Physicians React to Meaningful Use Stage 2 Final Rule

CMS on Thursday announced the final rule for Stage 2 of the Medicare/Medicaid EHR Incentive Programs.

It’s clear from the final rule that when it comes to Stage 2, which is slated to begin for eligible providers (EPs) in 2014, CMS is expecting much more from physicians.

“The requirements do become more challenging in Stage 2 ...,” physician Chuck Dietzen, chief medical officer at iSalus Healthcare, told Physicians Practice via e-mail, noting that physicians will need to fulfill 17 of 20 "core" objectives in Stage 2 (rather than 15 of 20, as they had to fulfill in Stage 1); and they will need to fulfill three of six menu objectives (rather than five of 10).

In addition, the Stage 2 requirements expand both in scope, (many of the Stage 1 objectives combine to make up more unified Stage 2 objectives), and in threshold, (the percentages required to meet many of the objectives are higher than the percentages required in Stage 1).

Here’s a look at some of the key challenges physicians can expect to encounter in Stage 2:

Information Exchange. Stage 2 ups the ante when it comes to interoperability. One core requirement, for example, is that when the physician transitions his patient to another care setting he must provide a summary of care record for more than 50 percent of transitions of care. In Stage 1 this was a menu set measure.

The requirement also states that the EP must electronically submit transition of care using Certified EHR Technology so the recipient receives the summary of care record via exchange facilitated by an organization that is an NwHIN Exchange participant or in a manner that is consistent with the governance mechanism ONC establishes for the nationwide health information network more than 10 percent of the time.

Nick van Terheyden, MD, CMIO at Nuance Healthcare, told Physicians Practice the increasing focus on interoperability in Stage 2 will be one of the biggest struggles for physicians.

“Sharing of data is a key value proposition but to do so requires the data to be in shareable/interoperable form,” he said via e-mail. “This is not just sending HL7 messages to and from systems, this requires the use of data standards, vocabularies, and transport mechanisms. All good news for inbound data easing the burden of recapture/data entry but systems have to be able to create this data as well. This cannot be a manual data entry nor abstraction task and technology will be the key to successfully delivering against this requirement.”

Patient Engagement. Another challenge will be that many of the Stage 2 requirements also focus on increasing patient engagement, said Dietzen. “...The Stage 2 requirements take the meaningful use responsibility and requirements away from a physician per se and push towards a more active engagement from the patient.”

For example, one objective requires that a percentage of the physician’s patients send secure health messages to him. Another requires that a percentage of patients view, download, or transmit portions of their health record.

It’s not all bad news:

Still, despite the challenges when it comes to Stage 2, physicians may have reason to be optimistic. Here’s why:

Brian Zimmerman, physician and co-founder of consulting company Physician Technology Partners and current Epic Physician Champion for the Emergency Department at Miami Valley Hospital, told Physicians Practice via e-mail that to him, Stage 2 appears “easier” than Stage 1.

“Many of the large [EHR] systems have already built in some of the functionality that is required [in Stage 2],” he said. That of course, should make it easy for many physicians to attest to the new requirements.

In addition, Terheyden said it’s that by the time physicians attest to Stage 2 they will have already attested to Stage 1. As a result, they will have valuable experience to build upon.

“Many of the new certification standards are incremental, increasing percentage compliance/uptake so compliance will be focused on increasing the participation as opposed to building from scratch,” he said.