Lower Bar Sought For Health IT Stimulus Funds

Healthcare providers call for government to make requirements dictating meaningful use of electronic medical record systems easier to comply with.
The Centers for Medicare and Medicaid Services (CMS) has made its way through half of the 2,000 comment letters it received on the Meaningful Use Notice of Proposed Rulemaking.

From those comments, it's clear that healthcare providers would like it to be easier to comply with basic meaningful use requirements, and they would also like greater clarity on the rules, said Tony Trenkle, director of CMS's Office of e-Health Standards and Services at the Health IT Policy Committee meeting on Wednesday in Washington.

The meaningful use rules will determine whether a healthcare provider qualifies for the more than $20 billion in stimulus funds the federal government plans to start paying out next year to reimburse them for investments in electronic medical record and other health IT systems.

Many of those commenting expressed called for greater flexibility in qualifying for incentive monies, including allowing stimulus reimbursements for organizations that meet only a percentage of the requirements and scaling incentive payments for providers that meet some measures, which CMS can't do, Trenkle says. They also asked reductions in the number of clinical quality measures providers have to comply with as well as the thresholds for compliance

Commenters asked that healthcare providers not have to report the total number of orders for medication, lab work, imaging scans, and other tests. They also raised concerns about the non-clinical, administrative measures being required and overly aggressive requirements for computerized physician order entry (CPOE) systems. Some commenters noted that stages two and three of the meaningful use rules haven't been laid out, making strategic planning difficult. Other concerns focused on:

  • The ineligibility of hospital-based physicians;
  • Health systems with multiple hospitals operating under a single provider number not being eligible for multiple stimulus payments;
  • Too long a reporting period in second year. No matter how well intentioned a comment is, the proposed solutions need to be realistic, Trenkle said. "When you talk about flexibility, I understand that from a conceptual standpoint, but we have to be able to translate that into something operationally feasible," he said "The more complexity you build into this process, the more difficult it is to launch a program quickly and efficiently."

    Over the next few weeks, CMS will analyze the rest of the letters looking for common policy themes, Trenkle said. Ones that require major policy decisions, get floated up through the ranks, he said. From there, the organization will create policy papers and have them reviewed by the Department of Health and Human Services, the Office of Management and Budget, and the administration, if necessary.

    CMS will come back to the HIT Committee in April with a more comprehensive report on the comments. A final rule is expected in late spring.

    Anthony Guerra is the founder and editor of, a site dedicated to serving the strategic information needs of healthcare CIOs. He can be reached at [email protected]

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