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Act III for meaningful use — The EHR incentive program Stage 3 proposed rule
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CMS issued its Stage 3 Meaningful Use Proposed Rule on March 30 (Proposed Rule). Stage 3 is expected to be the final stage of the Electronic Health Record (EHR) Incentive Program when the regulation is finalized. This article provides a high-level review of the Proposed Rule. A more comprehensive assessment of the proposed objectives and measures is available here.
Providers who fail to meet the meaningful use requirements face payment reductions
Initially, the EHR Incentive Program provided incentive payments to eligible professionals (EPs) participating in Medicare and Medicaid programs who adopt and meaningfully use certified EHR technology (CEHRT). Today, EPs who were not meaningful users faced Medicare payment adjustments of up to 2% starting on Jan. 1. The penalty will increase to 5%.
If the Proposed Rule is finalized as proposed, it will be more difficult for providers to meet the meaningful use standards and avoid payment reductions. CMS has raised the bar and imposes heightened requirements, many of which will require providers to expand and modify their existing EHR technology to meet these new proposed targets by 2018.
The same meaningful use requirements will be applied to all practices for the entire 2018 calendar year
Starting in 2018, CMS proposes to require all providers to meet the Stage 3 meaningful use requirements, regardless of their previous stage of participation. Providers have the option to begin attesting under Stage 3 in 2017. Providers will need to report for a full calendar year, rather than the 90-day reporting period permitted in the earlier stages, to avoid Medicare payment reductions. Providers attesting under the Medicaid program will still have the option for the shorter 90-day reporting period for the first year.
Significant Stage 3 changes your practice needs to know
In Stage 3, CMS proposes to make some significant changes to the structure of the Meaningful Use Program. Stage 3 measures require all providers to:
- Use electronic format, utilizing EHR functionality rather than paper-based actions as is permitted for certain activities under Stage 1 and 2
- Use the 2015 edition of certified EHR technology beginning in 2018
- meet significantly higher compliance rates for several measures from the Stage 2 requirements
- Protect electronic protected health information through administrative, physical, and technical safeguards and to conduct a security risk analysis of its CEHRT upon installation of CEHRT, or an upgrade to a new edition of CEHRT, and risk analysis of its CEHRT and administrative, physical, and technical safeguards on an annual basis
- Incorporate an electronic summary of care document that is transmitted to and received by the provider into its CEHRT accept and incorporate patient-generated health data or data from nonclinical settings into the provider’s CEHRT
- Create a summary of care record using CEHRT and electronically exchanging the record with other providers
- Expand the CPOE function to include diagnostic imaging and permit only credentialed staff to perform CPOE functions
- Demonstrate active engagement on public and clinical data reporting, which means the provider must be sending production data to, or in the process of moving toward sending such data to, a public health agency or clinical data registry; and provide patient access to their health information within 24 hours of the information being available to the patients’ provider.
For a detailed list of the Stage 3 proposed objectives, measures, exclusions, and significant revisions from Stages 1 and 2, please refer to our meaningful use chart here.
Comments:
CMS is soliciting comments on a number of aspects of the Proposed Rule. Comments are due to CMS on May 29.
References:
1. 80 Fed. Reg. 16732 (March 30, 2015) (to be codified at 42 C.F.R. pt. 495)
Nicole Liffrig Molife, JD, is a counsel at Arnold & Porter, LLP, in Washington, DC and a member of the FDA and Healthcare practice group. She can be reached at Nicole.Liffrig@aporter.com.
Victoria M. Wallace is only admitted in Virginia. She is not admitted to the practice of law in the District of Columbia.