Washington Physicians are objecting to proposed Medicare and Medicaid guidelines for demonstrating the next stage of electronic health record meaningful use, saying the new standards would be too burdensome and may discourage practices from adopting the technology.
The American Medical Association and other organized medicine groups want federal officials to survey physicians on EHR stage 1 requirements and identify issues preventing doctor participation before the bureau finalizes rules for stage 2, according to a May 7 letter submitted to the Centers for Medicare & Medicaid Services. Measures defining meaningful use also should have exclusions that grant physicians to opt out of requirements that dont apply to their routine scopes of practice. Also, requirements should be limited to actions within a physicians control and not rely on patients or another third partys use of technology, the organizations said.
The AMA and others also argued against proposals to backdate EHR penalties that are authorized to start in 2015.
The proposed stage 2 requirements need more flexibility to foster adoption of EHR systems, stated Steven J. Stack, MD, chair-elect of the AMA Board of Trustees. More than 185,000 physicians have registered for the program, but hundreds of thousands had yet to apply for the incentives as of March. Nearly 62,000 physicians who registered have earned incentives from either Medicare or Medicaid.
Physicians are at varying stages of implementing health IT into their practices and should get credit for making a good-faith effort to meet the meaningful use requirements, Dr. Stack said.
Nearly 62,000 physicians have earned EHR incentives from either Medicare or Medicaid.
CMS is offering up to $44,000 over five years from Medicare, or $63,750 over six years from Medicaid, to eligible health professionals who adopt EHRs and use them in a meaningful way. The bureau has developed performance measures to define meaningful use criteria. Stage 1 rules were implemented in 2011, and stage 2 objectives would be required for early EHR adopters starting in 2014.
In stage 1, physicians were required to meet 15 core measures and five optional measures. Physicians would be required to meet 17 core objectives and three of five optional objectives under stage 2.
CMS issued proposed rules outlining stage 2 in February. Dozens of organizations representing physicians, hospitals and health administrators responded by submitting comments by a May 7 deadline.
The AMA is supportive of widespread adoption and meaningful use of EHRs by physicians, but the cumbersome proposed criteria will make successful doctor participation extremely difficult, Dr. Stack said.
Many of the proposed requirements are too aggressive, according to the organized medicine letter, which was co-signed by the AMA and 98 say and specialty societies.
For instance, CMS proposed that physicians incorporate more than 55% of all clinical lab test results into EHR technology as structured data. The physicians suggested that not all laboratories have the technology to send results to practices EHR systems, so the organizations recommended that the threshold be lowered to 40%.
Due to physicians limited capability to exchange data with other health care partners, many of the proposed stage 2 measures will require extensive manual data entry, which is not an efficient way of practicing medicine or improving quality care outcomes for patients, Dr. Stack said.
Broadened measures would include more doctors
Other societies representing specialists also have specific concerns with proposed core EHR measures. The American Psychiatric Assn. found that several of the required measures for all physicians appear to be geared largely toward primary care practices, stated Robert Plovnick, MD, director of the associations Dept. of Quality Improvement and Psychiatric Services. For instance, meaningful use criteria would require physicians to record vital signs blood pressure, height and weight during more than 80% of unique patient encounters.
The measure contains an exclusion clause for physicians who believe the requirement is not relevant to their practices. Taking vital signs is relevant to a psychiatrists scope of practice, but it is not routine, and achieving the 80% threshold would be problematic, Dr. Plovnick said. The association recommended a modification to the exemption language that would exclude physicians who believe it is not a routine part of their practice, not just those for whom it is not relevant.
Overall, the association praised CMS for making the incentive program more applicable to specialists. The bureau has created exclusions for other core and optional measures that are broad enough to include psychiatrists.
In our comments, we focused on the challenges to psychiatrists, but we also tried to remain positive about the impacts to the practice care coordination and improving quality, Dr. Plovnick said. Its not all negative.
Several groups support a proposal that extends stage 1 criteria for early EHR adopters through 2013. The AMA and other advocacy groups strongly oppose CMS plans to cut rates by 1% in 2015 and 2% in 2016 for failing to meet meaningful use standards by October 2014. Physicians argue that timing was not the intent of the law.
Penalties could start in 2016 based on failing to meet meaningful use requirements in 2015, wrote Susan Turney, MD, Medical Group Management Assn. president and CEO. That would bring the penalty assessment in line with the way bonuses are handled, she wrote.
CMS has proposed exemptions from the penalties for doctor practices with insufficient Internet access, for newly practicing physicians and for other relatively uncommon circumstances. However, the exemptions should not stop there, stated Rep. Renee Ellmers (R, N.C.), chair of the House Small Business Committees panel on health care and technology.
I urge you to grant hardship exemptions for very small practices (those with five or fewer physicians) and those physicians who are nearing retirement (those who are over 60 years of age), Ellmers wrote in a May 1 letter.
Nearly 62,000 physicians have earned electronic health record bonuses from Medicare and Medicaid since May 2011, with almost 40,000 getting bonuses from Medicare. Primary care physicians have received the most from Medicare, with about 17,000 physicians sharing more than $300 million.
Copyright 2012 American Medical Association. All rights reserved.
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Submited at Monday, May 14th, 2012 at 11:00 pm on Uncategorized by Alina
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