Earlier this week, after considering more than 2,500 comments, the Centers for Medicare and Medicaid Services (CMS) released the much anticipated Final Rule for Electronic Health Record Incentive Program - Stage 3 and Modifications to Meaningful Use in 2015 and 2017. Uncharacteristically, CMS is permitting additional comments for an additional 60 days on Stage 3 measures, objectives and reporting periods. In a CMS call, the agency noted that the comments may be rolled into future rule-making for the Merit-based Incentive Payment System (MIPS).  

The Modifications bring some relief. For 2015 only, the final rule permits providers to demonstrate meaningful use through any continuous 90-day period during the calendar year. Hospitals are permitted a 15-month period (Oct. 1, 2014 to Dec. 31, 2015).  Going forward, except for first-time demonstrators, a full calendar year will be required. In its call, CMS stressed that a 2014 certified product must be used in 2015. For 2015-2017, the final rule reduces the number of objectives which must be met to 10 for providers and 9 for hospitals. 

The most dramatic change from the proposed rule is that CMS has agreed to consider hardship exception applications under the extreme and uncontrollable circumstances category for those providers and hospitals who fail to meet meaningful use for 2015 based on the uncertainty in the rule finalization.

For 2016 and 2017, eligible professionals (EPs) and eligible hospitals (EHs), except for those that are demonstrating meaningful use for the first time, must show meaningful use of the CEHRT over the calendar year periods for 2016 and 2017.  

The Final Rule for Stage 3:

  • Extends that program’s start date to Jan. 1, 2018.  Providers would have the option to move to Stage 3 starting in 2017. 
  • Adopts a uniform calendar-year EHR reporting period for all, except for those attesting to the Medicaid meaningful use program for the first time.
  • Further consolidates demonstration to eight objectives with some flexibility in proof of the public health objectives
  •  Aligns Clinical Quality Measure (CQM) reporting with the CMS reporting

Industry stakeholders and Congress had mixed responses to the release of the Final Rule and Modifications, including:

  • The Health Information and Management Systems Society (HIMSS) was generally supportive of the Final Rule and applauded CMS for its efforts to simplify and provide flexibility for meeting the Meaningful Use program requirements.
  • The American Medical Association (AMA) was pleased with CMS’ response to its request for a hardship exception for those unable to successfully attest in 2015 due to the uncertainty; encouraged CMS to provide technology vendors sufficient time to adequately develop and test products for interoperability, usability, safety and security; and requested additional consideration to “improvements in the program to promote technological innovation that supports patient care.”
  • The American Hospital Association (AHA) perceived the Final Rule as a “mixed bag” and felt that it presented new and challenging requirements in light of the fact that less than 60% of all hospitals and 90% of physicians have yet to successfully attest to Stage 2.  The organization requested a delay in implementation of Stage 3 and requested that CMS “focus instead on ensuring that providers could easily and efficiently share health information to support dare delivery and new models of care.”
  • Congress was less pleased with the Final Rule.  Senator Lamar Alexander (R-TN) stated, “… 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.” He added, “Congress will carefully review this rule and has the option of fixing it through legislation or overturning it through the Congressional Review Act.”