Editor’s Note: We originally wrote this post detailing the reasons that Stage 2 Meaningful Use was unattainable for most eligible providers before CMS announced the proposed rule on May 20 that changes the requirements. In the article, we outlined the obstacles that were preventing most providers from successfully attesting in the existing ecosystem. As we predicted, CMS was forced to change the requirements due to these issues.

CMS’s role in Meaningful Use was never supposed to be a political one, but with Stage 2 Meaningful Use we have noticed that CMS officials are acting like garden variety politicians. We have come to expect that our political leaders may offer information that is skewed toward their political bias, and we understand that oftentimes we must question the “facts” or policies they propose.

We never expected that behavior from CMS.

So far, as we discussed in part I of this blog post, Meaningful Use Stage 2 has been an unsuccessful endeavor for most providers. CMS hyped Stage 2 compliance well in advance of the 2014 start date. The best and most nimble EHR companies spent millions of dollars preparing for 2014 certification. CMS encouraged stakeholders to become early adopters and the outcome is that CMS has been unsupportive of their most ambitious vendors and Eligible Professionals (EPs).

Building EHR systems to the 2014 standard is a challenge. In fact, most EHR products that were certified to the 2011 standards have not yet been certified to the 2014 standards. It takes a lot of dedication and financial wherewithal to meet the 2014 standards.

More importantly, it is even more challenging to integrate them into provider workflow such that Meaningful Use Stage 2 compliance does not present a distraction from patient care. But in spite of vendors’ best efforts, well-intentioned EPs who believe in Meaningful Use and wanted to participate in the first part of this year have mostly been thwarted by CMS rulemaking.

We are approaching 5 months into Stage 2 and it is still almost impossible for community-based providers who operate in geographies that have a diverse population of providers on disparate EHRs to meet Meaningful Use Stage 2. If one attends CMS webinars or probes their website, one would never know that for hundreds of thousands of EPs Meaningful Use Stage 2 is unachievable. It is the little secret that CMS absolutely won’t divulge.

No Relief from CMS

We have contacted CMS multiple times to raise this issue, but we continue to be rebuffed. Our belief is that they hope the ecosystem will catch up in the 4th quarter of this year and that the various disparate systems will miraculously begin communicating with each other.

We doubt that this will happen fast enough to help providers meet this requirement. In fact, we suspect that some providers may find an out. In its zeal to accelerate the development of the secure messaging ecosystem, CMS has created a perverse incentive to not record transitions of care in the EHR. The measure offers an exclusion “if you transfer a patient to another setting or refer a patient to another provider less than 100 times during the reporting period.”

In the original version of this blog post, we said that we wouldn’t find it surprising if some providers used paper referrals during their reporting period to present the appearance that they refer less than 100 times.

Now, due to pressure from a variety of groups including medical societies and industry associations, particularly at a contentious industry meeting last week, CMS has changed course with its new proposed rule. Until these obstacles in the healthcare ecosystem can be resolved, this only makes sense.