Yesterday the Centers for Medicare and Medicaid Services (CMS) announced its long-awaited rule specifying the requirements that physicians and other health care providers must meet in order to qualify for roughly $19 billion in federal subsidies for electronic health records. But the issuance of the rule, which runs 864 pages, will not end widespread concern about a lack of clarity of the required criteria.
In its proposed meaningful use rule, issued in January, CMS set forth numerous measures for hospitals and physicians to show they were using electronic records to improve quality of care. The measures address safety, patient engagements, care coordination, and privacy and security. During the comment period, many health groups, including the American Medical Association and the American Hospital Association, complained that the criteria were too ambitious and confusing. They asked for greater flexibility and more time to meet the requirements.
The final rule appropriately abandons the initial all-or-nothing approach and offers health care providers some amount of flexibility, allowing alternative ways of demonstrating meaningful use. But this is not the end of the process. More rulemaking is forthcoming. CMS will set further meaningful use criteria in two additional stages between today’s issuance and 2013, with the final stage covering payment year 2015 and thereafter. CMS will tighten the requirements at each step.
Thus, uncertainties and doubts remain about which systems will qualify for payments, increasing investment risk and reducing the incentives to innovate in a rapidly evolving environment. Future regulatory uncertainty will hold back health care providers and software developers as they contemplate the investments they must make in order for the benefits of electronic health records to be realized. Uncertainty can slow innovation and adoption of electronic health records, contrary to the intent of the subsidies.
