No Stage 3 EHR Regulations in 2013, CMS Says

March 22, 2013

When organized medicine raises its voice, it often gets the government to bend its way.

Case in point is when Marilyn Tavenner, administrator of the Centers for Medicare & Medicaid Services (CMS), announced earlier this month that her agency would not propose stage 3 criteria this year that physicians must meet to earn a bonus for meaningful use of electronic health record (EHR) systems.

Tavenner's announcement followed a flurry of letters from the American Medical Association and other medical societies asking her to postpone the new requirements until physicians get the swing of stage 1 criteria now in place and acclimate to stage 2 criteria coming online next year.

Organized medicine also said that CMS should first assess how stage 1 and stage 2 are playing out before designing stage 3, which is supposed to take effect in 2016. Furthermore, the medical societies said the healthcare system must be more digitally connected, and EHRs must be capable of talking to each other, before CMS can expect physicians to meet requirements for sharing patient data with colleagues, hospitals, and laboratories. These interoperability standards become more ambitious with each phase of the 2-year-old incentive program, which rewards physicians for using EHRs in specified ways that improve and streamline patient care. Transmitting prescriptions electronically to a pharmacy is one example.

In November 2012, CMS began soliciting feedback from the healthcare industry on a very rough sketch of stage 3 criteria. Then, on March 6 of this year, during a session of the annual conference of the Health Information and Management Systems Society (HIMSS) in New Orleans, Louisiana, Tavenner said that CMS is holding its horses. The agency will not formally issue a set of proposed stage 3 regulations this year (proposed regulations are put out for public comment, which guides government officials in crafting a final version). Instead, CMS will use 2013 to assess how the healthcare industry is coping with the imminent stage 2 regulations, and the agency will make it easier for providers to share patient data electronically, according to Tavenner.

That same day, CMS issued a press release announcing that it is taking steps to "accelerate health information exchange" among providers. One of its goals is for 50% of EHR-equipped medical practices to get an incentive payment for meaningful use by year's end. Physicians who attest to meaningful use can receive up to $44,000 over 5 years through Medicare or up to $64,000 over 6 years through Medicaid.

The agency's decision to postpone development of stage 3 regulations pleased Jeffrey Cain, MD, president of the American Academy of Family Physicians.

"Physician practices are struggling with stage 2 implementation," Dr. Cain told Medscape Medical News. "Slowing down is something we want."

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