Auditing of participants in CMS' Medicare and Medicaid Electronic Health Record programs is in full swing, and the AAFP is defending family physicians against an inefficient process.
The Academy took action after hearing from multiple members that auditors were causing undue hardship by making unreasonable and burdensome documentation requests.
In an April 6 letter(2 page PDF) to CMS Acting Administrator Andy Slavitt, the AAFP pointed out that family physicians had embraced electronic health records (EHRs) "in the full spirit" of CMS' meaningful use program with the understanding that some of their implementation costs -- including initial decreased practice productivity -- would be offset by future incentive payments.
Unfortunately, those payments are at risk for some physicians randomly selected for an audit by HHS' Office of Inspector General (OIG).
- In an April 6 letter to CMS, AAFP Board Chair Reid Blackwelder, M.D., said meaningful use audits associated with the Medicare and Medicare Electronic Health Record Incentive programs were unreasonable and created undue administrative burden.
- AAFP member comments indicate that auditors lack expertise in health care and health information technology.
- The AAFP urged CMS to take several actions, including increasing transparency of audit statistics and outlining the nature of missing documentation that triggers failed audits.
"When the auditors demand that family physician practices produce documentation years after the fact, we find that to be unreasonable, an administrative burden and certainly not timely," wrote AAFP Board Chair Reid Blackwelder, M.D., of Kingsport, Tenn.
Special circumstances make producing documentation particularly difficult for family physicians who have made changes to their practices or whose practices have been bought by a larger health care system.
In the case of employed physicians, their employment contracts often require all Medicare payments to flow directly to the practice. "Years later, the individual physician is held responsible for repaying the payment after a failed audit," said Blackwelder.
Based on reports from family physicians, the AAFP questioned the effectiveness, responsiveness and expertise of OIG auditors.
"Auditors do not appear to have a health care background or expertise in EHRs, which makes the communication process challenging," said Blackwelder, citing physicians' stories of repetitious back-and-forth conversations with auditors and then weeks of waiting for an eventual audit resolution.
The lengthy and confusing process takes physicians away from patient care, he said.
The AAFP also hammered CMS' "zero-tolerance" policy that serves only to undermine the purpose of meaningful use requirements. Blackwelder pointed out that a physician could easily fail an audit because of a missing piece of documentation and, as a result, forfeit the incentive payment.
Selected for a Meaningful Use Audit?
The AAFP is soliciting feedback from family physicians who have positive or negative experiences with a meaningful use audit.
Steven Waldren, M.D., director of the AAFP's Alliance for eHealth Innovation, encouraged members to tell their stories to the Academy in email messages to firstname.lastname@example.org.
"We want to hear the good, the bad and the ugly," said Waldren in an interview with AAFP News. "We are cataloging AAFP member comments to strengthen our hand as we advocate for changes to the meaningful use program."
The practice is not only unfair, said Blackwelder, it also discourages practices that lag behind in EHR implementation from moving forward.
Blackwelder asked CMS to increase transparency of audit statistics -- specifically, to confirm the number of audits conducted and the audit failure rate, as well as to generate a report outlining the nature of specific documentation that triggered failed audits.
Such information would help physicians understand "the type and granularity of documentation required," said Blackwelder.
He urged CMS to take the issues outlined in the letter into account and provide immediate relief to those physicians "who have acted responsibly and legally and had no intent to defraud or deceive by participating in the meaningful use program."
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