Meaningful Use of Electronic Health Records by Anesthesiologists and Pain Physicians – 2014
Anesthesiologists are automatically exempt from the meaningful use requirement and from penalties in 2015 as long as they have registered in the Provider, Enrollment, Chain and Ownership System (PECOS) using anesthesiology’s specialty designation (05). Any anesthesiologist who is at all unsure should check that he or she has created an account in PECOS and that the information is correct—also before July 1, 2014. Hospital-based anesthesiologists are not merely excepted; they are excluded from the EHR incentive program altogether and can neither earn the bonus nor be subjected to penalties. “Hospital-based” is defined narrowly under the program’s rules, however: the EP must provide 90 percent or more of his or her covered services in a hospital inpatient or emergency room setting. Most anesthesiologists do not provide anything like 90 percent of their covered services in the hospital inpatient or ER setting unless their practice is limited to cardiac, transplant or critical care work.
A recent change to the hardship exception that will spare certain non-excepted or non-excluded EPs—such as pain specialists who provide no anesthesiology services—the financial penalties for non-participation is another example of CMS’ attempts to make the program easier. In March 2014, CMS added a new hardship exception for EPs whose “EHR vendor was unable to obtain 2014 certification or the EP was unable to implement meaningful use due to 2014 EHR certification delays.” Practices deploying ABC’s F1RSTUseTM technology should note that it has received 2014 certification, which means that it satisfies certain new functional criteria known as the “2014 Edition” software standards. Other practices may want to heed the following MGMA recommendation:
As a new participant in 2014, even if you have heard from your EHR vendor that it anticipates being certified and able to support your EPs for the July 1 through Sep. 30 quarter, it is recommended that you apply for software-related hardship exceptions on behalf of your EPs prior to July 1. Applying for the hardship exception would mean avoiding the 2015 penalty in the event that the vendor is not ready. Should your vendor be certified and fully support your EPs as they seek to participate in the meaningful use program, the EPs will not be bound by their hardship exception application.
EPs who need the hardship exception to the 2015 meaningful use penalty should apply no later than 11:59 pm ET on July 1, 2014. Applications and supporting documentation can be submitted electronically to ehrhardship@provider-resources.com. Instructions for faxing or mailing the application are on page two of the application.
Is the EHR Incentive Program a Success?
At a meeting with CMS’ Health Information Technology Policy Committee on Tuesday, May 6th, when asked if the Stage 2 program was successful, the Office of eHealth Standards and Services’ representative answered, “We don’t have enough data.”
What the data do show is that only 50 EPs have attested to Stage 2 meaningful use, four months into the reporting year. Among hospitals, the reporting year for which began last October, just four have attested now that two 90-day reporting periods have elapsed. In a survey conducted by the College of Healthcare Information Executives (CHIME) in November 2013, 50 percent of responding hospitals said they planned to have attested to Stage 2 by the end of the second reporting period on March 31, 2014. “That would mean about 750 hospitals should have attested by now, so we’re basically 746 short,” the CHIME CEO told Becker’s Hospital Review on May 7th.
The problems preventing hospitals from demonstrating meaningful use are new Stage 2 requirements including care transitions and “EHR vendor issues.” CMS has granted 66 hardship exceptions to hospitals thus far.
On the other hand, more than 70 percent of EPs and 90 percent of hospitals have received incentive payments, mostly under Stage 1 of the Medicare, Medicaid and Medicare Advantage portions of the EHR incentive program. The total CMS outlay has been $22.9 billion in payments. F1RSTUse clients have collected nearly $20 million for approximately 1,400 EPs.
With that kind of outlay, CMS has predictably been conducting audits of EPs and hospitals that have attested and received incentive payments. In an article entitled How to Prepare for a Meaningful Use Audit posted on KevinMD.com on April 26th, Emily Richmond, MPH recommends familiarizing oneself with CMS’ audit preparation guidance for Stage 1 and for Stage 2 before the reporting period begins: “Start looking through your EHR to find out what reports you’ll need to print and take note of what documentation you’ll need to gather at certain points during the process.”
For further information, you or your staff might want to participate in CMS’ public conference call on “Stage 2 Meaningful Use Requirements, Reporting Options, and Data Submission Processes for Eligible Professionals,” which is scheduled for Thursday, May 29; 1:30-3:00 pm ET. To Register: Visit MLN Connects™ Upcoming Calls.
Based on the evidence, we know that anesthesiologists can successfully participate in the EHR incentive program—even Stage 2. We certainly encourage you to try, even if you have an exception in your hip pocket.