Many hospital health IT executives are still holding out hope that CMS will dial back some Medicare requirements for those seeking to achieve Stage 2 meaningful use of EHRs for the first time in fiscal 2015.

If the requirements are kept as is for the duration of the government’s fiscal year, which begins Wednesday, hospital representatives say that far too many will end up paying a penalty, which is equal to three-fourths of their Medicare reimbursement inflation update for 2017.

"CMS set the bar for Stage 2 very high, and didn't follow guidance from the field about what is doable in setting the Stage 2 rules," says Chantal Worzala, director of policy for the American Hospital Association.

A couple of the requirements stand out as particular problems for the hospital field, one of them relating to the implementation of a patient portal, the design of which may have a fundamental flaw. To qualify for Stage 2 in 2015, generally speaking, more than 5 percent of unique patients during the reporting period must use the hospital's portal to view, download or transmit their health info to a third party, according to

I can see why that 5 percent might have seemed reasonable when drafting the requirement; it's about as low as you can go without making the requirement appear meaningless. And the writers of the regs probably figured that a back-end requirement is a simple way to ensure that the portals have some value by requiring that the portals get some degree of use.

But what if demand is so low for portals right now that even 5 percent of patients aren't going to be interested in using their portal no matter how well the portal works? "Not all patients are interested," says Pamela McNutt, senior vice president and chief information officer for Methodist Health System in Dallas.

Ask the managers of the floundering social site Google+ how easy it is to command attention online. Hospitals face an even steeper uphill battle in getting their portals used even if there is demand for one.

And it seems like the true demand for health information portals right now has yet to be determined, placing a lot of reimbursement on the line based on a major uncertainty. "It seems unfair that we have to be made responsible for a patient's action," McNutt says.

In an attempt to spur interest in its portal and meet the regulation's requirements, Methodist Health is introducing the portal to patients while they're still in the facility, and assisting patients with accessing the portal, when it's feasible. "This is very staged to do this, but this is what everyone is doing," McNutt says.

Staged or not, it's the one time that the hospital has a degree of control over the process.

McNutt and Worzala also cite a requirement that clinical summaries be sent electronically between providers when there is a transition of care as a major problem. McNutt says the requirement that 10 percent of transitions and referrals include an electronic transition of care that is sent and received is not realistic. The required formats for the transition of care summaries are not easily met because physicians are not often ready to receive the information, she says.

A logical solution to these problems, according to hospital officials, would be to shorten the reporting period for those seeking Stage 2 readiness in 2015 for the first time to 90 days from the currently required full year. Stage 2 providers in 2014 had a 90-day window. "Shortening the reporting period keeps people on track, but gives a little more space" to hospitals in meeting the requirements, Worzala says. Legislation has been introduced in the House that would do that.

She notes that just 140 hospitals had met Stage 2 requirements as of August, a sign that the requirements are out of step with the field. "We'd like to see this program succeed, though we think that giving folks a little bit of breathing space to get this all working well is really much more important than any kind of arbitrary regulatory timeline," she adds.

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