CHIME CEO: New MU flexibility rule is complex, creates timing issues

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 - Riddle Reformatted

The new proposed rule issued by the Centers for Medicare & Medicaid Services (CMS) giving eligible professionals and hospitals more flexibility in how they use certified electronic record technology to meet Meaningful Use, “should give our members—in their own unique ways—the flexibility to move forward” with the program, said Russell Branzell, president and CEO of the College of Healthcare Information Management Executives (CHIME) in an interview with

The proposed rule would allow providers to use 2011 Edition certified EHR technology (CEHRT)—or a combination of 2011 and 2014 certified technology—for the EHR reporting period in 2014. The rule also would extend Stage 2 through 2016 and begin Stage 3 in 2017.

According to Branzell, CHIME and other stakeholders have been lobbying for this kind of flexibility for more than a year. “One of the lessons learned from Stage 1 had to do with the late delivery of software, issues of getting it implemented, and numerous patches and updates to get it where it was useable,” he said. “And what we were hearing from members recently was that they had significant concerns about getting software installed and doing any kind of transformation process and seeing any outcomes and improvements.”

Those concerns were apparently heard. As CMS Administrator Marilyn Tavenner said when the proposed rule was announced, “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 small providers and hospitals.”

That said, the complexity of the rule, along with the issues related to the calendar, will make things challenging, said Branzell.

“There is a great risk for all organizations that haven’t attested yet for Stage 2, and that is that July 1 (the start of the last eligible quarter for MU 2 year one) is only about five weeks away,” he said. “And this is going to take a lot longer than five weeks.” He speculated the process—which includes a 60-day comment period—won’t be completed any earlier than the end of August, which is a “probably as fast, if not faster than they’ve ever don it before.”

What that means is that organizations are “going to have to make a calculated decision to bet that this NPRM will generally have the meat on it that it has today, and that it will go through in a way that is appropriate for a particular organization,” Branzell said. “But I don’t think CMS and ONC [Office of the National Coordinator for Health Information Technology] would have done this unless they were going to find a way to get us through this.”

There are also some serious technical issues that will have to be resolved, Branzell pointed out. “For example, if you’ve gone live with the 2014 software, but haven’t started collecting all that data, can you even go backwards to collect Stage 1 data—the way it was being defined—on your 2014 platform? We don’t know the answer to that because we never thought through that scenario.

“At the beginning of Stage 1 we went through a lot of effort to get everyone’s knowledge up to the level it needed to be, got there and moved past that point to where we were answering one-off kinds of questions,” he added. “Now I think we may have to go back to a grass-roots 101 kind of approach in order to help organizations that are going to struggle to make sense of all this. It almost sounds negative to talk this way about something that has the potential of being so positive, but to do the right thing now, given our circumstances, is going to be difficult.”

Given all that, Branzell said he appreciates that CMS and ONC have done what other federal agencies are often loath to do. “They’ve listened to concerns from the field and have tried—even with the added complexity and issues with timing—to meet our needs.”