A House bill to reduce the growing regulatory burdens of meaningful use (MU) of electronic health records (EHRs) proposes major changes that the AAFP has advocated, including ending "all-or-nothing" assessment and extending the 90-day reporting window to 2016 and beyond.
That alignment prompted the AAFP to write a letter(2 page PDF) to the bill's sponsor, Rep. Renee Ellmers, R-N.C., last week expressing support for the legislation.
The Further Flexibility in HIT Reporting and Advancing Interoperability Act(www.congress.gov), known as Flex-IT 2, would eliminate the all-or-nothing approach to assessment of performance measures in the MU program and instead allow physicians to earn credit for achieving part of the measures. Both penalties and incentives would be determined according to a sliding scale.
Physicians also would be able to attest to MU based on a 90-day reporting window rather than a full year, which many physicians consider too burdensome. In January, CMS modified rules to allow 90-day reporting for 2015, but the AAFP has said that's not enough. Flex-IT 2, if enacted, would set the shorter window as the reporting standard for all subsequent years.
- A bill introduced by Rep. Renee Ellmers, R-N.C., calls for major changes to the meaningful use program that the AAFP has been fighting for.
- The bill would allow physicians to attest to meaningful use based on a 90-day reporting window rather than a full year in 2016 and beyond.
- It also would eliminate the "all-or-nothing" approach to assessment of performance measures, instead giving physician credit for achieving part of the measures.
The legislation also would make hardship exceptions easier to obtain. Physicians who switch health IT vendors, are hit by trouble such as cyber-attack, are about to retire or have limited interaction with patients outside the hospital could apply for more time to meet MU standards.
"These common-sense policies would strengthen MU, prevent physicians from being unfairly penalized and increase program participation," the AAFP letter reads.
There is no Senate companion legislation yet, but senators from both parties have expressed a desire to improve interoperability of EHR systems and make the MU program "physician-friendly."
Family physicians need greater flexibility in the program's requirements because many offices are still adjusting to their EHR system. And many have trouble exchanging information with hospitals or other health facilities because different EHR systems are not compatible. That's particularly unfortunate because MU stage two is focused on timely and effective exchange of information between physicians, hospitals and other health institutions. And by stage three, health professionals are expected to focus on reporting improved health outcomes.
In the view of the AAFP and others, federal regulators have often not taken such difficulties into account. Accordingly, the Academy has sought to delay implementation of MU stage three and to delay or eliminate the penalties associated with the program.
"We need to fix meaningful use (stage) two and halt meaningful use (stage) three," health IT expert and AAFP consultant David Kibbe, M.D., M.B.A., told a Senate committee last month. "Quality reporting, security and interoperability need to be improved."
Flex-IT 2 also would subject some EHRs to interoperability testing. Family physicians have complained that regulatory penalties imposed by the MU program do not apply to vendors who should be held accountable for a lack of EHR interoperability.
Under the Medicare Access and CHIP (Children's Health Insurance Program) Reauthorization Act, MU criteria will be included in the Merit-based Incentive Payment System (MIPS) along with other CMS quality measures. That's been another source of angst for the Academy -- that implementation of MU stage three would begin before the MIPS standards had been developed and harmonized with stage three criteria.
The deadline for meeting stage two criteria has already been extended until 2016. According to CMS, implementation of stage three(www.cms.gov) is scheduled to begin in 2017 after physicians and hospitals have completed at least two years in stage two.
Ellmers' bill would prohibit CMS from announcing a final rule on stage three before Jan. 1, 2017, unless one of two conditions has been met: either 75 percent of eligible physicians or hospitals meet stage two criteria or MIPS standards are in place.
Related AAFP News Coverage
Meaningful Use Stage Three
AAFP Demands Physician-Friendly MU Rules