The Centers for Medicare & Medicaid Services (CMS) will be busy over the next several weeks as it analyzes the more than 2,000 letters it received with public comments on its proposed meaningful use rules.
CMS officials on Wednesday briefed the federal Health IT Policy Committee on the comments during its regular monthly meeting. The public comment period closed March 15 for both the proposed rule and the companion interim final rule (IFR) for standards and certifications, which had been released by the Office of the National Coordinator for Health Information Technology (ONC).
The proposed meaningful use rules generated wide interest among providers and industry stakeholders, and the CMS has just begun the process of analyzing letters, according to Tony Trenkle, director of the CMS’ Office of e-Health Standards and Services. “We received a lot of thoughtful comments.”
The federal agency will look for patterns and trends in the comments to gauge how best to respond, Trenkle said. By law, each comment must be answered in the final rule. In cases where comments require policy changes, they will be cleared through a process with the U.S. Department of Health & Human Services.
Some patterns already are emerging from the comments the agency has begun to read, Trenkle said. While most agree with the CMS’ approach to the meaningful use rules, one of their main concerns is about the speed with which the government wants to enact meaningful use mandates. And many ask for more clarification in the rule.
“The biggest issue was not how we laid it out, but the speed,” Trenkle said.
In addition, provider groups in particular are questioning the use of patient counts versus percentages of a patient population for determining the equations required in some of the meaningful use rules. In their comments hospitals have expressed concerns about the implementation of computer physician order entry systems. They also are asking for more clarification of the definitions of hospital-based eligible providers and hospital identification numbers in a multifacility health system. Everyone is asking for more flexibility in the criteria that will be required for the first stage of the rollout, Trenkle said.
The biggest issue was not how we laid out [the meaningful use rules], but the speed.
Tony Trenkle, director of the Office of e-Health Standards and Services, Centers for Medicare & Medicaid Services
Comments also were submitted about the standards and certification IFR. The ONC received several hundred comments, which are revealing patterns in the industry’s questions and concerns, according to Steve Posnack, policy analyst for ONC, who also gave a presentation to the policy committee.
Standards development organizations, vendors and other health IT stakeholders are asking the ONC to coordinate closely with the CMS to ensure the two rules work together efficiently, Posnack said. The office will try to ensure that coordination as it balances its policies with requirements that might be made through other regulations, he said. The final standards rule will be timed to be released with the final meaningful use rules.
The CMS now will establish broad policy issues, and draft responses to the letters it received to create the final meaningful use rule. The agency did not name a deadline, but hopes to have the final rule ready by late spring. “We’ll have to see how long it takes to pull this together,” Trenkle said.
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