Doctors, hospitals unite to improve meaningful use stage 2

Washington Predicted problems that physicians and hospitals will encounter in upgrading and using electronic health record systems with new functionality mandated by the federal government have prompted an urgent call for additional flexibility from users of the technology.

The transition dates to move to stage 2 of the program for demonstrating meaningful use of an EHR system are near, and they may leave some physicians and hospitals behind, the American Medical Association and the American Hospital Assn. warned in a joint July 23 letter to Health and Human Services Secretary Kathleen Sebelius.

Vendor readiness in creating software that complies with robust criteria developed by HHS is just one of many concerns shared by physicians and hospitals. They are worried that problems will put practices and facilities in the position of needing to throw out their EHRs and buy new systems, or else fall short of requirements and pay a financial price through missed bonuses and future Medicare penalties.

The AMA and AHA have found that many stakeholders, including the vendors designing the systems, are not ready and will struggle to move to stage 2 after investing significant time and money during stage 1. An estimated 500,000 hospitals and physicians who met requirements for stage 1 beginning in 2011 or 2012 will go to the next level of adoption. Hospitals are scheduled to begin stage 2 on Oct. 1, with physicians following on Jan. 1, 2014.

“Our members share the administration's commitment to the widespread adoption of EHRs; however, we believe that the best way to move the program forward and ensure that no providers, particularly small and rural ones, are left behind is to realign the meaningful use program's current requirements to ensure a safe, orderly transition to stage 2,” the joint letter stated.

Only 11 EHR products designed for physician offices have completed 2014 certification requirements for stage 2 as of July 17, even though about 1,300 products had been certified under stage 1 standards. Physicians and hospitals will be pressed to upgrade systems, and the vendors probably will experience a surge of EHR users, which could drive up prices for systems and consulting, the associations said.

“These time constraints are exacerbated by the need for health care providers to meet coinciding federal requirements, such as the transition to ICD-10 by Oct. 1, 2014,” the letter stated.

The AMA will continue urging the Obama administration to make necessary changes to stage 2 and increase efforts to improve the usability of these systems for physicians, said AMA Immediate Past Chair Steven J. Stack, MD. Stage 2 is considerably tougher than stage 1. Physician systems will be expected to exchange data and communicate electronically more with patients.

“The AMA is increasingly alarmed at the pace the meaningful use program is moving ahead without a mechanism to correct the program as we learn from provider and vendor experiences over the past few years,” Dr. Stack said. “It is clear from the experience in stage 1 that unless stage 2 requirements are modified to allow greater flexibility for physicians, particularly specialists, not only will many physicians not qualify for incentives, they'll also be hit with a penalty. We continue to strongly urge the administration to revise stage 2 criteria and require EHRs to meet more usability criteria to achieve certification.”

Physicians new to the incentive program spend two years in stage 1 before progressing to stage 2. Since 2011, Medicare and Medicaid have offered bonuses for adopting the paperless systems. In Medicare, the incentives begin to turn into penalties for nonadopters in 2015. Physicians must start achieving requirements for meaningful use by July 2014 — and attest that they have done so by Oct. 1, 2014 — to prevent their 2015 Medicare pay being lowered by 1%.

White House resistance to delays

While the AMA and AHA fight for more flexibility in the program, administration officials have rejected calls to halt or further delay stage 2. In December 2011, HHS granted physicians who first reported meeting stage 1 that year a one-year reprieve from moving onto the next stage. Previously, early adopters had been scheduled to begin stage 2 in 2013.

Stage 2 represents a big step forward on patient engagement through EHRs and on system interoperability, said Farzad Mostashari, MD, the HHS national coordinator for health information technology, during a July 17 Senate Finance Committee hearing. Dr. Mostashari was asked by Sen. Orrin Hatch (R, Utah) if pausing the program temporarily to evaluate progress to date and assess the government's return on investment into EHR adoption would be a good idea. A pause also would involve a delay in penalties to nonadopters of EHR systems.

“No, sir,” Dr. Mostashari responded. “I believe a pause in the program would stall the progress that's been hard-fought. With the movement we've accomplished through stage 1, we need to give stage 2 a chance to move ahead and to meet the urgency of the moment in providing support for coordinated care for the transformation of health care. A pause would take momentum away from progress.”

Vendors, others sound alarm

The challenges for physicians and hospitals who already met the stage 1 criteria are daunting. These EHR users will be required to move to stage 2 with new editions of certified technology, while at the same time preparing for and switching to the ICD-10 diagnosis coding sets and adapting to upcoming payment reforms in Medicare, Medicaid and the private sector, John Glaser, PhD, CEO of health services for Siemens Healthcare, said at a second Senate Finance Committee on July 24.

Federal officials should extend stage 2 deadlines until Oct. 1, 2015, Glaser told the Finance Committee. Adopters also should be given three years under stage 2 before being mandated to move to the third and final stage, currently set at 2016 for early adopters.

“The industry overall is challenged to address the demands of stages 1, 2 and 3,” Glaser said. “So the vendors are challenged with staffing, as are the providers.”

Physicians at small and rural hospitals in particular are in danger of coming up short in the process, Marty Fattig, CEO of Nemaha County Hospital in Auburn, Neb., told the July 24 hearing. The hospital expects to move forward to stage 2 in mid- to late 2014, but only after it purchases new software and adjusts its work flow. For instance, a secure patient portal must be brought online, along with an interface that enables public health reporting to state officials. He said some may find that current vendors won't be able to satisfy the new standards, and many lack the financial resources to adapt to the evolving EHR program.

“I believe policymakers will need to make changes to the meaningful use program to ensure small and rural hospitals are not left behind as we make the transition to stage 2 of meaningful use,” Fattig said.