Yesterday, the Proposed Rule defining Meaningful Use Stage 2 was officially posted in the Federal Register. This means that the clock has begun ticking on the 60-day comment period, and the opportunity to influence the decision makers will end on May 6. It is critical that physicians speak up, particularly now that some will be able to respond from the perspective of their experiences in—or familiarity with—Stage 1.
In upcoming posts (after we have had the time to read, re-read, and analyze the lengthy Proposed Rule), I will discuss specific measures that I believe require modification due to their limited practicality and/or potentially adverse impact on physician workflows. Today I want to provide some high-level observations drawn from an initial evaluation of the Rule and highlight a few major implications that immediately come to mind:
- The bar has definitely been raised! The emphasis on interoperability, patient engagement, and more extensive quality measure reporting impose very demanding requirements that represent a huge step up in capability and effort. The term “more stringent”—which is used in the ARRA legislation to characterize successive stages of meaningful use—does not begin to describe the relative intensity of Stage 2.
- Expectations are very high, despite the fact that a vast number of physicians have not even begun to participate in Stage 1. Although CMS claims that the number of core and menu measures remains steady at a total of 20 (through some sleight-of-hand counting magic!), the actual requirements have expanded in number, complexity, and depth.
- The proposed leap forward in the exchange of clinical data is monumental in scope. Although this is an important long-term program goal, it must be reconsidered in light of the dismal experience in this area in Stage 1. The requirement to simply test the ability to exchange clinical data met with such confusion and failure that the measure has been retroactively eliminated for 2013—the second year of Stage 1.
- Patient engagement is another area of focus in Stage 2. Again, this is a noble goal, and physicians should be rewarded for doing everything possible to encourage patient and family involvement in care. The Proposed Rule, however, defines meaningful use to include specific patient actions, such as e-mailing their physician and accessing their information on a portal. It is unacceptable to make a provider’s incentive payment dependent upon actions by patients over which he or she has no ultimate control.
- The Rule proposes some appealing options for streamlining clinical quality measure (CQM) reporting and harmonizing the various CMS programs that involve CQMs. However, the number of measures has exploded, and the administrative aspects of the various options will be very difficult for providers to discern.
Those are my first impressions. I will follow up with more information on these and other issues and on the procedure for submitting comments to CMS. In the meantime, I am interested in hearing your thoughts and/or concerns about the Proposed Rule and how it could impact your practice.