For family physicians who were just getting comfortable with the requirements of stage one of meaningful use of electronic health records (EHRs), HHS just released(www.hhs.gov) the final rule for stage two of meaningful use in the Sept. 4 Federal Register(www.federalregister.gov).
The Academy has been actively engaged with the Office of the National Coordinator for Health Information Technology (ONC) throughout the meaningful use process, said AAFP President Glen Stream, M.D., M.B.I., of Spokane, Wash., adding, "We appreciate that some of our comments to the proposed rule were taken into consideration for the final rule to make it more achievable for family physicians."
Stream noted that there is enough lead time ahead of the 2014 implementation date for physicians to prepare to adhere to the additional rules in stage two, and the AAFP will continue to work with members to keep them updated on the process and provide resources for their use.
Steven Waldren, M.D., director of the AAFP's Center for Health IT, reviewed the stage two meaningful use final regulation and pulled out some key points family physicians should be aware of.
CMS has updated a tip sheet(www.cms.gov) designed to help physicians and other eligible professionals understand the penalties associated with the Medicare and Medicaid Electronic Health Record (EHR) Incentive programs.
For example, the document explains that physicians who participate in Medicare and who have not achieved meaningful use of an EHR will see a decrease in payment for Medicare services beginning in 2015. The tip sheet illustrates how the penalty increases each successive year.
CMS also addresses how physicians can apply for hardship exemptions that would exclude their participation in the EHR incentive programs and therefore help them avoid an automatic reduction in their Medicare payment. A frequently-asked-questions section rounds out the tip sheet.
For example, the AAFP opposed a criterion requiring that more than 10 percent of all unique patients seen by a physician view, download or transmit their health information to a third party during the EHR reporting period.
"That requirement remains in place, but the threshold has been reduced to 5 percent," said Waldren. "However, the AAFP still has an issue with the precedent being set here that allows future Medicare penalties to be tied to the inactivity of individuals outside of the practice -- in this case, patients," said Waldren.
"The AAFP is supportive of patient engagement, but penalties should not be tied to events outside of a practice's control," he added.
In addition, the final rule, despite the AAFP's strong objection in its May comment letter, still penalizes physicians and other eligible providers who are not meaningful users of EHRs by October 2014.
"The final rule makes changes to decrease the burden on physicians by allowing a three-month reporting period for 2014 instead of a year," said Waldren, but he added the Academy still does not appreciate the "regulatory freedom" taken by the ONC in the interpretation of language pertaining to 2015 penalties.
The Academy also took issue with language in the proposed rule regarding computerized physician order entry for lab and radiology orders and argued that the rule was unfair because not all entities were able or willing to accept electronic orders.
Waldren noted that the stage two final rule separates the measurement of computerized order entry for each category and lowered the threshold for computerized entry of lab and radiology orders to 30 percent; however, the requirement that the order be entered by a licensed professional stands.
Other key points for physicians to keep in mind include that meaningful use stage two requirements do not have to be met until 2014; therefore, meaningful use participants will use stage one criteria for the remainder of 2012 and all of 2013.
Also noteworthy, the end of 2012 marks the last chance for physicians to receive the maximum incentive of $44,000 for Medicare meaningful use participation. The maximum incentive if physicians start in 2013 will be $39,000. That drops to $24,000 in 2014.
Waldren also pointed out that funding for regional extension centers -- which were set up in every state to help physicians implement EHRs and achieve meaningful use -- was provided for two years only and soon will be ending. With questions arising about the sustainability of these centers, physicians who are considering seeking technical support from their regional extension center should engage with the center sooner rather than later, especially those centers that provide free assistance to primary care physicians.