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CMS releases Stage 3 proposed rule

The Centers for Medicare & Medicaid Services (CMS) has released the proposed rule for Stage 3 of meaningful use under the Health Information Technology for Economic and Clinical Health Act.
 
Along with proposed rule, CMS and the Office of the National Coordinator for Health Information Technology (ONC) released the 2015 edition health IT certification criteria.
 
Stage 3 is the final stage of meaningful use, as stated by CMS in the rule. It will begin in 2017 and include measures to earn incentives or avoid payment penalties. 
 
One of the major proposals for Stage 3 is CMS will establish a single set of objectives and measure, tailored to eligible providers, eligible hospitals and critical access hospitals. This will be optional for providers in 2017 and required by 2018, regardless of a provider's prior participation in the Electronic Health Record (EHR) Incentive Program. The reporting period for this would be a calendar year, although that doesn't apply to Medicaid EPs and EHs demonstrating meaningful use for the first time.
 
CMS says this proposal will aim to reduce program complexity. It addresses complaints the agency said it got in prior stages over the burden, the multiple stages of participation, and the timing of reporting periods. 
 
Another major proposal suggested for Stage 3 is to align meaningful use closer with the other CMS quality reporting programs, such as the Physician Quality Reporting System and Hospital Inpatient Quality Report. By aligning the timeline of the differenct program, CMS aims to reduce provider burden and improve the agency's operational efficiency, it says. 
 
In terms of specific objectives and measures, CMS has reduced the objectives to eight to focus on "advanced use" of EHRs. It is focusing heavily on interoperability and patient engagement. For the latter, providers would have to report on all three of the following measures but successfully meet thresholds on two of them. For the controversial Stage 2 measure of getting patients to view, download and transmit their data, the agency has proposed a 25 percent threshold to providers. This would be up from 5 percent, which is the requirement in Stage 2. 
 
Stage 3 would require that more than 35 percent of all patients seen by the provider or discharged from the hospital would received a secure message using the EHR’s electronic messaging function or in response to a secure message sent by the patient (or the patient's authorized representative).
 
Finally, the proposal calls for more that 15 percent of patients to contribute patient-generated health data or data from a non-clinical setting into the certified EHR technology during the EHR reporting period.
 
For health information exchange, for more than 50 percent of patients referred there must be a summary of care record using certified electronic health record technology and an electronic exchange of the summary of record. For new patients, providers must incorporate into the EHR an electronic summary of care document from a source other than their EHR system for more than 40 percent of patients. For more than 80 percent of patients, providers must implement clinical information reconciliation with medication, medication, and the patient's current problems. 
 
"The flow of information is fundamental to achieving a health system that delivers better care, smarter spending and healthier people. The steps we are taking today will help to create more transparency on cost and quality information, bring electronic health information to inform care and decision making, and support population health," U.S. Department of Health and Human Services Secretary Sylvia M. Burwell said in a statement with the release of the proposed rule.
 
CMS rejected recommendations from the American Medical Association and others for Stage 3 to allow a provider to fail any two objectives and still meet meaningful use or to allow providers to receive an incentive payment or avoid a downward payment adjustment based on varied percentages of performance, and removing all measure thresholds.
 
CMS also identified some earlier stage objectives that have "topped out," meaning they have achieved widespread adoption at a high rate of performance and no longer represent a basis upon which provider performance may be differentiated, and may therefore be dropped. An example of a current Stage 1 objective that would be considered topped out under this approach is the objective to record demographics. (For the record demographics objective, it reviewed performance data submitted by providers through attestation and determined that across all years of participation, the 75th percentile is performing at 99.8 percent with the 99th percentile performing at 100 percent.)
 
Also, any manual, paper-based workflow process from Stages 1 or 2 is removed or transition to electronic format for Stage 3, CMS says.
For example, it is removing a measure that required EHs and EPs to have more than 10 percent of patients be provided patient-specific educational resources.
 
For the public health measures in Stage 3, CMS has made it so in order to successfully meet the requirements of the measure, there must be bidirectional data exchange between the provider's certified EHR technology and an immunization registry. Also new in Stage 3 is a requirement to be in active engagement with a public health agency to submit case reporting of reportable conditions. To support case reporting, the ONC has proposed a certification criterion that includes capabilities to enable certified EHR systems to send initial case reporting data and receive a request from the public health agency for supplemental or ad hoc structured data in the 2015 Edition proposed rule.
 
CMS is taking comments on the proposed rule until May 29. It can be read in its entirety here.
 
This article originally appeared in Long-Term Living sister-publication Healthcare Informatics.

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