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Next Stage of Meaningful Use Regulations Drawing Hill Scrutiny

By John Reichard, CQ HealthBeat Editor

September 4, 2012 -- Consumer advocates are giving good marks to the latest round of federal rules designed to spur the use of information technology to improve the quality and efficiency of health care. Hospitals and vendors? Not so much—but each for different reasons.

For their part, lawmakers haven't had much so to say so far, but at least one House committee may hold a hearing later this month to review the rulemaking program, which aims to promote the "meaningful use" of health IT by paying providers who employ the technology higher Medicare and Medicaid payments and paying less to providers who don't.

"We are pleased that the new rule gives patients the ability to go online and view, download and transmit their health information from the Electronic Health record to secure places of their choosing," said Christine Bechtel, vice president of the National Partnership for Women & Families. But Linda Fishman, an American Hospital Association official, said, "We are disappointed that this rule sets an unrealistic date by which hospitals must achieve the initial meaningful use requirements to avoid penalties."

Published last week in the Federal Register, the rule issued by the Centers for Medicare and Medicaid Services governs "stage two" of the meaningful use program. In stage one, in order to qualify for higher payments, doctors and hospitals have to begin recording health data digitally and provide patients with electronic copies of health information. About 120,000 health professionals and 3,300 hospitals have qualified for higher payments by meeting stage one requirements, according to a Health and Human Services news release.

Also published were criteria that electronic health records must meet to be certified as eligible for the meaningful use program. Issued by the HHS Office of the National Coordinator for Health IT, the criteria allow technology certified in 2011 to be used until 2014. The IT office also said it is modifying the certification program to cut red tape.

"The stage two rules we issued last week include new standards that will help to make sure that electronic health record systems are interoperable, which means that vendors will need to develop and sell EHRs that can talk to one another," said Peter Ashkenaz, a spokesman for National Coordinator's office. "Interoperability means that there is robust health information exchange that will help to improve care coordination between providers."

Bechtel in particular expressed satisfaction with the stage two requirement that consumers be given online access to their medical data. "The fact that this is now a core requirement, and will apply to the hospital setting as well as to physicians, is key to finally recognizing the critical role patients play as partners in their own care," she said.

Bechtel added, "It is good that the new rule also recognizes the essential role that providers and their staff play in encouraging patients to use this online access. It does that by holding physicians and hospitals accountable for ensuring that 5 percent of their patient population logs in once during the year."

That may seem like a low percentage, but HHS officials say it prods providers to adopt the technology that makes such access possible, and that many more than 5 percent of patients may take advantage of it.

Bechtel added that "the rule's requirements that a summary of care document be sent from one provider to the next for at least one of every two transitions of care or referrals is a good step. CMS also is requiring 10 percent of those transmissions to be electronic."

But Joel White of the Health IT Now coalition, which represents health care purchasers and IT vendors, was disappointed that the stage two rule doesn't do more to push wider exchange of electronic information to help providers better manage the cost and quality of health care. "The technology can support that today," he said.

AHA meanwhile said that although CMS has pushed back compliance with stage two requirements from 2013 to 2014, the agency is asking for too much too fast and suggested that some facilities, particularly in rural areas, won't be able to comply. "We do believe that when you take all of the requirements together this is a very significant lift," said AHA's policy director, Chantal Worzala. She also expressed concern that clinical quality measures CMS is requiring to show meaningful use in stage two are excessive.

The House Committee on Science is considering whether to hold a hearing on the meaningful use program, possibly on Sept. 13, CQ HealthBeat has learned.

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