ARRA on the Job / e-HIM Best Practices / Data Standards / Quality Care
What’s New in 2
Top Changes in the Stage 2 Rule
By Kevin Heubusch
THERE ARE FEW surprises in CMS’s proposed rule on stage 2 of the meaningful use program. The provisions generally reflect he recommendations of the Health IT Policy Committee made last year, and in the case of the intended change to the timeline, an announcement was made last December. Nonetheless, the Centers for Medicare and Medicaid Services has proposed some notable changes, several of particular inter- est to HIM professionals. Deadline Changes CMS is sure to find support for its proposal to give providers who demonstrated meaningful use in 2011 a one-year extension on advancing to stage 2. Under the modification, stage 2
would have a uniform start date of 2014. All participants would
be in stage 1 through 2013, no matter what year they join the
The rule proposes new objectives for stage 2, eliminates some,
and combines others.
With two exceptions, the objectives from the “menu” set in
stage 1—the list of 10 items from which providers were required
to choose five—would be required in stage 2. There are new objectives with greater applicability to specialty practices.
Stage 2 would retain the core-menu approach. Eligible professionals (EPs) would have 17 core items and choose three of five
menu items. Eligible hospitals (EHs) would have 16 core items
and choose two of four menu items.
Nearly all stage 1 core and menu objectives would be retained
in stage 2. However, some stage 1 objectives would be combined
into more unified stage 2 objectives.
Reporting quality measures would be removed as an objective
and instead incoporated directly into the definition of meaningful use.
Also proposed are exclusions for the stage 2 menu objectives
intended to accommodate EPs who are unable to meet certain
objectives due to the scope of their practices.
CMS summarizes the changes to stage 1 in a table on page
13705 in the published rule. The complete set of proposed stage
2 objectives and measures begins on page 13734.
A Shift from Electronic Copies to Online Access
Some of the most significant changes to objectives focus on patient engagement, an area that CMS had identified as a priority
for stage 2.
Beginning in 2014, the patient engagement objectives would
shift from providing copies of information to providing online
For EPs, a new measure would require that more than half of
patients receive online access to their information within four
business days of the information becoming available to the EP.
More than 10 percent of patients must view, download, or transmit their information. EPs could withhold information at their
Hospitals would be required to offer more than half of their
inpatient and emergency department patients online access to
information about their admission within 36 hours of discharge.
More than 10 percent of patients must view, download, or transmit the information.
The objective would replace three stage 1 requirements related to providing patients with electronic copies of their information (EPs and EHs) or online access (EHs only).