Healthcare's Bumpy Road To ICD-10

The American Hospital Association (AHA) is pushing back hard against what it views as the overly ambitious agenda and timetable of the Meaningful Use stage 2 proposal unveiled in February. The proposal from the Centers for Medicare and Medicaid Services (CMS) is now in a public comment period that ends May 7.

In a 68-page letter to CMS acting administrator Marilyn Tavenner, AHA executive VP Rick Pollack objected to specific stage 2 criteria, requested changes in the timeframe for meeting the new objectives, and also asked CMS to separate the incentive and penalty phases of the Meaningful Use program.

To date, Pollack notes, more than 80% of hospitals have not yet met the stage 1 requirements in Medicare's electronic health record (EHR) incentive program. Given that experience, Pollack said, AHA is concerned that some elements of the stage 2 proposal will prevent widespread adoption of EHRs by hospitals.

The biggest obstacle, in AHA's view, is the requirement that patients be given the opportunity to view, download, and share personal health information via Web portals. "The AHA believes that this objective is not feasible as proposed, raises significant security issues, and goes well beyond current technical capacity," the letter said.

In contrast, the College of Healthcare Information Management Executives (CHIME), did not question the feasibility of providing this information to patients in its comments to CMS. But CHIME did object to the requirement that makes providers responsible for ensuring that at least 10% of patients view, download, and/or share their medical records.

[ For more background on e-prescribing tools, see 6 E-Prescribing Vendors To Watch.]

AHA also wants CMS to allow hospitals to provide discharge information to patients within 30 days, rather than 36 hours, as CMS proposes. Christine Bechtel, VP of the National Partnership for Women & Children and a member of the Health IT Policy Committee, strongly criticized that AHA position on her blog.

"This is the very information that can help keep patients from being readmitted unnecessarily," Bechtel said. "No patients in this day and age should have to wait a full month for access to their own health information, which is vital to their ability to get and stay well. And no hospital should want to do this--especially with payment penalties for unnecessary readmissions about to be put in place."

AHA also said it wants CMS to give hospitals a 90-day reporting period in the first year of stage 2, just as they have in stage 1. This would have the effect of postponing hospitals' Oct. 1, 2013 start date for stage 2, which has already been delayed a year, said Marie Copoulos, strategic research consultant for the Advisory Board, in an interview with InformationWeek Healthcare.

Shifting to a 90-day period, she noted, would allow hospitals to begin measuring their compliance with the new criteria up to nine months after the start date. That would give the facilities breathing space after having to show compliance with stage 1 for all of 2013 if they attested to Meaningful Use in 2011 or 2012.

Finally, AHA would like CMS to change the rules that would financially penalize hospitals for not meeting Meaningful Use objectives in fiscal year 2013 and that would apply the penalty adjustment in their Medicare rates to payments made for fiscal year 2015. The two-year look-back would also be applied in future years. AHA says this is unfair and proposes that Medicare evaluate hospitals' compliance in the same year that the adjustment is made. It also proposes additional hardship exceptions for hospitals.

Copoulos commented, "We'd agree that it seems redundant for CMS to be both potentially penalizing a provider and offering them an incentive for the same timeframe. It would make more sense if they followed through with the incentive phase and then the penalty kicked in after."

AHA is also correct in pointing out that hospitals are not gearing up for Meaningful Use "as fast as CMS initially expected," Copoulos said. "There's absolutely a lag. The stage 1 requirements were very challenging for hospitals."

What this means is that hospitals that have already attested in stage 1 will be in better shape to meet the stage 2 criteria than those that haven't, she noted. This echoes AHA's point about a widening "digital divide" between large, urban hospitals and smaller and rural facilities.

Copoulos anticipates that CMS will modify its stage 2 requirements and perhaps change other aspects of its proposal in its final rule, expected this summer. "I think we'll see a softening of it through the rulemaking process. It will go through public comment, and we'll see something less aggressive this summer than what we've seen out."

The 2012 InformationWeek Healthcare IT Priorities Survey finds that grabbing federal incentive dollars and meeting pay-for-performance mandates are the top issues facing IT execs. Find out more in the new, all-digital Time To Deliver issue of InformationWeek Healthcare. (Free registration required.)