On Friday August 29th, 2014 CMS released the final rule for the modification of the CY/FY 2014 incentive program. The rule is based on the interim rule released in May of this year. As expected the final rule made very few changes from the interim rule. The two major provisions of the rule were related to options hospitals have to attest to a different stage or Edition of Meaningful Use in 2014. Those options are based on the hospitals inability to get their 2014 Edition CEHRT in place due to availability issues. The other provision was that CMS officially pushed back the start of stage 3 of Meaningful Use to CY/FY 2017. For more details on each of these provisions see below:
FY2014 Reporting Options
Hospitals have three options in 2014 for reporting:
- If the hospital still has all their systems on the 2011 Edition CEHRT then they can attest using the FY2013 stage 1 standards
- If a hospital has a mix of 2011 and 2014 Edition CEHRT systems then they can attest using either the FY2013 stage 1 standard or the FY2014 stage 1 standard or if they are eligible for stage 2 they can use the FY 2014 stage 2 standard
- If a hospital is completely on the 2014 Edition CEHRT system then they can attest using the FY 2014 stage 1 standard or if they are eligible for stage 2 they can attesting using either stage 1 or stage 2 standards (must have justification for moving from stage 2 to stage 1)
Hospitals choosing to use a different CEHRT Edition or different stage then what they are scheduled to use must attest to the fact that they were unable to “fully implement 2014 Edition CEHRT to meet meaningful use for an EHR reporting period in 2014 due to delays in 2014 Edition CEHRT availability.”
Additional information
- For a hospital to quality for the Medicaid incentive payment for 2014 they must implement a 2014 Edition CEHRT and will not get credit for implementing a 2011 Edition CEHRT
- CMS did not specify what constitutes a combination of 2011 and 2014 Edition. It could be due to amount of time on each system during the EHR reporting period. It could also be certain modules on the two Editions. It could also be due to a critical module (i.e. eMAR) not being available.
- Reasons why you CANNOTuse another Edition or stage of meaningful use:
- Did not upgrade due to cost being too high
- Because they can’t meet the stage 2 measure thresholds (there is one exception for Electronic Summary of Care discussed later)
- Hospital was not able to upgrade or train staff due to staff changes or turnover
- Provider just waited too long to get started
If a hospital cannot meet the 10% threshold for Electronic Summary of Care due to receiving providers not upgrading to 2014 Edition CEHRT they can choose to move to stage 1 measures
- “The referring provider must retain documentation clearly demonstrating that they were unable to meet the 10 percent threshold for the measure to provide an electronic summary of care document for a transition or referral for the reasons previously stated.” [Reason: “the recipients of the transitions or referrals were impacted by issues related to 2014 Edition CEHRT availability delays and therefore could not implement the functionality required to receive the electronic summary of care document.”]
- Even if a hospital got the 2014 Edition software installed they can still switch to an earlier stage or version if they were not able to get it installed in adequate time to train and educate their staff to use it
- Even if a hospital got the 2014 Edition software installed they can still switch to an earlier stage or version if they had problems with the software that could have led to safety issues or if they required patches that the vendor had not released yet
- Hospitals are not required to have documentation on availability at the time of attestation, but they will need it for audit
- Audit guidance was limited but CMS stated that they will direct the auditors to consider hospitals on a case by case basis. It will be critical that hospitals have something to show auditors why they could not have attested to the stage and Edition of meaningful use they were supposed to and that documentation should clearly show that it was an availability issue.
Extension of Stage 2
CMS officially moved the launch date for Stage 3 of meaningful use to CY/FY 2017. This move was done to give them time to review the stage 2 results in 2014 before having to complete the final rule for stage 3. Additionally it gives them more time to refine the details for the new measures coming in stage 3. It was stated that the focus of stage 3 will be on: enhanced patient engagement, interoperability, and health information exchange.
