CHIME’s initial analysis of the provisions favors the phased approach used to measure the meaningful use of EHRs. “Through the phased approach, first-year meaningful use criteria will apply to hospitals whenever they are eligible. However, the current schedule places pressure on hospitals that delay in implementing electronic health records, because by 2015, all hospitals and eligible providers would need to meet Stage 3 criteria to avoid payment penalties,” according to the organization.
To qualify for the incentive payments in either Medicare or Medicaid, eligible providers and hospitals must use certified EHRs to meet specific objectives and report specific HIT functionality measures to CMS. Additional quality measures also will need to be submitted, and as a whole, reporting requirements will be burdensome; many of the measures will require organizations to gather information that spans both electronic and paper-based systems, such as the percentage of orders entered through CPOE systems. Initial reporting will be done through attestation to CMS, but that will still require hospitals to provide data on each of the HIT functionality measures.
Quality reporting provisions of the regulation also will require hospitals to develop reporting capabilities, since only nine of the 35 quality measures being proposed in the regulations currently are in use in the Medicare pay-for-reporting program.
For physicians, the use of PQRI indicators for reporting quality data “will be a major challenge,” CHIME believes. The proposed regulations indicate that medical groups that qualify for stimulus funding no longer will be eligible for the 2 percent bonus for reporting PQRI data.
The regulations also stipulate that hospital-based physicians are not eligible to receive stimulus payments. “That creates a disincentive for healthcare systems and teaching programs from investing in ambulatory records systems for these physician groups,” states CHIME.
CHIME also is concerned about the regulations’ burden on providers to demonstrate that they are using “certified EHR technology.” To receive Medicare and Medicaid incentive payments, providers must attest to CMS that the EHR system they use meets the statutory definition of a qualified EHR and has been “tested and certified in accordance with the certification program established by the National Coordinator.” CHIME is concerned that the certification process won’t be known until it is described in a forthcoming proposed rule from ONC, and that neither of the just-released CMS and ONC regulations provide for acceptance of previous CCHIT certification or allows for a transition time between when certification criteria are announced and when providers will be expected to use products certified to those criteria.
CHIME is conducting an intensive analysis of the regulations, primarily through the efforts of its Policy Steering Committee, which is composed of member CIOs who will closely examine the proposed regulations for their potential impact on widespread implementation of EHRs.