Physician EMR Stimulus

New EHR Exemptions Proposed

Margaret Young Levi Electronic Health Records, Eligible Professional Incentives, Health Information Technology, HITECH Law, Meaningful Use, Physician EMR Stimulus , , , ,

Doctor Speaking with PatientA 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.

February 28th Deadline for EPs To File Attestation for EHR Incentives and CQMs

Margaret Young Levi EHR Certification Standards, Electronic Health Records, Eligible Professional Incentives, Health Information Technology, HITECH Law, Meaningful Use, Physician EMR Stimulus

The deadline is fast approaching for eligible professionals (“EPs”) to file attestations to receive electronic health record (“EHR”) incentives available under Medicare’s Health Information Technology for Economic and Clinical Health Act of 2009 (“HITECH Act”). 

To receive an EHR incentive payment, EPs, such as physicians, dentists, podiatrists, optometrists and chiropractors, must show they are “meaningfully using” their EHRs in ways that can positively improve patient care by meeting certain objectives and reporting certain clinical quality measures (“CQMs”).  EPs must also file an attestation that they have met the thresholds and all of the requirements of the Medicare EHR Incentive Program.  EPs who participate in the Medicare EHR Incentive Program in 2012 must submit the CQMs and file an attestation with CMS for the 2012 program year by February 28, 2013. 

If you are participating in the pilot program to submit your CQM data electronically, please be aware that your window to file is limited because of a planned system downtime.  You will be unable to file your CQM data beginning at 11:59 p.m. ET tomorrow, Friday, February 22 through Sunday, February 24 at 11:59 p.m. ET because CMS has a system outage already scheduled that will affect CQM filing.  (We understand, but have been unable to verify, that you may still file an attestation during the outage.)  The Centers for Medicare & Medicaid Services (“CMS”) warns that “[f]ailure to submit your CQMs electronically by 11:59pm ET on February 28 will result in your attestation being rejected for the 2012 program year.” 

We also recommend you not wait until the last minute—as CMS expects a high volume of users on both the Physician Quality Reporting System (“PQRS”) and EHR Incentive Program systems over the next week.  Please keep this in mind when planning for your CQM data submission and completion of your 2012 attestation. 

For additional information regarding the EHR Incentive Program, check out CMS’ EHR Incentive Programs website.  Its Educational Materials in particular are quite helpful.  In addition, CMS has recently updated its frequently asked questions (“FAQs”) related to the EHR Incentive Programs.    

CMS Releases Proposed Rule for Stage 2 Meaningful Use of Electronic Health Records

Kathie McDonald-McClure EHR Certification Standards, Electronic Health Records, Eligible Professional Incentives, Health Information Technology, HITECH Law, Hospital EHR Stimulus, Meaningful Use, Physician EMR Stimulus , , , , , , ,

On Thursday, February 23, 2012, the Centers for Medicare and Medicaid Services (CMS), pursuant to the Health Information Technology for Economic and Clinical Health (HITECH) Act, released a 455-page Proposed Rule specifying the Stage 2 criteria that eligible professionals (EPs), eligible hospitals and critical access hospitals (CAHs) must meet in order to qualify for Medicare and/or Medicaid incentives related to electronic health records (EHRs).  The Proposed Rule also proposes to modify certain Stage 1 criteria, as well as criteria that apply regardless of Stage, as previously published in the Final Rule on July 28, 2010 in the Federal Register.  The proposed provisions related to Medicaid (calculations of patient volume and hospital eligibility) would take effect shortly after the finalization of the Proposed Rule and would not be subject to the proposed one-year delay for Stage 2 meaningful use of a certified EHR.  The Proposed Rule states that the changes to Stage 1 would take effect for 2013, but that most changes would be optional until 2014.  Last but not least, the Proposed Rule addresses the Medicare payment adjustments that will take place for EPs, eligible hospitals and CAHs who fail to demonstrate a meaningful use of certified EHRs by 2015 and proposed exceptions to such adjustments.

