CMS Vows Flexibility on EHR Hardship Exemptions


February 27, 2014

Physicians who do not comply with stiffer criteria for meaningful use of electronic health record (EHR) systems this year may be able to avoid a Medicare penalty if their software vendor is the problem, the head of the Centers for Medicare & Medicaid Services (CMS) said this morning.

However, the federal government will not delay upgrading from stage 1 to stage 2 requirements for its EHR incentive program in 2014, said CMS Administrator Marilyn Tavenner, turning down a recent request for a deadline extension from the American Medical Association (AMA), the American Hospital Association (AHA), and 45 other healthcare organizations.

"Now is not the time for us to stop moving forward," Tavenner said at the annual conference of the Healthcare Information and Management Systems Society in Orlando, Florida.

As a concession, Tavenner said her agency would be more flexible in granting hardship exemptions to physicians at the mercy of an EHR vendor that is slow in supplying them with stage 2–compliant software. Physicians who earned bonuses in the EHR incentive program for at least 2 years under stage 1 must demonstrate meaningful use in 2014 under stage 2 or else see their Medicare reimbursement cut by 2% in 2016. A hardship exemption would spare noncompliant physicians the axe.

The problem of tardy software vendors came up in a letter that the AMA, the AHA, and other groups sent to the Department of Health and Human Services last week, seeking a deadline extension and more flexibility overall in the incentive program. They noted that only a fraction of EHR programs that were certified for stage 1 have graduated to stage 2 certification.

"It is clear the pace and scope of change have outstripped the ability of vendors to support providers," the groups wrote.

At her talk at the conference today, Tavenner said CMS also would consider granting hardship exemptions to physicians who, for reasons beyond their control, could not attain some of stage 2's higher performance thresholds this year.

Stage 2, for example, raises the bar for the electronic prescribing requirement. Physicians now must send more than 50% of their scripts (ie, those eligible for electronic transmission) from their computer to the pharmacy's computer, up from more than 40% under stage 1. Tavenner did not cite this or any other performance threshold but seemed to suggest that CMS might deem a physician compliant in 2014 if he or she electronically prescribed just 45% of the time.

"I can think of examples, but I'll just say that we're going to try to listen," said Tavenner.

The government is turning a deaf ear, however, to requests from organized medicine to delay the mandatory use — set to begin October 1 — of the new ICD-10 diagnostic codes on Medicare, Medicaid, and private insurer claims. ICD-10 stands for the International Statistical Classification of Diseases and Related Health Problems, 10th Revision. Medical societies say switching to the new codes, which are more numerous and complex than their ICD-9 predecessors, will cost physicians tens of thousands of dollars. Furthermore, inadequate testing of claims submission with the new codes could lead to disastrous logjams in medical practice cash flow, organized medicine contends.

"There are no more delays, and the system will go live October 1," said Tavenner. "Let's face it, guys, we've already delayed this more than once, and it's time to move on."


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