CMS Proposes Relief for Providers, Hospitals Unable to Upgrade EHRs for Meaningful Use

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By Alex Ruoff  

May 20 — Health-care providers and hospitals that can't obtain an electronic health record system with the latest meaningful use program certification can participate in the program in 2014 using their existing EHR system, according to a proposed rule released May 20 by the Centers for Medicare & Medicaid Services.

The proposed rule (CMS-0052-P; RIN 0938-AS30), to be published in the May 23 Federal Register, would allow providers and hospitals to use EHR systems certified under the 2011 Edition certification program to qualify for meaningful use program incentive payments in 2014. Comments are due July 21.

Health-care providers and hospitals are currently required to adopt EHRs certified under the 2014 Edition certification criteria to be eligible for incentive payments in 2014 and avoid Medicare penalties in 2015. However, program participants have complained they have been unable to update their systems to the newest edition this year.

The proposed rule also would formalize a promise the CMS made in December 2013 to delay the start of Stage 3 of the program until 2017.

“Increasing the adoption of EHRs is key to improving the nation's health care system and the steps we are taking 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, national coordinator for health information technology, said in a May 20 release.

The Office of the National Coordinator for Health IT, through its EHR Certification Program, certifies EHR systems for use in the meaningful use program. In order to receive an incentive payment in 2014, providers and hospitals must adopt an EHR certified under the 2014 Edition, an updated version of the 2011 Edition that requires additional functionality from the technology.

Rule Changes

Under the proposed rule, providers and hospitals in 2014 may either continue to use their 2011 Edition-certified EHR or use a combination 2011 Edition- and 2014 Edition-certified EHR to earn incentive payments through the meaningful use program. The proposed rule doesn't allow the use of 2011 Edition EHRs beyond 2014.

The proposed rule does allow providers and hospitals that are required to move on to Stage 2 of the program this year but were are unable to obtain a 2014 Edition EHR system to attest to Stage 1 for an additional year. The meaningful use program launched in 2011, and is being phased in over three stages. Stage 1 focuses on data capture and sharing; Stage 2 aims to advance clinical processes. Stage 3 of the program is expected to be the most rigorous in requiring hospitals and clinicians to use EHRs in their practices.

Without the proposed changes, hospitals that have participated in the meaningful use program for at least two years would be required to attest to meeting Stage 2 requirements in 2014 or face a Medicare reimbursement penalty. Additionally, any providers or hospitals eligible to participate in the meaningful use program, regardless of what phase they are in, must comply with program requirements or face a Medicare reimbursement penalty.

While the proposed rule doesn't expressly prohibit it, the CMS “strongly recommended” providers and hospitals purchase a 2014 Edition-certified if 2014 is their first year in the Medicare meaningful use program.

Providers and hospitals participating only in the Medicaid meaningful use program can't obtain an incentive payment if they adopt a 2011 Edition EHR in 2014 if they are in the adopt, implement or upgrade phase, the CMS said.

Availability Concerns

Health-care industry associations have voiced concerns that a lack of available certified health IT products might stymie hospital and health-care providers' ability to meet requirements of the meaningful use program in 2014.

The American Hospital Association and Federation of American Hospitals in July 2013 asked for a delay in the implementation of Stage 2 of the meaningful use program, citing a lack of available certified technology.

CMS Administrator Marilyn Tavenner said in February that, despite the concerns from health-care associations, the CMS would not further delay the deadlines of the meaningful use program because agency officials see them as critical to the success of their payment-reform efforts.

However, Tavenner did say that the CMS will make it easier for providers to obtain hardship exemptions in 2014 if they aren't able to adopt EHRs with 2014 Edition certification.

As of March, the CMS had paid $22.9 billion in incentive payments to more than 350,000 providers and 4,532 hospitals through the meaningful use program.

To contact the reporter on this story: Alex Ruoff in Washington at

To contact the editor responsible for this story: Kendra Casey Plank at

Text of the proposed rule is at

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