Meaningful Use Stage 3 a Mixed Bag for Physicians

It's a case of good news, bad news for physicians, when it comes to CMS's latest modifications to the EHR Incentive Program, affecting both Stages 2 and 3 of the program.

The rule finalizes proposals that were made by the agency back in April.

The good news, said Robert Tennant, health information technology policy director at Englewood, Colo.-based Medical Group Management Association (MGMA) in an exclusive interview with Physicians Practice, is that CMS finalized several proposals easing reporting requirements in 2015 for eligible professionals (EPs). This included reducing the thresholds for Stage 2's view, download, and transmit (VDT) requirement from 5 percent of an EP's patient panel to one single patient and reducing the secure messaging requirement from 5 percent to simply having the capability. It also finalized the elimination of redundant measures and installed a 90-day reporting requirement for this year.

Like MGMA, the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME) was pleased with those measures from CMS. However, CHIME did express concern because the final rule came out so late in the year.

"CHIME has long called for a 90-day reporting period and applauds CMS for adopting this new standard. While several members are positioned to take advantage of this shorter period, others will be challenged to meet it since there are fewer than 90 days remaining in the year. We urge CMS to implement a hardship exemption for those unable to meet this timeframe," CHIME Board of Trustees Chair Charles E. Christian, said in a statement.

The MGMA's Tennant said something similar, noting that many EPs were waiting on their software updates before moving ahead. "We're looking into options for EPs," he said. For new meaningful use providers, there is a 90-day reporting requirement, rather than a full-year reporting requirement, in 2016 and 2017.

Stage 3 Disappointment

The biggest disappointment from MGMA's point-of-view, however, is the inclusion of final Stage 3 requirements. Tennant said that MGMA and other associations, as well as members of Congress, have urged CMS to delay publication of Stage 3 rules until there is more experience derived from Stage 2.

"[CMS] did lower thresholds for key measures in Stage 3, reducing the [VDT] and secure messaging requirements to 5 percent, but it's overall disappointing that Stage 3 wasn't delayed period," Tennant said. Currently, Stage 3 is optional for EPs in 2017 and required by 2018.

The Chicago-based AMA, another group that lobbied to delay Stage 3, released a statement echoing Tennant's sentiments. "The AMA continues to believe that Stage 3 requires significant changes to ensure successful participation, and improve the usability and interoperability of [EHR] systems," the AMA's Stephen J. Stack, an emergency physician, said in a statement.

From Meaningful Use to MIPS

On a positive note, as part of the final rule, CMS is asking for feedback on Stage 3 of the EHR Incentive Program, as it relates to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which established the Merit-based Incentive Payment System (MIPS). MIPS consolidates several physician quality reporting programs by 2019.  CMS is looking to use this comment period to shape the future of the EHR Incentive Program during rulemaking to implement MACRA.

MIPS could lead to significant changes to meaningful use, said Tennant, noting that the "program continues to be fluid." There is also a chance Congress could step in, he said. In other words, MGMA isn't giving up its fight to advocate for a delay to Stage 3.

John Halamka, a noted health IT expert and the CIO for the Boston-based Beth Israel Deaconess Medical Center, said as much in his blog reacting to the news. "It would not surprise me that the CMS final rules are not really final," he noted.

Still, one important thing for physicians to know is that as of today, there are still penalties for non-compliance to meaningful use. Tennant said it would take an act of Congress to remove them. He also noted that under MIPS, EPs could very well still see reductions in payment for non-adherence to meaningful use-type regulations. "If an EP decides to not participate [in the EHR Incentive Program] in 2017, that could result in a lower MIPS score," he said.

Tennant also warns EPs that the main reason they're failing meaningful use audits is failure to conduct a security risk adjustment. He said they cannot ignore that component of the program.

Pediatrician Rebecca Fox, based in Loudon, Va., saw little surprise in the latest CMS announcement. She foresees a future where CMS' "pay-for-performance" model, which is basically what MIPS boils down to, is adopted by third-party payers.

"Personally, I think this will be very difficult for most U.S. physicians with our current healthcare model.  And [to take] a very dystopian view of medicine reimbursements in the coming years, physicians will be paid less and patients will pay higher premiums if they don't follow the recommended medical procedures and lab work as documented in their charts. The only winners will be the insurance companies," Fox said.

As part of yesterday's news, CMS and the Office for the National Coordinator of Health IT (ONC) released a final version of its

.

Physicians Practice will have more on this news as it develops.