEHRT--even providers who are attesting for the first time in 2018. CMS is concerned about supporting three different stages of meaningful use in perpetuity and believes that focusing on a single set of objectives and measures will ultimately reduce burdens on CMS and providers and allow stakeholders to focus on the goals of meaningful use: improving outcomes, enhancing interoperability, and increasing patient engagement.

Under the Proposed Rule, providers would be required to attest to a set of eight objectives and their associated measures in Stage 3. Certain objectives will have more than one measure. Providers would be required to attest to the results of each measure of an objective. For some objectives, however, providers would only be required to meet the threshold of a portion of those measures to satisfy the objective.

For example, an eligible professional (EP) attesting to the proposed "health information exchange" objective would be required to attest to three measures:

  • For more than 50% of transitions of care and referrals, the EP that transitions or refers their patient to another setting of care or provider of care:
    • Creates a summary of care record using CEHRT; and
    • Electronically exchanges the summary of care record.
  • For more than 40% of transitions or referrals received and patient encounters in which the provider has never before encountered the patient, the EP incorporates into the patient's EHR an electronic summary-of-care document from a source other than the provider's EHR system.
  • For more than 80% of transitions or referrals received and patient encounters in which the provider has never before encountered the patient, the EP performs clinical information reconciliation. The EP must implement clinical information reconciliation for the following three clinical information sets:
    • Medication: Review of the patient's medications, including the name, dosage, frequency, and route of each medication.
    • Medication allergy: Review of the patient's known allergic medications.
    • Current problem list: Review of the patient's current and active diagnoses.

Although the EP must attest to all three measures, the EP needs only to meet the percentage threshold of two of the measures to satisfy the objective.

Notably, CMS proposes to eliminate the 90-day EHR reporting period for Medicare EPs, eligible hospitals, and critical access hospitals (CAHs) demonstrating meaningful use for the first time in 2017. Beginning in 2017, the EHR reporting period for all of these providers will be the calendar year. However, CMS will continue the 90-day EHR reporting period for Medicaid EPs, eligible hospitals, and CAHs attempting to demonstrate meaningful use for the first time.

Given the difficulties faced by the industry in upgrading from 2011 Edition CEHRT to 2014 Edition CEHRT, CMS hopes to ease the industry into 2018 by providing flexibility in attesting to meaningful use in 2017. If a provider does not have 2015 Edition CEHRT with the functionality required to meet all Stage 3 objectives in 2017, the provider would use 2014 Edition CEHRT to attest to: (1) either Stage 1 or Stage 2 if the provider first demonstrated meaningful use in 2015 or 2016; or (2) Stage 2 if the provider first demonstrated meaningful use before 2015. If the provider does have 2015 Edition CEHRT, the provider may attest to: (1) Stage 1, Stage 2, or Stage 3 if the provider first demonstrated meaningful use in 2015 or 2016; or (2) Stage 2 or Stage 3 if the provider first demonstrated meaningful use before 2015. If the provider has 2015 Edition CEHRT, it would only attest to Stage 3 in 2017 if it has all the functionality required to meet all Stage 3 objectives. Similarly, CMS proposes to continue encouraging the electronic submission of clinical quality measures (CQMs) in 2017. CMS would then require the electronic reporting of CQMs in 2018.

CMS intends for Stage 3 to be the final stage of meaningful use. Although there probably will not be a Stage 4 rule, CMS does not foreclose the possibility of future rulemakings to address technological and clinical care standard changes affecting EHR technology.

Both proposed rules are scheduled to be published in the Federal Register on March 30.

The comment period for both proposed rules ends May 29.