Not even three months ago, Marilyn Tavenner, Administrator of the Centers for Medicare and Medicaid Services (CMS), announced that there would be no more delays of the compliance dates for the Meaningful Use program (she said the same thing about ICD-10, but let’s not go there). Earlier this week, CMS essentially reversed that position in what amounted to a big smack in the face to any health care provider that has put in the effort and time to knock Stage 2 out of the park.
In a proposed rule, CMS finalized its decision to extend Stage 2 through 2016 — a year longer than initially planned. In doing so, the extension gives so much leniency to any vendors that cannot implement a 2014 certified EHR across its entire provider base that it basically delays Stage 2 another year. Providers using these vendors can stay on their 2011 certified EHR and have the option to satisfy the much easier Stage 1 measures, even if by previously published CMS timelines they should be in Stage 2 by now. Providers who purchased wisely and have had no trouble adopting a 2014 certified EHR with their vendor will be held to the more demanding Stage 2 requirements. CMS can call it an “extension,” or whatever they want, but this is a delay of Stage 2, and an inequitable one at that.
This new "rule" also isn't a rule so much as the latest in a rolling series of capitulations to vendors who are only too happy to continue to sell annual licenses for federally-certified outdated technology. Meaningful Use began as a well-intentioned program before it was hijacked by bureaucrats pandering to dinosaur systems. We can’t fault CMS for some accommodation of providers using technology that simply cannot fulfill the goals of Meaningful Use because they purchased those EHRs in reliance of the federal government’s certification. Surely those providers deserve some leniency now that those federally certified EHRs aren’t up to the task of Stage 2.
However, that leniency was actually already provided through expanded hardship exemptions that would grant a penalty exemption (not meeting Meaningful Use now comes with a financial penalty) to providers struggling to implement a 2014 certified EHR because of problems with their vendor. As we proposed in an earlier blog post, we think that even the leniency that came from hardship exemptions would benefit from an infusion of transparency and equity. By allowing providers to also stick with Stage 1 requirements as part of the new “rule,” CMS is now agreeing to actively subsidize, with billions of taxpayer dollars, technology that everyone acknowledges cannot achieve the overarching goals of the Meaningful Use program. It’s just bad policy.
It also creates some perverse incentives. The government has created a system where providers will receive additional federal money for meeting the low Stage 1 standards with outdated technology that does not support things like interoperability or patient engagement. Providers who have done the right thing and prepared well for Stage 2 using cloud-based services like athenaClinicals are required to stick with Stage 2’s tougher set of requirements. We would never advocate penalizing providers who made a bad EHR purchasing decision for Stage 1, but their vendors should not indirectly be rewarded for underperformance. At some point health IT in this country is going to have to join the 21st century.
Providers working hard to successfully meet the Stage 2 measures shouldn’t feel that it is all for naught. You are on the cutting edge of using technology to deliver better care, and that makes you some of the best care providers out there. As we move away from fee-for-service reimbursement and toward value-based models, you will hit the ground running with an engaged patient base that is wired in for excellent care management. We could not be more proud of our Stage 2 providers — 18.6% of whom that were ready to attest or attested in the first quarter — who are leading the way.
We don’t know where the Meaningful Use program will go from here. And as always, athenahealth will continue pushing in DC for a level playing field. We are committed to doing everything we can so that our providers can spend less time focusing on administrative tasks and more time caring for patients. So long as those administrative tasks include satisfying Meaningful Use requirements, we will make sure that our providers are ready to be the best of the best, as easily as possible.