CMS also proposed several changes to existing Stage 1 criteria for meaningful use -- optional for use by providers in Stage 1, but essential for Stage 2. The proposal includes: Changes to the denominator of computerized provider order entry; changes to age limitations for vital signs; elimination of Stage 1's core objective "exchange of key clinical information" in favor of a "transitions of care" core objective, requiring electronic exchange of summary of care documents in Stage 2; and replacing the "provide patients with an electronic copy of their health information" objective with a "view online, download and transmit" core objective. The proposal's objectives have greater applicability to many specialty providers, recognizing the leadership role that many specialty providers have played in the meaningful use of health IT for quality improvement purposes, according to CMS.

For clinical quality reporting to become routine, CMS acknowledges that the administrative burden of reporting must be lessened. To do this, CMS has proposed a set of measures that align Stage 2 clinical quality measures with existing quality programs for EPs. Likewise, for eligible hospitals and CAHs, CMS is proposing to align Stage 2 CQMs with the Inpatient Quality Reporting and the Joint Commission's hospital quality measures. By submitting their CQM data electronically, EPs, eligible hospitals and CAHs may find it easier to report on quality measures for providers, noted the proposal.

CMS proposed that any Medicare EP or hospital that demonstrates meaningful use in 2013 would avoid 2015's payment adjustment. Exceptions to these payment adjustments were also proposed by CMS, including the availability of Internet access or barriers to obtaining IT infrastructure; a time-limited exception for newly practicing EPs who would not otherwise be able to avoid payment adjustments; and unforeseen circumstances such as natural disasters that would be handled on a case-by-case basis.

While big bucks are in store for physicians who meet Stage 1 requirements, earning them up to $64,000, those who fail will lose 1 percent in Medicare reimbursements in 2015, with the penalty increasing to 2 percent in 2016, 3 percent in 2017 and so on.

Finally, CMS is proposing an extension of Stage 1, so that providers have an additional year for implementation of Stage 2 criteria. This proposed rule delays the onset of those Stage 2 criteria for providers who first attested to Stage 1 criteria in 2011 until 2014, which CMS believes allows the needed time for vendors to develop Certified EHR Technology that can meet the Stage 2 requirements proposed here.

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