On Friday, November 6, 2013, the Centers for Medicare & Medicaid Services (CMS) and the Office of National Coordinator of Health Information Technology (ONC) announced its proposal to extend the timeline by which eligible healthcare providers must demonstrate a “meaningful use” (MU) of a certified electronic health record (EHR) in compliance with the MU Stage 2 criteria set forth in regulations issued pursuant to the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009. Originally, eligible providers who demonstrated Stage 1 MU by the end of 2013 would have had to demonstrate at least 3 months of Stage 2 MU by September 30, 2014 for eligible hospitals and critical access hospitals (CAHs) and by December 31, 2014 for eligible professionals, do one more year of Stage 2 in 2015, and then move to Stage 3 by 2016. The CMS – ONC apparently will give all eligible providers more time to stay in Stage 2, stating: “Under the revised timeline, Stage 2 will be extended through 2016 and Stage 3 will begin in 2017 for those providers that have completed at least two years in Stage 2.” In essence, the start of Stage 3 is being delayed and, apparently (pending further rule making), nothing else.
By Margaret Levi and Kathie McDonald-McClure
As we previously reported in a blog post on September 24, 2013, an eligible professional, eligible hospital, or critical access hospital receiving an incentive payment for the meaningful use (MU) of electronic health records (EHRs) will likely be subject to a stringent audit from either Medicare or Medicaid. The fact that these MU audits are underway is now fully evident.
We have heard from several sources that CMS auditors are hitting Tennessee and Kentucky hospitals and physician practices and demanding repayment of meaningful use incentive monies if providers cannot fully back up their attestations for Stage 1 compliance in every respect.
On May 22, 2013, Kathleen Sebelius, Secretary of the United States Health & Human Services Department, announced that over 50 percent of doctors and over 80 percent of hospitals are making a “meaningful use” of electronic health records (EHRs) and have received incentives for such use. By comparison, in 2008, just nine percent had adopted EHRs. Secretary Sebelius credits the “dramatic increase” in adoption of EHRs to the Health Information Technology for Economic and Clinical Health Act (HITECH Act) that was passed as part of the American Recovery and Reinvestment Act of 2009 (ARRA). The HITECH Act awards incentives to eligible professionals (physicians) and hospitals who make a “meaningful use” of EHR technology that has been certified by the HHS Office of National Coordinator of Health Information Technology (ONC). The HHS press release with further information is available here.
On April 25, 2013, the Officer of National Coordinator for Health Information Technology (ONC) announced that it had revoked certification for two electronic health record (EHR) products that the ONC had previously certified for use as part of the incentive program implemented pursuant to the Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH Act). The products for which ONC revoked certification are EHRMagic-Ambulatory and EHRMagic-Inpatient. The ONC’s press release with additional information is available here.
Whether the providers who purchased these products in reliance on the previous ONC certification will be able to recoup their investment in these products may depend on the terms of any vendor agreement signed between the parties. For providers who are purchasing ONC-certified products, this development highlights the importance of examining the provider’s EHR vendor agreement to ensure that it contains adequate warranty and indemnification provisions that will protect the provider in case the vendor’s product is de-certified by the ONC. Importantly, without “certified EHR technology”, the provider will not qualify for the HITECH Act’s meaningful use incentive payments.
A new bill entitled the “Electronic Health Records Improvement Act” has been introduced in the U.S. House of Representatives. Its stated purpose is to “amend certain requirements and penalties implemented under the Medicare and Medicaid programs by the HITECH Act of 2009, which would otherwise impede eligible professionals from adopting electronic health records to improve patient care.” Most notably, this bill proposes two new exemptions to the requirements to be a meaningful user of electronic health records (“EHRs”) that will be beneficial to solo physician practices and physicians nearing retirement:
- Eligible Professionals in Small Physician Practices. A physician who is a solo practitioner in 2015 would be exempt from the application of the downward payment adjustment for not demonstrating EHR meaningful use during the payment years 2015-2017. Implementing EHRs require significant investments in time for vendor selection, capital, and staff resources—and solo practitioners typically do not have the necessary resources to invest in EHRs. This exemption allows undercapitalized solo practitioners an additional three years to become a meaningful EHR user.
- Exception for Certain Physicians Near Retirement Age. A physician who will be eligible for Social Security by December 31, 2015 (or will be eligible during the 5-year period following that date) is also exempt from the application of the downward payment adjustment for not demonstrating EHR meaningful use during the payment years 2015-2017. This exemption will encourage physicians nearing retirement to continue practicing medicine for several more years instead of retiring early to avoid implementing an EHR. (Because this section of the Bill uses the terms “eligible professional” (in the text) and “physician” (in the title), there is some question as to whether this exception applies only to physicians nearing retirement or also applies to other types of eligible professionals, such as dentists, chiropractors, podiatrists, and optometrists. Hopefully, this confusion will be clarified if this Bill progresses into law.)
Here is a link to H.R. 1331. This Bill is currently in committee, and we will watch its progress closely.
Update (1/31/2015): Unfortunately, H.R. 1331 died in Committee.