Any day now, the U.S. Department of Health and Human Services (HHS) will release proposed rules for Stage 2 of its Meaningful Use incentive program for adoption of electronic health records (EHRs). National health IT coordinator Dr. Farzad Mostashari is delivering a keynote address at HIMSS Thursday morning. His Office of the National Coordinator for Health IT (ONC) and other HHS agencies are scheduled to participate in HIMSS 12 sessions Tuesday, Wednesday, and Thursday that address Stage 2.
[ Among the hundreds of health IT presentations, demos, and vendor offerings at HIMSS12, don't miss What To See At HIMSS12. ]
Last week, HHS secretary Kathleen Sebelius announced that the department would push back the deadline to comply with the ICD-10 diagnostic coding regimen, from Oct. 1, 2013, after the American Medical Association (AMA) complained about the combined burden of addressing ICD-10, Meaningful Use, and other elements of healthcare reform.
"We stand by the position we have established that the [ICD-10] deadline in isolation was reasonable," HIMSS CEO H. Stephen Lieber told InformationWeek Healthcare in an extensive interview last Wednesday, one day before Sebelius announced the delay, and one day after acting Centers for Medicare and Medicaid Services (CMS) administrator Marilyn Tavenner told AMA leaders that federal officials were re-examining the ICD-10 compliance date.
But Lieber understands some of the concerns raised by physicians. "Unfortunately, it's not in isolation," Lieber said. "It's also when [ANSI X12] 5010 conversion had to occur. It's in the middle of Stage 1 and Stage 2 [of Meaningful Use]." Providers are also struggling with how to transform into accountable care organizations (ACOs), and with other reforms.
However, providers may also get a bit of a reprieve with Stage 2 Meaningful Use, based on what Lieber understands. He noted that the number of hospitals and individual providers attesting to Stage 1 in 2011 was far below what some had hoped, a reality that is causing HHS to dial back expectations.
For one thing, HHS already has agreed to delay the start of Stage 2 by a year, until 2014. Now, Lieber believes the requirements for Stage 2 will be less stringent than previously expected. "It's been a tremendous challenge for hospitals and physician practices to reach Stage 1, and what I am expecting is that the somewhat lower level of registration and qualification for Stage 1 payments is going to influence Stage 2," he said.
HIMSS last week released a survey of Meaningful Use readiness indicating that, at the end of 2011, just 9% of hospitals were capable of meeting all 14 core items and at least five of the 10 menu items, as required to attest during Stage 1. Another 23% were close. Notably, small, independent, and rural hospitals were much farther behind their large, urban, and academic counterparts.
Lieber said that these numbers suggest EHR adoption may have been slower than advertised. "It's almost like the economy," the HIMSS chief surmised. "We just didn't realize how bad it was, and that's why it's taken so long to come back. Well, healthcare technology is kind of the same thing. We didn't realize how far behind healthcare organizations were four years ago, three years ago. To get to the point where they ought to be was a bigger jump than I think everybody anticipated."
Stage 1 of Meaningful Use roughly correlates to Stage 4 on the HIMSS Analytics EMR Adoption Model. "You really do need to be at Stage 4 [on the HIMSS scale] to have a realistic opportunity" of meeting Meaningful Use right now, he said. The expectation had been that the second stage would be about the same as Stage 6 on the seven-stage HIMSS scale, but it might be closer to Stage 5 in the second phase of Meaningful Use, because of the low level of qualification for the first stage so far.
"I think what you will see is an expansion of all of those [Stage 1 requirements] but not to house-wide. That's a point where they would just knock too many people out of the sequence of qualifying," Lieber predicted.
"It's still going to be a big challenge. It has to follow a progression here that the bar is going to be raised. I'm just thinking that it might be raised a little bit less than it otherwise would've been."
Healthcare providers must collect all sorts of performance data to meet emerging standards. The new Pay For Performance issue of InformationWeek Healthcare delves into the huge task ahead. Also in this issue: Why personal health records have flopped. (Free registration required.)