AAFP Continues to Fight for Reasonable Meaningful Use Rules

May 27, 2015 10:05 am News Staff
[Chalkboard with writing in neon chalk

The AAFP continues its collaborative but tough stance with CMS regarding the agency's oversight of the Medicare and Medicaid Electronic Health Record (EHR) meaningful use programs.

Most recently, AAFP Board Chair Reid Blackwelder, M.D., of Kingsport, Tenn., responded on behalf of family physicians to a proposed rule(www.gpo.gov) published in the April 15 Federal Register that would modify meaningful use stage two requirements for 2015 through 2017.

In a May 21 letter(2 page PDF) to CMS Acting Administrator Andy Slavitt, Blackwelder said he was pleased to see the reporting period for 2015 shortened to 90 days, as requested by the AAFP.

Without the change, a significant number of family physicians likely would not achieve meaningful use in 2015, he added. (Physicians should note that the proposed rule returns the program to a 90-consecutive-day reporting period as opposed to the quarterly timetable currently in place.)

Story Highlights
  • In a recent letter to CMS, the AAFP continued to push for rules that would help family physicians succeed in the agency's meaningful use programs.
  • AAFP Board Chair Reid Blackwelder, M.D., acknowledged CMS' attempt to simplify the program and expressed support for portions of the modified meaningful use stage two proposal.
  • The Academy continued to oppose the "all-or-nothing" nature of the program and called out CMS for its attempt to change course midstream on critical parts program of the program.

The AAFP also expressed support for CMS' decision to modify patient engagement measures by removing the current "5 percent threshold" and replacing it with a requirement that a physician must have at least one patient who views, downloads or transmits his or her health information to a third party during the EHR reporting period.

"The AAFP agrees this would demonstrate the capability is fully enabled, and workflows to support the action have been established by the provider," said Blackwelder. The Academy also supports removing the attestation of "topped out" measures.

Blackwelder acknowledged CMS' intent to simplify the program by, in effect, making meaningful use a "single stage with slightly different measures for pre-2015 and for post-2017," but he expressed concern that CMS planned to eliminate stage one with just six months left in the 2015 calendar year.

"This change is likely to cause significant confusion," noted Blackwelder. CMS could mitigate physicians' discomfort by releasing educational materials to help participants understand the changes once the rule is final, he said.

In addition, the AAFP offered an alternative to CMS' abrupt change in rules that would require physicians to advance in the meaningful use program "faster than they initially planned based on the established policies in 2011 (i.e. two years in a stage before progressing to the next stage)."

Rather than mandate unreasonable action, Blackwelder urged CMS to "provide the option for eligible professionals to accelerate their usage every other year."

AAFP's EHR Expert
Clarifies MU Changes

Steven Waldren, M.D., director of the AAFP's Alliance for eHealth Innovation, acknowledged that the rules and regulations surrounding the federal government's Medicare and Medicaid electronic health record meaningful use programs were, at the very least, difficult to keep up with.

He offered further explanation to AAFP News regarding the AAFP's support for a policy that would allow physicians to make the decision to attest at a higher level whenever they felt ready to do so.

"That practice currently is allowed in the meaningful use program, and in 2017, anyone can attest to meaningful use stage three," he said. "For instance, if a practice is working on meaningful use stage three and hires a new physician who's only at stage one or two, it might be easier for everyone in the practice to work toward attesting to stage three," said Waldren.

But he pointed out that in the proposed rule, CMS changes the regulation by retiring stage one and essentially forcing physicians to enter a much more difficult stage two, perhaps before they are ready to do so.

Simply put, the CMS' practice of changing rules midstream continues to frustrate physicians trying to participate in an already complicated program, he noted.

Furthermore, notwithstanding the AAFP's support for much of the proposal, the Academy reiterated its oft-stated concerns with the "all-or-nothing" nature of the meaningful use program.

"We sincerely hope CMS improves this characteristic of the program rather than increasing the number of required measures," said Blackwelder. Many family physicians embraced EHRs in the "full spirit" of the meaningful use program expecting that that federal incentive payments would help offset costs associated with implementation, he added.

"However, auditors are causing undue hardship for family physicians with unreasonable and burdensome documentation requests," said Blackwelder. He urged CMS to address the situation in the final rule.

"If the government believes that a strong primary care foundation is the key to an improved and sustainable health care system, then we urge you to … provide immediate and increased relief to those who have acted responsibly and legally and had no intent to defraud or deceive by participating in the Meaningful Use program," he added.

Related AAFP News Coverage
CMS Plans to Revise Meaningful Use in 2015
AAFP Welcomes Reduced Administrative Burden

(2/3/2015)

More From AAFP
In The Trenches Blog: Put the Baseball Bat Down: What the AAFP is Doing to Address EHR Issues
(10/6/2014)

Additional Resources
CMS: EHR Incentive Programs(www.cms.gov)