Marcia Frellick

April 14, 2015

CHICAGO — The Centers for Medicare & Medicaid Services (CMS) has agreed to relax the threshold for patient engagement in the next stage of its incentive program for the meaningful use of electronic health records.

"The number 1 thing we hear from providers is that this has been a struggle, and our data show that they may have a point, so we have revisited that," said Elisabeth Myers, MBA, policy lead for health information technology at CMS.

The meaningful use program is designed to encourage physicians to use electronic health records in ways that improve patient care and lower costs. The proposed stage 3 rule, formally released April 10, will begin to govern practice in 2018.

Myers and her colleague Elizabeth Holland, director of health information technology at the CMS, explained how the rule differs from the first stages of the CMS incentive program here at the Healthcare Information and Management Systems Society (HIMSS) Annual Conference and Exhibition.

A change to the stage 2 threshold that requires 5% of patients to access their health data electronically has been proposed in stage 3. This was driven by the huge variation in the ability of providers to engage their patients, Myers said.

"We're not getting rid of the objective," she said. "We're relaxing the threshold restriction."

The stage 2 requirement to provide access to view, download, and transmit health information to a third party for at least 50% of unique patients stands. However, in the stage 3 proposal, you only "have to demonstrate that one patient has done it," she explained.

Michael Painter, senior program officer at the Robert Wood Johnson Foundation in Princeton, New Jersey, told Medscape Medical News that the proposal was a disappointing surprise to the foundation, which has been working to raise the bar for patient engagement.

"We should all be working to get more patient views of their record, rather than less, so this is a dramatic pullback. It sends all the wrong signals to the health professional team," he said.

An audience member asked whether the view, download, and transmit requirement is still valued if the threshold has dropped from 5% to one patient, and whether the CMS considered eliminating the requirement.

Myers said that she could not discuss the intent of the proposed rule while it is in a public commenting period, and referred the questioner to the language in the proposal.

New Reporting Period

The news that the required reporting period for 2015 would be any continuous 90-day period, instead of a full calendar year, was met with applause. For now, this applies to those new to the program and to those who have participated previously. However, in 2016, that 90-day period will apply only to new participants.

Roger Neal, vice president and chief information officer at the Duncan Regional Hospital in Oklahoma, told Medscape Medical News that he is excited about the proposal to relax the patient engagement rules.

However, "while I do agree that everyone should be heavily involved in their care, ask questions, make decisions, etc., the drive to that goal across the board will take years before we see high numbers of engagement," he said. "Until then, we as providers need to keep pushing the utilities and ability for patients to be more involved, but it's not right to penalize us because we can't drive the public faster than the public wants to adopt. This change will be a huge help going forward."

David Collins, senior director of health information systems at HIMSS, said he thinks the CMS is doing what it needs to do to make the patient engagement requirement more palatable by proposing that the bar be lowered to a single patient. But he noted that the buzz he's hearing at the conference is that one is too low.

"This is a proposed rule. Comments will be sent back to the government and I have a feeling that number's going to bump up," he said.

Myers reported that the CMS is often asked whether providers have to get recertified for the different stages, she reported. The answer is no.

"You don't have to get a new product. You don't have to change your EHR. If your software is certified to the 2014 edition that the Office of the National Coordinator for Health Information Technology put out, it's fine. It works for all of these," Myers said.

The proposed rule seeks to relieve the burden on providers by eliminating some of the duplication, such as having to provide the same information in two different sections, sometimes in both paper and electronic formats.

Under the proposed stage 3 rule, areas in which providers have been "blowing thresholds away" — measures that have become givens with electronic health records instead of challenges — have been eliminated, Holland reported.

She reminded the audience that any provider who successfully demonstrates meaningful use can be audited, whether or not they get the incentive. In fact, audits have begun for stage 2, she reported.

Audit determination letters are sent by email, so it is important that providers ensure that the email address the CMS has on file is up to date, Holland stressed. The 30-day appeal period starts the date the letter is sent; if the letter is sent to an outdated address, providers might miss the chance to file an appeal.

It is expected that the proposed stage 3 rule will be finalized by August 1. Comments are being accepted until May 29 on the website.

Myers and Holland have disclosed no relevant financial relationships.


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