CMS Finalizes EHR Program Modifications and Stage 3 Rule; ASCRS•ASOA Presses for Clarifications on Modifications Rule 
As we alerted you on Tuesday, the Centers for Medicare and Medicaid Services (CMS) released the Meaningful Use Modifications and Stage 3 Meaningful Use final rule . When first proposed, the Modifications to Stage 1 and 2 and Stage 3 were separate rules. ASCRS•ASOA advocated for the immediate release of the modifications rule because it provided much-needed flexibility for physicians to achieve Meaningful Use in 2015. Due to the delay in releasing the rule, however, physicians who were waiting for the last 90 days of the calendar year may not be able to be successful. Further, the timing of the rule would make achieving the public health objective nearly impossible. In response, ASCRS•ASOA reached out to CMS for clarification that providers impacted by the delay would be able to apply for hardship exemptions. We continue to be in communication with CMS regarding the public health reporting requirements and will be providing additional information as soon as it is available.
Meaningful Use Modification Highlights
- Reporting Period:
- In 2015, CMS is allowing all eligible professionals to attest to an EHR reporting period of any continuous 90 days.
- For 2015, 2016, and 2017, CMS finalized allowing new participants to attest to Meaningful Use for 90 days.
- All returning participants in 2016 and 2017 will attest for a full year reporting period.
- Patient Engagement Objectives:
- Stage 2 Patient Electronic Access measure: CMS lowered from “5 percent” to “equal or greater than 1” for 2015 and 2016 only. The measure will increase to require that 5 percent of patients view, download or transmit their health information in 2017.
- Secure Electronic Access measure: CMS finalized that in 2015, providers must have the capability for patients to send and receive a secure electronic message. For 2016, at least one patient seen by the eligible professional during the EHR reporting period must be sent a secure message. In 2017, for more than 5 percent of unique patients seen by the eligible professional during the EHR reporting period, a secure message must be sent using the electronic messaging function of CEHRT to the patient.
- Public Health Objectives:
- CMS consolidated these measures, and providers are now required to actively engage with an immunization agency, a public health agency, or a clinical data registry—or qualify for exclusions for each measure to successfully attest to Meaningful Use. (See more on this issue below.)
- Overall Requirements:
- CMS eliminated the distinction between menu and core measures, and all retained objectives and measures will be required to successfully attest. CMS finalized all eligible professionals must report on 9 objectives and one consolidated public health reporting objective for both Stage 1 and Stage 2 of Meaningful Use.
Public Health Measures and Reporting Period Clarification
Previously in 2015 Meaningful Use, the public health measures were menu measures, so providers could choose not to report them. Under the new Modifications Rule, providers are required to report the public health objective, which means they must actively engage with two of the three of: an immunization agency, public health agency, and clinical data registry or qualify for exclusions for each measure to successfully attest to Meaningful Use. Since there is an ophthalmic clinical data registry that providers could have engaged with in 2015 up until the last quarter, our members will not be able to claim an exclusion for this objective if they choose to report a 90-day period prior to September. Currently, the IRIS data registry is closed for the remainder of 2015, and therefore, if providers choose to report for the last 90 days then they can claim an exclusion for this measure, “operates in a jurisdiction for which no specialized registry for which the EP is eligible has declared readiness to receive electronic registry transactions at the beginning of the EHR reporting period."
We think that this is a new, unfair requirement for providers. Therefore, we have reached out to CMS and explained this is an unrealistic new requirement that must be achieved in a short time period. We informed CMS that there is not time now for providers to enter into contracts with clinical data registries, and reiterated this was not an original Stage 2 requirement. CMS has assured us they did not intend to create additional measures that members had to meet within this Modifications Rule. In fact, the intent was to make it easier for providers to achieve. We are still in conversations with CMS regarding how to provide a work-around for our members on this issue. As soon as we have additional guidance, it will be posted to the list serv, and we will send out an alert. In addition, CMS is developing an FAQ on this issue.
We are also working with CMS to clarify the options for Meaningful Use reporting periods in 2015. Providers do have the option to report for any continuous 90-day period. We are in discussions with CMS regarding whether providers can report for a longer period, and will provide guidance on this issue as soon as we receive additional information.
Due to the extreme delay in releasing the final rule, ASCRS has concerns that physicians and practices who have not yet begun Meaningful Use for 2015 and were waiting for the last 90 days will not be able to attest successfully. Specifically, we are concerned about the lack of a hardship exemption included in the rule that would apply to this situation.
On Wednesday, ASCRS reached out to CMS for clarification and received the following response to our question, which CMS indicates will become one of their FAQs:
Q: If an Eligible Professional (EP), eligible hospital or Critical Access Hospital (CAH) is unable to effectively plan for a reporting period in 2015 due to the timing of the publication of the 2015 through 2017 Modifications final rule, can they apply for a hardship exception?
A: CMS finalized the modifications to reporting requirements in 2015 in order to align with future Stage 3 requirements and to ease the overall burden associated with reporting on the EHR Incentive Programs. These modifications did not add any new requirements for EPs, eligible hospitals, or CAHs, but instead reduced the number of measures that had already been required for 2015.
In addition, the modifications allowed for a 90-day reporting period in 2015 for all providers—which can be any 90 consecutive days in the 2015 calendar year (or between October 1, 2014 and December 31, 2015 for eligible hospitals and CAHs).
Because of the wide flexibility in reporting periods and the reduced number of previously established requirements, CMS expects that the majority of all providers will be able to meet the modified 2015 reporting requirements for a 90-day reporting period. Providers have until February 29, 2016 to attest to their meaningful use data, which allows sufficient time for any necessary changes to the reports generated for attestation. In most cases, no such changes will be necessary as providers may use the same report and simply only input the data for the retained objectives and measures.
However, if a provider is still unable to meet the requirements of meaningful use for an EHR reporting period in 2015 for reasons related to the timing of the publication of the final rule, a provider may apply for a hardship exception under the “extreme and uncontrollable” circumstances category. Each hardship exception application will be reviewed on a case-by-case basis, as required by law.
Stage 3 Meaningful Use
CMS finalized Stage 3 Meaningful Use as optional in 2017 and required it for all participants beginning in 2018. CMS also finalized increased threshold reporting requirements for many Stage 3 Meaningful Use measures, including a requirement that for more than 25 percent of all unique patients seen by a provider during the EHR reporting period, a secure electronic message must be sent. CMS did lower some thresholds from the proposed rule, including lowering the number of unique patients that have to actively engage with the EHR from 35 percent to 10 percent, and reducing electronic prescribing from 80 to 60 percent. There is a 60-day comment period for the Stage 3 Meaningful Use section of the rule only.
ASCRS will continue to work with the medical community and Congress in an effort to delay the implementation of Stage 3.
If you have any questions, please contact Ashley McGlone at 703-591-2220.