The Centers for Medicare & Medicaid Services (CMS) released October 6 the final rule with comment period for Stage 3 of the Medicare and Medicaid Electronic Health Records (EHRs) Incentive Programs despite a growing chorus of lawmakers and stakeholders in recent weeks asking the agency to delay implementing the final stage of the meaningful use.

The Office of the National Coordinator for Health Information Technology (ONC) also released October 6 the final rule for 2015 Edition Health IT Certification Criteria (2015 Edition).

CMS said it tried in the rules to streamline and simplify requirements to ease the burden on providers. To that end, providers would be required to comply with Stage 3 by 2018, with 2017 remaining optional as the agency originally proposed in its proposed rule issued in March.

The rule also moves from fiscal year to calendar year reporting for all providers beginning in 2015, and offers a 90-day reporting period in 2015 for all providers, for new participants in 2016 and 2017, and for any provider moving to Stage 3 in 2017.

“We eliminated unnecessary requirements, simplified and increased flexibility for those that remain, and focused on interoperability, information exchange, and patient engagement. By 2018, these rules move us beyond the staged approach of ‘meaningful use’ and focus on broader delivery system reform,” Dr. Patrick Conway, M.D., M.Sc., CMS deputy administrator for innovation and quality and chief medical officer, said in a press release.

CMS simultaneously announced a 60-day public comment period to facilitate additional feedback on Stage 3 of the EHR Incentive Programs going forward, signaling that further changes to the program are likely.

In a fact sheet, CMS said it is seeking comments in light of the recently passed Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which established the Merit-based Incentive Payment System (MIPS) for physicians and consolidates certain aspects of a number of quality measurement and federal incentive programs into one more efficient framework.

“We will use this feedback to inform future policy developments for the EHR Incentive Programs, as well as consider it during rulemaking to implement MACRA, which we expect to release in the spring of 2016,” CMS said.

CMS said it views the regulations as a “bridge to the new payment system for physicians and providers” and anticipates receiving input “about how best to incorporate the EHR Incentive Programs into the new payment system.”

Lawmakers and provider groups expressed dismay, however, that CMS released the Stage 3 rule.

Senate Health, Education, Labor and Pensions (HELP) Committee Chairman Lamar Alexander (R-TN), who asked the administration in a September 29 letter to delay finalizing Stage 3 until at least January 1, 2017, released a statement critical of the rule and threatening to modify it through congressional action.

“Instead of taking the time to get the stage 3 rule right, they’ve rushed ahead when only 12 percent of doctors and less than 40 percent of hospitals can comply with the program’s stage 2,” Alexander said.

He added that “Congress will carefully review this rule and has the option of fixing it through legislation or overturning it through the Congressional Review Act.”

The American Medical Association (AMA), which also urged delayed action on Stage 3, said it “continues to believe that Stage 3 requires significant changes to ensure successful participation, and improve the usability and interoperability of electronic health record systems.”

AMA expressed hope that “the decision by CMS to leave Stage 3 open to additional comment will allow for further improvements in the program and promote technological innovation that supports patient care."

The group did praise the agency, however, for “allowing a hardship exemption for physicians who are unable to attest this year,” noting that the exemption will provide “needed relief for those uncertain about the 2015 program requirements.”

The American Hospital Association (AHA), another group who has been vocal in asking CMS to delay Stage 3, called the rule’s release “deeply disappointing.”

“Despite the urging of hospitals, physicians and Congress, the Stage 3 final rule includes many new and more challenging requirements. More than 60 percent of hospitals and about 90 percent of physicians have yet to attest to Stage 2. The Stage 3 rule is too much too soon,” AHA said in a statement.

CMS said in a second fact sheet it reviewed and considered more than 2,500 comments in devising the final rules, which are slated to be published in the October 14 Federal Register.

In its effort to simplify requirements, the agency said the EHR Incentive Programs in 2015 through 2017 include 10 objectives for eligible professionals including one public health reporting objective, down from 18 total objectives in prior stages. And nine objectives for eligible hospitals and critical access hospitals (CAHs) including one public health reporting objective, are required, down from 20 total objectives in prior stages.

In addition, CMS noted it “provided flexibility so that providers may choose measures that are most relevant to their practice.”

For Stage 3 of the EHR Incentive Programs in 2017 and subsequent years there will be eight objectives for eligible professionals, eligible hospitals, and CAHs. However, in Stage 3, more than 60% of the proposed measures require interoperability, up from 33% in Stage 2.

Acknowledging that many providers are struggling with EHR implementation, CMS said it would use “administrative flexibility” as much as possible “to help physicians and other providers who are making efforts to adopt and use this technology to succeed.”

“We encourage providers to submit requests for a significant hardship exception from the payment adjustment through the existing request process,” CMS said.

2015 Edition final rule

According to ONC, the 2015 Edition final rule focuses on interoperability and enhances the Health information technology (IT) Certification Program “by including provisions for more rigorous testing of health IT exchange capabilities, establishing explicit requirements for in-the-field surveillance and transparency of health IT, and by making granular information about certified health IT publicly available through an open data certified health IT product list.”

“This rule is a key step forward in our work with the private sector to realize the shared goal of making actionable electronic health information available when and where it matters most to transform care and improve health for the individual, community and larger population,” said Karen B. DeSalvo, M.D., M.P.H., M.Sc., national coordinator for health IT.

Among other things, ONC said in its fact sheet, the final rule aims to improve patient safety by applying enhanced user-centered design principles to health IT, enhancing patient matching, requiring relevant patient information to be exchanged (e.g., Unique Device Identifiers), improving the surveillance of certified health IT, and making more information about certified products publicly available and accessible.

The rule also allows technology developers “more flexibility, opportunities, and time for the innovative, usability-focused development and certification of health IT.”