Stage 2 Rule Released

The Centers for Medicare and Medicaid Services released a proposed rule on stage 2 of the meaningful use EHR incentive program late yesterday. The rule is available in prepublication form, with official publication in the Federal Registerscheduled for March 7. (Read the published rule here.)

The proposed rule maintains the direction of the program set in stage 1, with a focus on increased requirements for health data exchange and patient engagement, as expected. The provisions generally reflect the recommendations of the Health IT Policy Committee made last year.

Audio Seminar
AHIMA director of federal relations Allison Viola reviewed the proposed rule in a free audio seminar March 1. Watch a replay.
Deadline Changes, Shuffled Objectives

Within the rule CMS proposes changes to the stage 2 timeline that would give providers who demonstrated meaningful use in 2011 a one-year extension in advancing to stage 2.

Under the modified deadline, such providers will have until 2014 to graduate to stage 2, which would create a single start date for stage 2.

The modification was first announced in late 2011, when it became clear that stage 2 rulemaking was running so late that vendors and providers would have insufficient time to meet the original deadline.

The rule proposes new objectives for stage 2, eliminates some, and combines others.

With two exceptions, the objectives from the “menu” set in stage 1—a list of 10 items from which providers were required to choose five—would be required in stage 2. There are new objectives with greater applicability to specialty practices.

Stage 2 would retain the core-menu approach. Eligible professionals (EPs) would have 17 core items and choose three of five menu items. Eligible hospitals (EHs) would have 16 core items and choose two of four menu items.

Nearly all stage 1 core and menu objectives would be retained in stage 2. However, some stage 1 objectives would be combined into more unified stage 2 objectives.

Raising the Bar on Patient Engagement

As expected, the proposed rule advances the patient engagement objectives. A new measure would require that more than half of an EP’s patients receive online access to their information within four business days of the information becoming available to the EP. More than 10 percent of patients must view, download, or transmit their information.

Hospitals would be required to offer inpatient and emergency department patients online access to information within 36 hours of discharge. More than 10 percent of patients must view, download, or transmit their information.

The objective would replace the stage 1 requirement to provide patients with electronic copies of their information.

The patient engagement objectives in stage 1 requirements have challenged providers, many of whom have found that their processes and IT systems are ill-prepared to provide patients with copies of their information within days, especially in electronic format.

Other proposed measures in stage 2 include secure electronic messaging to communicate with patients on relevant health information. As proposed, more than 10 percent of an EP’s patients must send a secure message using the messaging function in the provider’s EHR.

Easing Quality Measures Reporting

Acknowledging the challenges the industry currently faces in reporting quality measures, CMS proposes better alignment of stage 2 measures with existing programs, such as PQRS and Joint Commission accreditation.

EPs would report 12 clinical quality measures, and EHs would report 24. The rule also proposes a means to submit measures electronically and solicits comments on other methods.

Practices would be allowed to upload quality measures in batches, enabling them to report measures collectively for all physicians rather than individually.

What’s Next

Comments on the rule will be due 60 days following publication in the Federal Register.

AHIMA will release its comments on its Advocacy and Public Policy Center site in advance of the submission deadline. The Journal will offer summaries and analyses of the rule online and in print during that time.

CMS intends to publish a final rule in the summer.

A companion rule detailing the standards, specifications, and certification criteria for EHRs used in the meaningful use program is expected at any time. The rule will reflect the new or heightened standards and functionality EHR systems will require to support the objectives of the stage 2 rule.

[Editor’s note: the certification rule, released February 24, is reviewed here.]

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