fah hospital policy blog

Perspectives on health policy affecting America’s hospitals and the patients we serve.

FAH Supportive of Meaningful Use, but Urges CMS to Make Changes to Stage 3 Final Rule

December 15, 2015 | FAH Hospital Policy Blog Team

Category: FAH News, HIT, Legislation, Quality

The Federation of American Hospitals (FAH) sent a letter to the Centers for Medicare and Medicaid Services (CMS) Acting Administrator Andy Slavitt Tuesday urging that the agency make changes to the Meaningful Use Stage 3 rules.

The FAH is a strong supporter of The Health Information Technology for Economic and Clinical Health (“HITECH”) Act, enacted in 2009, to promote the adoption and meaningful use of health information technology. We believe that Interoperable Certified EHR Technology (“CEHRT”) can be a conduit for having the right information in the right place at the right time, resulting in better care for patients and empowering patients (and their caregivers) to assume a more active role in their own care.

While CMS did address some of our original concerns in the Stage 3 Final Rule, more must be done if the desired outcome of enhanced patient centered care is to be reached.

The FAH appreciates that CMS has delayed the requirement for compliance with Stage 3 until 2018, with the option for providers to move to Stage 3 in 2017 if they choose.

However as we wrote in the letter, the FAH “urges that all providers be allowed to use a 90-day reporting period for the first year in which they adopt a new Edition of CEHRT and begin to meet Stage 3 meaningful use requirements, which would be 2018 for most providers under the Final Rule…We also urge that a hardship exemption be made available for other circumstances.”

The FAH expressed that because of our strong concerns about Stage 3, we believe its viability will depend upon whether CMS makes significant changes to certain objectives and related measures.  This will assist hospitals in meeting the challenges presented by Stage 3.

In particular, we believe that CMS must lower significantly certain unrealistic measure thresholds, especially when the measures are newly required in Stage 3 or require certain technology or other functionality that is not yet mature enough to support success on a broad-scale basis.

For example, in the letter we explain that CMS should remove the Final Rule’s requirement that providers ensure that patients can access their health information through the application-programming interface (“API”) of their choice, stating “We believe imposing this requirement is grossly premature because the technology required for providers to satisfy it is not yet available.” There also remain key issues to resolve surrounding the connectivity, security and value of APIs. 

The FAH also continues to have strong concerns about the Stage 3 “Coordination of Care through Patient Engagement” objective and its related measures.  Compliance is heavily dependent on patient behavior, over which providers have little or no control.  Therefore, we recommended that “rather than establish numerical thresholds for each of the related measures, ideally CMS should instead require that providers attest that certain functionalities are available.”

Further, while the FAH appreciates CMS’s efforts effectively to delay until 2017 compliance with the electronic prescribing (“eRx”) objective and measure for hospital discharges under Stage 2 of meaningful use – the timing just doesn’t make sense. This has always been a Stage 2 menu option, and not a requirement.  Also, with the final rule not being published until October 2015, hospitals are being given very little time to implement a very complex program before being penalized.  The FAH urges CMS to ensure that the hospital eRx measure remains optional until Stage 3 is implemented. 

We appreciate the opportunity to comment on this Final Rule regarding Stage 3 Meaningful Use and look forward to working with CMS on this and related issues moving forward.