Ken Terry
The Centers for Medicare & Medicaid Services (CMS) is reminding physicians who did not attest to meaningful use (MU) of electronic health records (EHR) in 2013 that they have until July 1 of this year to apply for a hardship exception so they can avoid a financial penalty in 2015.
Physicians who attested in previous years but don’t attest to MU stage 2 this year have until July 1, 2015, to apply for a hardship exception to sidestep a penalty in 2016. Hardship exceptions are valid for one year and then must be renewed.
CMS will grant hardship exceptions to eligible professionals (EPs) who live in an area with insufficient Internet access or lack of broadband, are new in practice, have had to deal with a natural disaster or other "unforeseen barrier," don’t interact with patients, don’t have access to EHRs in all practice sites, or have technology issues. In the latter category are the inability of the EP"s vendor to obtain 2014 certification or the inability of the EP to implement meaningful use because of certification delays.
As previously reported by Medscape Medical News, medical associations maintain that the technology exemption, which was added in March of this year, is not specific enough because it refers to certification rather than the availability of the EHR upgrades to physician practices. The latest version of the CMS hardship exception application does not clarify this point.
How Many Are Prepared?
The Office of the National Coordinator of Health Information Technology (ONC) on Tuesday released datashowing that, as of April, 83% of EPs who had attested to meaningful use were "likely" to have access to the 2014-certified EHRs that are now required in both meaningful use stage 1 and stage 2. Seventy-eight percent of these EPs are presumed to be able to upgrade their current products, and 5% are deemed "likely" to meet the 2014 base EHR criteria with new products from their current vendors.
But observers told Medscape Medical News that this does not mean that all of these EPs actually have 2014-certified EHRs, five months into the first year of MU stage 2.
"There is a concern that certified product availability is an issue," said Robert Wah, MD, chief medical officer of consulting firm CSC. The ONC data means that 83% of EPs "can likely upgrade to the 2014 edition without having to switch vendors," he noted. "But I"m not sure that 83% represents people who have taken delivery of the 2014 edition."
Mark Anderson, a health information technology consultant in Montgomery, Texas, said that most practices that use EHRs from the top 20 vendors have gotten their upgrades. But even some of those practices may be having problems getting on their vendor’s schedule for training, he said.
Meanwhile, many smaller practices that use a wide variety of EHRs are struggling with meaningful use because their vendors didn’t get 2014 certified or haven"t delivered the upgraded versions yet, he pointed out.
According to ONC, 245 ambulatory EHR vendors had 2014-certified products as of April, compared with 384 EHR products that were used to attest to meaningful use from 2011 to 2013. Of the 2014-certified EHRs, 108 were upgrades of products that were used to attest in 2011 to 2013, 55 were upgrades of products that were not previously used in attestation, and 82 were products from new vendors.
A new CMS report, also released Tuesday, shows that just 600 EPs who did not attest in 2013 have applied for hardship exceptions so far. Dr. Wah said it is possible that some other providers who didn’t attest last year are unaware of the exceptions or are waiting until the last minute.
EPs who first demonstrate meaningful use in 2014 must attest by October 1. Other EPs have until the end of the year to show meaningful use, and all EPs must use a 90-day reporting period this year.
Very few EPs attested to MU stage 2 through the end of March, partly because of the 3-month reporting period. But 537,500 EPs have registered for the MU program, and more than two thirds of those have received Medicare or Medicaid payments.
Dr. Wah, who is president-elect of the American Medical Association, said he doesn’t know how ready most physicians are for stage 2. The reports he has heard vary widely, he noted.
"A lot of doctors are concerned about the all or none qualification. You can’t just meet some of the criteria; you have to meet them all, or you won"t make it." That"s the same as in stage 1, "but stage 2 is a lot more challenging," he observed.
Consequently, he expects the rate of attestations in stage 2 to be considerably slower than in stage 1. But the postponement of the ICD-10 transition for one year will "probably help," he added, by opening up more space for providers to work on meaningful use stage 2.
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