A 2015 Meaningful-use Update – The Rules Continue to Change, and Practices Must Adjust

Ever since the HITECH provision of the American Recovery and Reinvestment Act of 2009 helped provide the outline for meaningful use as we have come to know it, providers have continued to focus on the stimulus package and annual payouts that followed.

While many providers have worked to meet the certification requirements and receive these payments, others felt that it was not worth the burden and that they would continue to practice as they had been. Times have changed, however, and with stage 3 meaningful use, along with negative payment adjustments, just around the corner, the healthcare industry is starting to take notice. The problem for many is that the requirements have been difficult to meet, and the rules have continued to change.

On Oct. 6, the Centers for Medicare and Medicaid Services (CMS) helped address these problems by issuing some final and proposed regulations for stages 2 and 3 of meaningful use. This article will explore in a bit more detail some of the more significant changes that are part of these regulations, updates to the timing of future certification, and some of the reasons for establishing these regulations.

Note that the content of this article will focus on the requirements of eligible professionals (EPs) and not those of eligible hospitals or critical-access hospitals, for which there are some variations and differences. For additional information on the rulings that came out for these types of institutions, refer to the CMS website at cms.gov.

Briefs Meaningful-use Changes

The regulations that were just released included modifications to stage 2 meaningful use and a revised outline of stage 3. One of the most significant changes noted is that the reporting period for all EPs will become the calendar year. This will be a large change for those that were reporting on some other fiscal year, which was most likely tied in with their practice’s tax year end. This will be effective for all future years.

Specific to 2015 are three critical updates. The first is that the reporting requirement will be reduced to a period of any 90-consecutive-day period of time versus a full year. Second, the total number of objectives that must be reported on has been reduced from 18 to 10, which includes one in the area of public-health reporting. Finally, for those 10 reported objectives, the number and nature of measures to be reported on has also been reduced. Most specifically are reductions relative to patient electronic access and to secure messaging.

With an overall focus on the continued advancement in the actual use of EHR systems, there was an emphasis on better alignment between the stage 2 and stage 3 standards. Additionally, for those EPs that were initially scheduled to be in stage 1 for 2015, there has been a shift to stage 2 requirements, but with certain exclusions and specifications. Finally, an attestation date of Feb. 29, 2016 has been set for the 2015 meaningful-use year.

Certification-timing

Standards

In order to properly meet the certification requirements of meaningful use, certain timelines are critical to understand. For 2015, attestation for all EPs has been set at Feb. 29, 2016, which lines up with the new calendar-year reporting as outlined above.

For 2016, all returning meaningful-use participants will avoid a 2018 payment adjustment if they are able to demonstrate for the full year that they met all requirements and attest by Feb. 28, 2017. For new meaningful-use participants, they will need to demonstrate that they met the requirements for a consecutive 90-day period of time. Payment adjustments for 2017 will be avoided if they are able to attest by Oct. 1, 2016, and for 2018 if they are able to attest by Feb. 28, 2017.

For 2017, all new meaningful-use participants will need to demonstrate that they met the certification requirements for a consecutive 90-day period of time and are able to attest by Oct. 1, 2017.

Reasons for the Changes

Over time, the exercise of certifying an attestation of compliance with meaningful use has become one of checking boxes and producing reports, oftentimes relative to parameters that have no bearing on an individual practice. Those changes that have taken place over the years, including those this past October, are showing the recognition by CMS that meaningful use is really about improving patient care and outcomes.

Additionally, it has been recognized that many EHR vendors, who have diligently been working to improve their product, have not always been able to keep up with the pace. These regulation changes are designed to allow additional time for them to design and implement those updates to their programs that will provide for a better working product.

As we can see, times have continued to change, and CMS continues to re-evaluate the meaningful-use rules and regulations. With stage 3 meaningful use and the potential for negative payment adjustments just around the corner, it is important for all EPs to stay on top of the current and evolving guidelines and best practices. This is true for all medical practices and EPs, including those that plan on applying for incentive payments, as well as for those that do not want to face ‘adjusted’ reimbursements. v

The preceding facts and dates were obtained from the Centers for Medicare and Medicaid Services; www.cms.gov. James T. Krupienski, CPA, is senior manager of the Health Care Services niche at Meyers Brothers Kalicka, P.C. in Holyoke, certified public accountants and business strategists; (413) 536-8510; www.mbkcpa.com