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.
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