CMS Meaningful Use EHR softwareIn June, we attended a CMS meeting for EHR vendors that reviewed the Meaningful Use Proposed Rule that would offer more “flexibility” with regard to reporting in 2014. In addition, the rule proposed increasing the length of Meaningful Use Stage 2. We subsequently blogged about the rule and we presented an overview of the proposed version. In addition, we reported on some issues that we felt were ambiguous. CMS has just published the Final Rule and we believe it clarified the issue that we were most concerned with.

Overview of the September 2014 Meaningful Use Final Rule

  1. Stage 2 of the Meaningful Use incentive program will be extended through 2016
  2. Stage 3 will begin in 2017 for providers who first became meaningful users of electronic health records in 2011, 2012 or 2013
  3. Maintains the 3 month (quarterly for Medicare) reporting period
  4. Allows eligible providers to use any of the following options to meet Meaningful Use in 2014:
    1.  2011 edition certified electronic health record technology (CEHRT),
    2. a combination of 2011 and 2014 edition CEHRT
    3. 2014 CEHRT to report Stage 1 objectives
    4. 2014 CEHRT to report Stage 2 objectives
  5. Eligible professionals (EPs) must use the 2014 edition CEHRT in 2015
  6. The 2015 reporting period for EPs is the full calendar year

None of the above captioned flexibility rules have changed when comparing the May 2014 proposed rule to the September 2014 final rule, but CMS has clarified several issues that caused concern for many in the medical community.

Some MediTouch Eligible Professionals (EPs) have already attested to the Stage 2 objectives and others plan to report using those objectives in the 3rd or 4th quarters. We believe that most MediTouch EPs will opt to meet Meaningful Use by using our 2014 CEHRT to report the Stage 1 objectives. Many of them have been waiting for the proposed rule to become law and are planning on using the final Medicare Meaningful Use period (October – December) as their 90-day quarterly measurement period.

If you are a Stage 2 EP (you already attested for 2 years using Stage 1) then the ability to use the new flexibility option of using 2014 CEHRT to report Stage 1 measures hinges on the following portion of the final rule:

These proposed alternatives are available only for those providers that could not fully implement 2014 Edition CEHRT to meet meaningful use for an EHR reporting period in 2014 due to delays in 2014 Edition CEHRT availability.

CMS provides more detail on the use of the phrase “fully implement”:

A provider’s ability to fully implement all of the functionality of 2014 Edition CEHRT may be limited by the availability and timing of product installation, deployment of new processes and workflows, and employee training.

CMS must feel strongly about the above captioned clauses because they are asking Stage 2 EPs to attest to the fact that CEHRT was not available in time for them to fully implement the Stage 2 Objectives if they choose to use the Stage 1 Objectives instead.

On face value, it would be hard for a long-time MediTouch user to attest that our EHR software was not available for 2014 since it was certified and delivered via the cloud in June 2013. As is often the case with CMS rulemaking, there are always subtleties–and some of those apply to MediTouch users that are Stage 2 eligible. It is vitally important that MediTouch Stage 2 Eligible Professionals understand the detail.

First of all, take a deep breath: If you are a Meaningful Use Stage 2 MediTouch EP, we believe in most cases the new rule supports reporting on the Stage 1 Objectives. Before we explain why, let’s review how a MediTouch user could have difficulty with Stage 2.

We believe that our software is perfectly suited to meet the Stage 2 objectives today. We have maintained and authored several blogs with regard to a failure in the healthcare ecosystem as grounds for why Stage 2 is not feasible for most EPs. It was never related to the availability of our software or provider enthusiasm for the Stage 2 program.

Specifically, the failure in the healthcare ecosystem is related to the CMS Stage 2 Objective associated with the transitions of care measure that requires transmission of an electronic summary of care document using 2014 Edition CEHRT. This measure requires providers to send an electronic summary of care document for more than10 percent of transitions or referrals.

Most EPs are having trouble meeting the “electronic summary of care document for more than 10 percent of transitions or referrals” because it requires that their referral network is able to communicate with MediTouch via the new secure email (Direct Messaging) protocol.

There are several reasons why some vendors are behind schedule with regard to making Direct secure email available:

  1. They are not certified to the 2014 objectives
  2. They are certified but they have not implemented all of their providers
  3. They have partially implemented providers but have not provided Direct addresses
  4. They have not made their HISP directory available to other EHR vendors

CMS has clarified their position on the “transitions of care” objective in the final rule. We originally thought that this obstacle would be addressed by attesting that not being able to send Direct Messages to referral partners was a “workflow” issue. Instead CMS takes the issue on straightforwardly:

the sending provider may experience significant difficulty meeting the 10 percent threshold, despite the referring provider’s ability to send the electronic document, if the intermediary or the recipient of the transition or referral is experiencing delays in the ability to fully implement 2014 Edition CEHRT. We acknowledge referring providers may not be able to meet the summary of care measure in 2014, if receiving providers they frequently work with have not upgraded to 2014 Edition CEHRT.

CMS reinforces that providers not able to meet the transition / summary of care measure may attest to Stage 1 and they remind the provider to retain documentation that they were unable to meet the measure’s 10% threshold.

A referring provider under this circumstance may attest to the 2014 Stage 1 objectives and measures for the EHR reporting period in 2014. However, the referring provider must retain documentation clearly demonstrating that they were unable to meet the 10 percent threshold…

For MediTouch users, the choice is simple: Either attest to Meaningful Use Stage 2 as originally planned, or attest to Stage 1 if you are not able meet the 10 percent threshold for the electronic summary of care document for a transition or referral because your referral partners have not successfully implemented 2014 CEHRT.

As always, remember to retain your documentation!