Stage 2 Meaningful Use: What Do You Think?

At this week’s HIT Policy Committee meeting, the Meaningful Use Workgroup presented its Stage 2 thinking to date, based on the 422 comments they received on their initial proposal. As discussed in a previous EMR Straight Talk post, the issue at the forefront is timing—with providers and vendors expressing significant practical concerns, and consumer groups pushing for rapid advancement.

The workgroup presented the following options for consideration by the Policy Committee. (I invite you to voice your opinion by responding to the poll below.)

  1. Maintain current timeline. Stage 2 would begin in 2013 for providers who demonstrate meaningful use in 2011. Providers who first demonstrate meaningful use in 2012 would have until 2014 to meet the Stage 2 requirements.
  2. Maintain the current timeline (as above), but allow a 90-day reporting period, instead of a full year, when providers are first governed by Stage 2 requirements. This would give providers until October 1 to begin their first year at Stage 2, instead of January 1—a nine-month delay.
  3. Delay Stage 2 by one year, allowing providers 3 years instead of 2 years at Stage 1. This means that the earliest any provider would have to meet Stage 2 expectations would be 2014.
  4. Phased-in approach separating existing from new functionalities:
    – Stage 2a (2013) would increase thresholds for measures for which the functionality already exists, (required to meet Stage 1), adding only new clinical quality measures.
    – Stage 2b (2014) would add new measures that require new EHR functionalities .

The responses from various HIT Policy Committee members covered the gamut.

  • Some were in favor of moving aggressively at all costs, presenting various arguments such as: (a) If we don’t pressure providers now, we will face the exact same issues at the next stage; (b) More extensive data capture does nothing to move us towards Stage 3 goals; and (c) We cannot just address the physicians’ workflow problems and ignore the challenges patients face in dealing with the current, difficult-to-navigate healthcare system.
  • Other Committee members, like Gayle Harrell, cautioned against trying to do too much too quickly—as she has from the outset—and stressed the long-term value to the program of setting providers up for success. Pushing them too hard could cause them to drop out after they earn the bulk of the incentives associated with Stage 1.
  • The phased-in approach was perceived as creative, but I was surprised that there was not much discussion about the administrative complexities this plan creates—to say nothing of the challenge of conveying it to providers.


4 thoughts on “Stage 2 Meaningful Use: What Do You Think?

  1. The committee needs to understand that physicians do other things besides implementing EMR. They actually spend most of their time seeing patients. The committee has made all of this WAY too complicated, and so is decreasing the likelihood of physician participation. Increasing the demands of the already complex meaningful use criteria, in addition to the decreased incentives for years 3 and 4, means that many practices will drop out of the whole thing and go back to paper after they have received the year 1 and 2 bonuses.

    The committee needs to slow down and take a deep breath.

  2. The committee did not consider all specialties in developing this program. Radiologists who are independent contractors performing radiology services at hospitals across the country have no control over the hospital EHR systems. Most will not be able to participate because most hospitals are only preparing to participate under the inpatient criteria, not the ambulatory criteria. Therefore many radiologists (and pathologists) will not have the tools to participate in the program. But, they will be penalized for not participating because the definition of an EP includes them. Most of these inidependent contractors do not fall under ‘hospital-based’ provider rules.

  3. How about requiring all the EMR software vendors to put in Meaningful Use reports in their products?

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