Since its publication Oct. 16, CMS has received more than 170 public comments(www.regulations.gov) on the agency's final rule implementing stage three of the Medicare and Medicaid Electronic Health Record (EHR) Incentive Program, which included modifications to meaningful use (MU) requirements in 2015 through 2017. This latest round boosts the total number of MU comments received this year to well more than 900.
A quick scan of those messages indicates that although some physicians see the overall goals of the program -- that is, to promote the adoption of EHRs -- as worthwhile, sentiment is running decidedly against the administrative burdens it poses. In particular, the fact that the final rule was published so late in the year makes it extremely difficult for physicians to comply with the requirements for 2015.
That was a key point AAFP Board Chair Robert Wergin, M.D., of Milford, Neb., made in a Nov. 10 letter of support(2 page PDF) for legislation recently introduced in the House(www.mywcms.org) that would allow CMS to grant a blanket hardship exception for eligible health professionals who would otherwise face financial penalties for the year.
- The Academy is supporting legislation recently introduced in the House that would allow CMS to grant a blanket hardship exception for eligible health professionals unable to attest to meaningful use (MU) stage two for 2015.
- The bill would authorize CMS to waive the requirements without having to resort to time-consuming, case-by-case determinations of hardship.
- This latest development comes on the heels of advocacy by physician groups, federal lawmakers and others to identify a realistic timeline for implementation of the MU program's onerous criteria.
"CMS did not publish its proposed modifications to the rules for reporting meaningful use stage two until mid-October, allowing physician practices insufficient time to attest to their meeting these rules," Wergin said in the letter to Rep. Tom Price, R-Ga., sponsor of the Meaningful Use Relief Act. "Without your legislative solution, CMS would not have authority to waive the requirements, except by time-consuming, case-by-case determinations of hardship," he noted.
"This important legislation would give CMS authority to exempt eligible professionals from downward payment adjustments next year by allowing for a blanket hardship exemption," Wergin added. "We greatly appreciate your leadership in helping to make available a broad and efficient method to help physician practices continue to make progress in implementing EHR systems as CMS sorts out this regulatory framework."
Physicians aren't alone in expressing their mounting frustration with the program's onerous requirements. Shortly before the new rule was released, lawmakers in both the House and Senate appealed to HHS Secretary Sylvia Burwell and Office of Management and Budget (OMB) Director Shaun Donovan to hold off on finalizing stage three until policymakers have had sufficient time to evaluate how new Medicare payment models included in the Medicare Access and CHIP Reauthorization Act can be integrated with meaningful use.
AAFP, Other Groups to House Leaders: 'Refocus' MU Program
In a Nov. 2 letter(5 page PDF) to newly named House Speaker Paul Ryan, R-Wis., and House Minority Leader Nancy Pelosi, D-Calif., the AAFP joined 60 other national physician organizations and medical associations from all 50 states in urging Congress to "refocus" the meaningful use program to halt the current exodus of physicians and other health professionals from the program.
The groups note that Congress enacted the Health Information Technology for Economic and Clinical Health (HITECH) Act as part of the American Recovery and Reinvestment Act of 2009 "with the best of intentions," adding that whereas only 18 percent of physicians used electronic health records (EHRs) in 2001, more than 80 percent do so today.
"However," the groups add, "as the regulatory scheme to measure 'meaningful use' of this technology has evolved, CMS has continued to layer requirement on top of requirement, usually without any real understanding of the way health care is delivered at the exam room level.
"What has emerged from this morass of regulation is a system that relegates physicians to the role of data entry clerks, filling the patient record with unnecessary documentation requirements unrelated to the provision of quality care."
With the program now at a crossroads, and no help from the administration on the horizon, "Congressional action to refocus this program is urgently needed before physicians, frustrated by the near impossibility of compliance with meaningless and ill-informed bureaucratic requirements, abandon the program completely," the groups conclude.
"We believe that the stage three rule should be paused, as it should rely on proven technology -- designed outside the limitations of current federal requirements -- that can support a shift to outcomes and interoperability rather than measures and objectives," wrote the House members in their Sept. 28 letter(www.ascrs.org). "Unfortunately, the proposed stage three rule … exacerbates current problematic policies of stage two."
Senate Committee on Health, Education, Labor and Pensions Chair Lamar Alexander, R-Tenn., and Sen. John Thune, R-S.D., wrote to Burwell(www.ascrs.org) the same day, seeking immediate action to delay issuing stage three final rules until Jan. 1, 2017.
"While all hospitals and most physicians met the requirements of the first stage of the meaningful use program, stage two requirements are so complex that only about 12 percent of eligible physicians and 40 percent of eligible hospitals have been able to comply," the senators wrote.
The legislators' communications reflect concerns the AAFP, AMA and dozens of other medical organizations have previously made clear(3 page PDF) to HHS and OMB. The Academy also recently took the Office of the National Coordinator for Health IT(3 page PDF) to task regarding the unrealistic timetable for MU implementation.
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