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Early Meaningful Users Promised Stage 2 Extension

Margaret Young Levi Electronic Health Records, Health Information Technology, HITECH Law, Hospital EHR Stimulus, Meaningful Use, Physician EMR Stimulus , , , , , , ,

On November 30, 2011, U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius issued a press release announcing proposed steps to encourage physicians and hospitals to adopt electronic health records (EHRs) this year and receive incentive payments made available under the Health Information Technology for Economic and Clinical Health (HITECH) Act), which was part of the American Recovery and Reinvestment Act of 2009 (ARRA). 

Under the HITECH Act, physicians and hospitals have the opportunity to earn financial incentives from Medicare and Medicaid if they demonstrate the adoption and meaningful use of certified EHRs in a series of three stages. Under the current rules, physicians and hospitals that adopt EHRs in 2011 and attest to meeting Stage 1 meaningful use standards by February 28, 2012 must meet Stage 2 standards in 2013. If they wait until 2012 to attest to Stage 1, providers could delay Stage 2 compliance until 2014. To encourage more providers to adopt EHRs in 2011, instead of waiting until 2012, HHS proposes to allow providers who qualify for Stage 1 meaningful use in 2011 an extension until 2014 to meet Stage 2 standards. HHS clarified that providers first attesting to meaningful use in 2011 qualify for both 2011 and 2012 incentive payments.

These proposed steps are consistent with June 2011 recommendations from the Health IT Policy Committee (HITPC).  As we reported this summer, HITPC advocated that providers who begin to attest to meaningful use in 2011 be provided an extra year “to phase in the stage 2 expectations (i.e., Stage 2 for those who attest in 2011 would begin in 2014).”  HHS listened!

HHS intends to publish this extension in the Stage 2 meaningful use Notice of Proposed Rulemaking (NPRM) in February 2012.

At the same time, HHS also released new data from the Centers for Disease Control and Prevention (CDC) showing increased adoption of EHRs by physicians.  The CDC report documented that physicians’ adoption of health information technology (IT) doubled in two years, and 52% of physicians intend to apply for meaningful use incentives, up from 41% in 2010.  Click here to access additional information about achieving meaningful use, including the CDC report.

Health IT Policy Committee Recommends Delay for Stage 2 Meaningful Use

Kathie McDonald-McClure Electronic Health Records, Eligible Professional Incentives, Health Information Technology, HITECH Law, Hospital EHR Stimulus, Meaningful Use, Physician EMR Stimulus , , , , , , ,

UPDATE: On July 6, 2011, Farzad Mostashari, M.D., ONC Chief, backed the ONC Policy Committee’s recommendation to delay implementing Stage 2 meaningful use criteria.

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On June 16, 2011, Paul Tang, M.D. , as Vice Chair of the Health IT Policy Committee for the  Office of National Coordinator (ONC), wrote a letter to Farzad Mostashari, M.D., the ONC National Coordinator, requesting a delay in implementing Stage 2 of the meaningful use criteria that eligible healthcare providers must meet in order to obtain the monetary incentives for adoption of electronic health records (EHRs).  The monetary incentives were established pursuant to the Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH Act), which was part of the American Recovery and Reinvestment Act of 2009 (ARRA).  Dr. Tang states in the letter:

The HITPC has heard from both the vendor community and the provider community that the current schedule for compliance with stage 2 meaningful use objectives in 2013 poses a nearly insurmountable timing challenge for those who attest to meaningful use in 2011. With the anticipated release of the final rule for stage 2 in June, 2012, it would require EHR vendors to design, develop, and release new functionality, and for eligible hospitals to upgrade, implement and begin using the new functionality by the beginning of the reporting year in October of 2012. After careful consideration of the trade-offs between the urgency with which new functionality is needed and the ability to safely deliver and to effectively use the new functionality, the HITPC recommends that—only for those who begin to attest to MU in 2011—an extra year be provided to phase in the stage 2 expectations (ie., Stage 2 for those who attest in 2011 would begin in 2014).

The Committee asserts that the delay would only affect providers who implement Stage 1 in 2011.  This assumes that providers who wait until 2012 to implement Stage 1 would not have been ready to implement Stage 2 until 2014 anyway.  The letter also sets forth the proposals for stengthening Stage 1 criteria in Stage 2.  The Committee voted 12 to 5 in favor of the recommendations in the letter.  To read the entire 14-page letter, click here.