The Gift of a Meaningful Use Delay

By Matthew Weinstock	December 01, 2011
HHS' announcement that it will delay Stage 2 implementation is welcome news to providers.

HHS Secretary Kathleen Sebelius delivered some early holiday cheer to health care providers and IT vendors yesterday when she announced that the department will delay the start of Stage 2 meaningful use from fiscal 2013 to fiscal 2014.

The announcement wasn't a total surprise ? as we reported from the CHIME Fall Forum last month, CMS officials all but guaranteed that a delay was imminent ? and was well received by the field. "America's hospitals welcome today's announcement that HHS intends to delay the start of Stage 2 meaningful use," AHA President and CEO Rich Umbdenstock said in a statement. "While the flow of meaningful use incentives to date has been slow, the delay will better align EHR adoption policy with market realities, such as limited vendor capacity to work with providers. Giving hospitals another year to implement these changes before the bar is raised on the meaningful use requirements is good news, especially for small, rural and safety net facilities."

David Muntz, senior vice president and CIO at Baylor Health Care System and a CHIME board member, says the decision "demonstrates yet again that the regulators are doing a good job of balancing bold objectives with real-world constraints. They hear what we've said and when appropriate make adjustments that ultimately benefit all participants."

The most obvious beneficiaries of the delay are those providers that have already attested to Stage 1. Why? Because they'll no longer be penalized for being early adopters. Originally, hospitals attesting to Stage 1 in 2011 would have had to start meeting Stage 2 requirements in October 2012. The problem is this: CMS isn't expected to publish a proposed rule until February and finalize Stage 2 requirements sometime in the summer. That would have left a very small window for providers ? and their vendor partners ? to build in the necessary applications and workflows. Now, all providers will have until October 2013 to start meeting Stage 2 requirements. Additionally, early adopters will get three years of Stage 1 incentive payments.

As of October, CMS reports that 6,040 providers (235 hospitals and 5,805 eligible providers) have received a Medicare incentive payment, to the tune of $527,486,150. Medicaid has paid 9,306 providers $711,620,108.

Chantal Worzala, director of policy at the AHA, makes a couple of other interesting points about the delay:

• Under the old timeline, hospitals would have been using the ICD-9 coding set during the first half of Stage 2 compliance and then shifted to ICD-10 when those codes kick off in Oct. 2013. That could have created challenges for building efficient clinical decision support systems since they key off of the codes.
• Between ICD-10, meaningful use, the 5010 transaction set and increased reporting of quality measures under the Affordable Care Act, there's been a "piling up of regulatory requirements." IT departments are being stretched thin, something we talked to leading CIOs about at the CHIME Fall Forum.

While the AHA and others applauded the extension, they don't want this to slow the rulemaking process. Hospitals, physicians and vendors need to know where Stage 2 and 3 are headed so that they can continue to evolve their IT adoption strategies. "It is important that the rulemaking continue as planned," says Worzala. She adds that the AHA is urging CMS to ensure that Stage 2 rulemaking is carefully thought out and uses sound evidence to set the new benchmarks that providers will need to meet.

Equally important, says Muntz, providers should not use the extension as an excuse to push back their implementation plans. There are enough indications from CMS and federal advisory boards to ascertain the general direction the regs will likely take, so he says, hospitals need to be ready.

Where are you in your meaningful use journey? Email me at mweinstock@healthforum.com.

Matthew Weinstock is senior editor of Hospitals & Health Networks.

The opinions expressed by authors do not necessarily reflect the policy of Health Forum Inc. or the American Hospital Association.

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