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Delayed Health IT Upgrade Spurs Debate over Toughening Standards

By John Reichard, CQ HealthBeat Editor

May 22, 2014 -- An administration proposal this week to ease the deadline for providers to adopt upgraded electronic health records was greeted with relief by hospitals and some other providers while consumer groups reacted with resignation.

The decision to delay "2014 compliant" systems by doctors and hospitals enrolled in the Medicare and Medicaid programs should be used to strengthen requirements to assure consumers benefit from the technology, said Debra Ness, president of the National Partnership for Women & Families.

The delay acknowledges the difficulties hospitals have encountered obtaining compliant systems, federal officials said. Current requirements call for hospitals to have such systems operating for at least one quarter of fiscal 2014, which ends Sept. 30, effectively requiring the systems in place by June 30.

Fiscal 2015 reimbursements would have been cut below a base payment rate for services delivered if facilities didn't have the systems operating by this summer. Conversely, those with systems in place by the designated time would have qualified for bonus payments above the base rate.

Hospital operators say that all too often, the 2014 edition systems aren't available from vendors.

"The steps we are announcing today will give new options to those who, through no fault of their own, have been unable to get the new 2014 edition technology, including those at high risk, such as smaller providers and rural hospitals," Karen DeSalvo, the national coordinator for health information technology at the Department of Health and Human Services, said this week.

The proposal allows providers to use 2011 edition electronic medical records this year in order to qualify for fiscal 2015 bonus payments and avoid penalties.

Beginning in 2015, eligible hospitals, doctors and other caregivers would be required to use 2014 systems.

The Centers for Medicare and Medicaid Services had notified hospitals they could avoid 2015 payment penalties by filing for hardship exemptions if they couldn't find 2014 compliant systems. But hospital officials complained that exemption status would cut them out of payment bonuses.

"The American Hospital Association welcomes this proposed rule and the enhanced flexibility it would provide," said Rich Pollack, the trade group's executive vice president.

The 2009 economic stimulus law (PL 111-5) provided for billions in Medicare and Medicaid payments for electronic health records, spurring their adoption throughout the health care system. But providers have to attest they are making "meaningful use" of the technology. The requirements ramp up in three stages, with deadlines varying based on what year providers first begin getting bonus payments for health IT.

"Without the flexibility the proposed rule offers, many, if not most, hospitals would not meet meaningful use in fiscal 2014," Pollack said. That "would be a setback to the movement toward widespread adoption of these new technologies."

Consumer advocates are less pleased. "While this proposed delay gives some parties time they need to overcome difficulties, it also means patients will have to wait longer for better access to health information, better care and better health," Ness said in a statement. Those were things "they deserved and expected this year."

"We recognize that the work is not simple or easy but at the same time, it is disappointing that, once again, patients and families will have to wait," she added.

The proposed rule also would make formal a previous statement by federal officials that they will extend the second stage of compliance with the health IT directive through 2016 and begin stage three in 2017.

"By extending stage two, we are being receptive to stakeholder feedback to ensure providers can continue to meet meaningful use and keep momentum moving forward," said Centers for Medicare and Medicaid Services (CMS) Administrator Marilyn Tavenner.

Ness said CMS should use the additional time in the third stage to revisit the recently withdrawn requirements to send patient reminders for preventive or follow-up care. She added that stage three criteria should be toughened to reduce health disparities among ethnic groups. That should be done by including "full access" to electronic medical records in languages other than English, she said.

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