After working through half the 2,000 comment letters it received on the Meaningful Use Notice of Proposed Rulemaking, the industry is looking for a lower bar and greater overall clarity, said the Centers for Medicare and Medicaid’s Tony Trenkle during the federal HIT Policy Committee meeting today in Washington, D.C. Other recurring issues taken up in the comments were:
- A desire for greater flexibility in qualifying for incentive monies
- Allowing payout if organizations meet a percentage of the overall measures
- Scaling incentive payments for providers that meet some measures (which CMS cannot do, according to Trenkle)
- Reducing the number of clinical quality measures overall
- Reducing the thresholds of the measures
- A desire that providers not have to report the number of overall orders written by their institution (the denominator)
- Complaints about manual process this necessitates
- Pushback on the administrative (non-clinical) measures being required
- Concerns about CPOE requirements being overly aggressive
- Concerns that Stages 2 and 3 have not been laid out, making strategic planning difficult
- Ineligibility of hospital-based physicians
- Concern that health systems with multiple hospitals operating under a single provider number are ineligible for multiple stimulus payments
- Concern that length of reporting period in second year is too long. A desire that it also be three months, like year one.
No matter how well intentioned a comment is, the proposed solutions need to be realistic, explained Trenkle, director of the CMS Office of e-Health Standards and Services. “When you talk about flexibility, I understand that from a conceptual standpoint, but we have to be able to translate that into something operationally feasible. The more complexity you build into this process, the more difficult it is to launch a program quickly and efficiently.”
Commenters should also understand the level of interplay required between the regulations — the Meaningful Use NPRM, Certification Process NPRM and Certification Standards IFR — which can further make it difficult to effect major changes in one. “There really is a dance that must take place between all the final regulations,” he added.
Over the next few weeks, CMS will continue to analyze the remaining letters and “tease out” the common policy themes, said Trenkle. “We group them with patters, rationale, data and statutory policy. If they require major policy decisions, we float those up through the ranks,” he said. From there, the organization will create policy papers and have them reviewed by members of the Department of Health and Human Services, the Office of Management and Budget, and the administration, if necessary.
He said CMS would come back to the Committee in April with a more comprehensive report on the comments, and expected a final rule sometime in “late spring, depending on whether some of the issues need further clarification.”