Despite pleas from organized medicine, the Centers for Medicare and Medicaid Services (CMS) says there will be no delays to Stage 2 of the meaningful use incentive program. In addition, implementation of ICD-10 will also go on as scheduled.
Marilyn Tavenner, administrator of CMS, made the announcement at a keynote address at the annual Healthcare Information and Management Systems Society trade show and convention held Feb. 23-27 in Orlando, Fla. It came a week after a group of 48 medical associations and societies sent a letter to Kathleen Sebelius, secretary of the Department of Health and Human Services, requesting more time to implement the 2014 edition certified software needed for Stage 2.
Healthcare organizations must have the technology implemented and in use before October to qualify for incentives and avoid penalties.
The group also requested more flexibility in the meaningful use requirements. The program is based on an "all or nothing" approach, which means missing a single objective, even by a narrow margin, would result in failure.
Although there won't be a delay, Tavenner said there would be more flexibility for eligible professionals and hospitals to claim hardship exemptions on a case-by-case basis. Hardship exemptions would not provide incentive payments for those who cannot qualify, but would make them exempt from penalties for noncompliance.
Exemptions are already available in cases such as unforeseen circumstances; lack of infrastructure such as broadband; or new eligible professionals who have not had time to become meaningful users. It's not yet clear how the exemptions may be expanded, but many say it's likely CMS will consider exemptions for providers whose vendors went out of business or did not receive 2014 certification in time.
"We were happy that the administration at least acknowledged that there needs to be changes," said Jeffery Smith, senior director of federal affairs with the College of Healthcare Information Management Executives (CHIME). "But you didn't hear an announcement on timing and flexibility which is what we, as an industry, had asked for in a letter to the secretary a week previous."
The American Hospital Association also reacted: "AHA is disappointed that CMS will not make changes to the timelines or provide additional flexibility in the meaningful use requirements," said Chantal Worzala, AHA director of policy, in a statement. "The AHA will work closely with the agency to ensure that the hardship exceptions protect hospitals from unwarranted penalties."
In the same speech, Tavenner said the deadline for ICD-10 implementation would not be changed either. Healthcare organizations must convert their billing systems from ICD-9 code sets to ICD-10 by October. The original date for compliance was 2011, but the American Medical Association successfully advocated for two delays and is pushing for another.
In early February, AMA Executive Vice President and CEO Dr. James Madera sent a letter to Sebelius asking her to "reconsider the ICD-10 mandate." Madera said many physicians are still waiting on vendors to upgrade their systems to comply with ICD-10 standards.
He also cited findings from a study by Nachison Advisors that found the price of making the necessary upgrades to meet ICD-10 will range from $56,639 to $226,105. This is up from an estimate of $83,290 set in 2008 which did not include the cost to upgrade electronic health record systems.
The Medical Group Management Association released a survey in February indicating less than 10 percent of practices were ready for ICD-10.
CHIME was not among the organizations requesting an extension to the ICD-10 deadline. But, it said, delaying meaningful use would bring some relief to practices working toward ICD-10.
"What we have been trying to communicate is that, in so far as ICD-10 is a priority for the administrator and a priority for the government, we need flexibility on meaningful use," Smith said. "Right now, meaningful use is, without a doubt, a complicating factor to the success of ICD-10."
