It has been a week since the release of the Stage 2 meaningful use final rule, with many groups and experts only beginning to resurface from studying the 700 or so pages that will define how eligible providers in the Medicare and Medicaid electronic health record incentive program can qualify for incentive payments. Some have emerged with opinions, however, and they are saying the rule isn't flexible enough and poses difficulties for physicians with fewer resources.

Steven J. Stack, MD, board chair for the American Medical Association (AMA) said his organization was encouraged by the greater flexibility included in the Stage 2 rule, but would like to see more done to increase physician participation in the program.

[See also: Final rules for Stage 2 meaningful use released.]

"We remain concerned that physicians have to meet all of the required measures, and failing to meet just one measure would cause a physician to miss out on incentives and even face financial penalties," Stack said. "In addition, physicians are being held accountable for measures outside their control in Stage 2."

Dianne Bourque, a health law attorney at Mintz Levin in Boston, has similar concerns. She said there are too many places in the rule that make a provider's ability to comply dependent on someone else.

One example is the requirement to report 40 percent of lab results in the universal standard known as LOINC (the Logical Observation Identifiers Names and Codes). Some physicians, particularly in small groups and solo practices, might be working with a smaller lab that does not use LOINC. "It's OK if you work with a big lab that uses that standard, but if you work with a small lab that doesn't, what are you going to do?" she asks.

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There are some practical concerns where the rubber meets the road," Bourque said. "There are real people involved and real challenges." 

For regulators upstream, it's always a challenge to recognize where the challenges will be downstream, she said.

Bourque, whose job it is to advise entities on regulation compliance, said she can see the government made an effort to make some positive changes in the final rule, but it may not be enough. "It is still going to be a struggle out there," she said. "It's a tall order."

On the other hand, some groups have shown a positive initial reaction to the rule.

Leaders of the Healthcare Information and Management Systems Society (HIMSS) said the rules allow the healthcare community to continue the necessary steps to ensure health information technology will support the transformation of healthcare delivery in the United States. Toward this end, they named several significant policy decisions included in the rule, including moving the start date for Stage 2 to 2014; allowing a 90-day reporting period in the first year of Stage 2 and accepting 2013 as the attestation deadline.

[See also: Stage 2 ready for primetime.]

Blair Childs, senior vice president of public affairs for the Premier healthcare alliance said Premier believes regulators have made "some extremely important changes that will help facilitate the rapid adoption of health information technologies, including electronic health records (EHRs)."

"We are also pleased that CMS decided to ease the proposed rule╒s reporting requirements. In taking a more manageable approach, hospitals will have additional flexibility, ensuring that a greater number of facilities will take steps to implement EHRs and improve patient care," said Childs.