AMA Urges CMS to Drop Meaningful Use Penalties

Ken Terry

November 11, 2014

The American Medical Association (AMA) has added to an earlier policy statement calling on the Centers for Medicare & Medicaid Services (CMS) to drop penalties for not meeting the meaningful use requirements of the electronic health records (EHR) incentive program.

The new statement, adopted at the AMA's annual interim meeting, asks CMS to "suspend all penalties to physicians and health care facilities for failure to meet meaningful use criteria."

The existing policy, which dates from 2009, says that CMS should remove penalties for noncompliance with meaningful use, as well as for noncompliance with the CMS electronic prescribing incentive program. The AMA strongly supports incentives for adoption of health IT, but it opposes financial penalties for doctors who don't acquire the technology.

In a press release about the new policy statement, the AMA notes that only 2% of physicians have demonstrated stage 2 meaningful use so far. The AMA has joined with other healthcare associations to demand that policymakers fix the incentive program by making the criteria more flexible and by shortening the 2015 attestation period from 12 months to 90 days, the news release points out.

"Reasons Outside Physicians' Control"

A key barrier to meeting the meaningful use criteria, the AMA says, is the lack of interoperability among disparate EHRs. "The whole point of the meaningful use incentive program," the release notes, "was to allow for the secure exchange of information across settings and providers, and right now that type of sharing and coordination is not happening on a wide scale for reasons outside physicians' control."

The association cites two problems with the current health information exchange capabilities. First, "when data is transferred, it is not always incorporated into the receiver's EHR in a digestible way, making it difficult to act on and defeating the purpose of sharing. Additionally, interoperability often comes at a price, which further hinders its use."

The latter point refers to the cost of operating health information exchanges, which is often borne by providers. Moreover, to exchange secure messages and attachments using the Direct protocol, physicians and hospitals must pay fees to the health information service providers that move Direct messages from one provider to another.

The AMA also wants policymakers to "ease regulations to allow for EHRs to become more usable." Regulatory requirements, the association observes, are forcing physicians "to do clerical work and distracting them from paying close attention to their patients."

Recently, the AMA released a blueprint for improving the meaningful use program along with a framework outlining eight priorities for more usable EHRs. Among other things, the AMA called on CMS to replace its all-or-nothing approach to meeting the program criteria with one in which physicians would have to meet 75% of the criteria to obtain incentive payments and 50% of the requirements to avoid penalties for not showing meaningful use.

Even though the AMA's nonpenalty policy has been in effect for five years, the new policy statement shows the association moving beyond this key part of the blueprint. This shift suggests that the AMA is concerned that many physicians will be penalized for not showing meaningful use because of the difficulties they're encountering in meeting the criteria.

Unless the requirements are changed, physicians who attested in stage 1 and don't qualify for a hardship exception will be financially penalized if they don't meet the stage 2 criteria in 2015.


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