February 16, 2015

On January 29, CMS stated that it plans to shorten the EHR reporting period from the full year 2015 to 90 days.  This will be accomplished through a formal rule-making process in which CMS will attempt to reduce program complexity and the reporting burden on providers including physicians.

Before addressing the requirements for earning MU incentive payments going forward, we would remind anesthesiologists that they benefit from an automatic exemption, based on their Provider, Enrollment, Chain and Ownership System (PECOS) specialty designation.  This exemption is particularly important now, since eligible professionals (EPs) who are not exempt—including physicians who have enrolled in PECOS using one of the pain medicine codes rather than the anesthesiology code as their primary specialty designation—will face a one percent (-1%) penalty in 2015 if they have not attested to 2014 MU by February 28, 2015.  The penalties will increase to two percent (-2%) in 2016 and three percent (-3%) in 2017. 

Pain physicians can be exempted from the MU penalty if they either (1) perform 90 percent of more of their covered professional services in the hospital inpatient or emergency department setting and thus are considered “hospital based,” or (2) apply for and are granted a hardship exception.

Anesthesiologists who chose to demonstrate MU and seek to qualify for the incentive payment, and other EPs, had until 2014 to begin participating.  The requirements differ depending on the first year in which the EP attested to MU. 

In the first year of participation, EPs must meet all of the requirements of Stage 1 and report data for any continuous 90-day period during the calendar year.  The first program year during which EPs could report Stage 1 was 2011, under CMS regulations, and the first year for Stage 2 was 2014.  CMS has postponed Stage 3 until 2017; regulations with the Stage 3 requirements are due in March 2015.  The timeline according to which EPs must begin the various Stages, through 2019, is as follows:

The difference between the Stages lies in the number of “Meaningful Use Objectives”; and “Clinical Quality Measures” that must be reported.  The chart below shows the requirements for Stage 1 and Stage 2 (which, like everything else concerning the MU program, are highly complicated):

Thus, for example, an anesthesiologist who started reporting Stage 1 in 2012 and successfully attested for that year will be reporting Stage 2 in 2015.  The information to be reported for Stage 2 is the same as for Stage 1 with one addition: Family history (or a notation that there is no relevant family history) must be documented.  Importantly, the case information must now be entered into the EHR within one business day (under Stage 1, the window was three business days).  The same requirements apply to anesthesiologists and pain physicians who first attested for 2013.  EPs whose first year of participation was 2014 will continue meeting the Stage 1 requirements through 2015.

The reporting periods have been changed several times during the life of the program.  In 2014, the reporting period was reduced from a full year to 90 days to give EPs time to adopt 2014 certified EHR technology and to prepare for Stage 2.  As noted above, CMS plans to shorten the period again for 2015, having heard complaints from physician organizations about the program complexities that have prevented many providers from meeting Stage 2 requirements. 

Those complexities will not necessarily be alleviated merely by CMS’ shortening the reporting period (assuming that it does so).  Although EPs across all specialties have been paid nearly $10 billion under the MU program to date, only 3,655 Medicare EPs had received payments for Stage 2 attestation as of early December, however, compared to 268,686 EPs for Stage 1.  According to a poll conducted by Medical Practice Insider together with Sermo in which physicians were asked whether they planned to attest for Stage 2 in 2015, negative responses outweighed positive responses 944 to 822. 

EHRs that facilitate MU reporting by anesthesiologists and pain physicians are available; many of our readers are familiar with F1RSTUse.  Those who successfully participated in 2014 and who continue to do so for the next two years, until the end of the incentive program, will earn bonuses (that may, or may not, outweigh the costs of participation).  It is our hope that every EP who participates find the effort worthwhile.

With best wishes,

Tony Mira
President and CEO