September 3, 2012
Patients Not Seeing Progress in Meaningful-Use
The Centers for Medicare and Medicaid Services (CMS) on August 23, 2012 released the final version of its second-generation criteria for "meaningful use" of electronic health records (EHRs). This will supposedly make it easier for physicians to earn bonuses and avoid penalties; however, little in the final version will benefit patients and their ability to view online their medical records. Again, the resistance of the American Medical Association has reared it ugly head to continue to make it difficult for patients to have transparency of their EHRs.
Two areas where physicians were able to delay aggressive implementation are the electronic transmission of prescriptions and delay of ability of patients to have access to their EHRs. Neither of these should have been that difficult to accomplish, but the AMA in their infinite wisdom have lobbied for slowing the progression of e-prescribing and wanted to junk the provision for patient online access.
On the topic of electronic prescribing, Stage 1 required physicians to transmit more than 40 percent of their scripts to the pharmacy. CMS in the proposed rules wanted to increase the threshold to 65 percent. The AMA and other medical groups held out for 50 percent and the CMS settled on 50 percent in the final regulations.
I am not surprised that the AMA and organized medicine is so opposed to letting patients view their health data online – they have something to hide. They wanted this entire part of Stage 2 thrown out. CMS had proposed a rule allowing more that 10 percent of patients to have access to their EHRs starting with Stage 2. Organized medicine says that CMS should not hold physicians accountable for patient behavior beyond their control. Thank you CMS for keeping this provision as part of Stage 2, but you should not have lowered it to 5 percent.
CMS did regrettably give four exceptions to meaningful use penalties to Stage 2 in 2015 for not achieving meaningful use and they are:
1. Infrastructure: Clinicians must prove that they practice in an area with inadequate Internet access or "insurmountable barriers" to obtaining it.
2. New practitioners: Clinicians who begin practicing in 2015 would be exempt from the meaningful-use penalty in 2015 and 2016, but they would have to demonstrate meaningful use in 2016 to avoid the penalty in 2017.
3. Unforeseen circumstances: Physicians may be able to avoid a penalty if natural disaster or some other unforeseeable event prevented them from meeting EHR meaningful-use criteria. CMS will consider this exception on a case-by-case basis, and sparingly so.
4. Scope of practice: Medicare will refrain from penalizing physicians who cannot achieve meaningful use by virtue of how they practice. They may not routinely see patients face to face, for example, or they may practice in multiple locations where they have no control over the availability of EHR technology.
However, CMS is not afraid to tread in areas they maybe should not have. CMS did deny a proposed exception for physicians nearing retirement. AMA and its cohorts wanted to exempt physicians if they are currently eligible or would be eligible by 2014 for Social Security benefits. CMS simply stated that a practitioner's age does not constitute a significant hardship.