Earlier this year, the Centers for Medicare & Medicaid Services (CMS) announced its intent to engage in rulemaking to update the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. These changes, CMS wrote, are intended to help reduce the reporting burden on providers and specifically address concerns about software implementation, information exchange readiness, and developments in the industry. The new rule is expected this spring.

The CMS announcement followed news that approximately 257,000 professionals would be affected by meaningful use (MU) penalties in 2015 for failing to meet MU requirements. Only about 3 percent of physicians and other eligible providers had attested to Stage 2 MU in 2014, highlighting the difficulty of the program. Though CMS believes some physicians failed to meet MU by choice, the reality is that physicians face significant timing, staffing, technological or financial difficulty in implementing the electronic systems. (See “Not Yet Ready for Stage 2 Meaningful Use?”)

The American Association of Orthopaedic Surgeons (AAOS) shares the goal of having physicians use health information technology in a meaningful way, but believes that appropriate standards for meaningful use of EHR should be collaboratively developed by physicians through their professional organizations in cooperation with government agencies. The AAOS has aggressively and continually urged CMS to consider the difficulties physicians face. In a letter to then CMS Administrator Marilyn Tavenner, AAOS noted that the meaningful use policies could “push healthcare delivery into larger multispecialty practices and threaten to put small and solo practitioners out of business, while simultaneously reducing access to care.”

AAOS has also submitted comments to the Office of the National Coordinator for Health Information Technology (ONC) at the Department of Health and Human Services (HHS) highlighting the complexity and expense of implementation of EHR systems in the orthopaedic office.

“As specialty physicians, we face unique technology challenges, ranging from certification issues to collection of appropriate data, as well as the larger issues impacting all physicians, such as interoperability and cost,” the letter stated. AAOS also made specific suggestions, including development of quality measures for orthopaedic surgery that can be used in the meaningful use definitions and refinement of the meaningful use criteria to better reflect the unique characteristics of surgical specialty practices.

A coalition of 35 medical societies, including the AAOS, has also raised concerns about patient safety and other issues. “Physician informaticists and vendors have reported to us that MU certification has become the priority in health information technology design at the expense of meeting physician customers’ needs, patient safety, and product innovation,” the letter stated.

Legislative relief?
In January 2015, AAOS sent a letter of support to Rep. Renee Ellmers (R-Mich.), who introduced legislation that would allow providers the option to choose any 3-month quarter for an EHR reporting period to qualify for the Meaningful Use Program in 2015, as opposed to a full year. “The time constraints imposed on doctors and hospitals are inflexible and simply unmanageable—and this is evident by the dreadful Stage 2 Meaningful Use attestation numbers released by CMS late last year,” stated Rep. Ellmers in a press release. This pressure is paying off: In addition to realigning the hospital EHR reporting period to the calendar year and reducing complexity, one of the proposals CMS is considering is, in fact, to shorten the EHR reporting period in 2015 to 90 days.

“We strongly believe that Meaningful Use requirements should be established through phased implementation with sufficient incentives over several years, rather than a single, hard deadline with non-adoption penalties,” AAOS President Frederick M. Azar, MD, wrote to Rep. Ellmers. “Requiring physicians to report a full year of Meaningful Use in 2015 is contrary to the intent of the program and may cause physicians who are in compliance to miss out on eligibility. We therefore applaud your efforts to relax this reporting requirement by shrinking the reporting period from a full calendar year to any 3-month period.”

Will efforts be coordinated?
Although CMS intends to use its rulemaking power to pursue changes to meaningful use, the effort is separate from the Stage 3 MU proposed rule expected to be released this month. Because it is working on multiple tracks, CMS intends to limit the scope of the Stage 3 proposed rule to the MU requirements and criteria in 2017 and subsequent years.

Further, the ONC recently released an interoperability roadmap that lays out a plan for “what needs to happen, by when, and by whom, to see that electronic health information is available when and where it matters most,” according to National Coordinator for Health Information Technology Karen B. DeSalvo, MD, MPH. The roadmap identifies critical actions that should be taken by a wide range of stakeholders to help advance nationwide interoperability—the ability of a system to exchange electronic health information with and use electronic health information from other systems—and is currently accepting public comment.

“It is only through everyone’s combined efforts that we will achieve a learning health system that brings real value to electronic health information as a means to better care, wise spending, and healthier people,” the draft stated.

Elizabeth Fassbender is the communications specialist in the AAOS office of government relations. She can be reached at fassbender@aaos.org

Additional Information:
Information from CMS about EHR Incentive Programs: http://www.cms.gov/EHRIncentivePrograms.

Information from AAOS on EHR and health information technology: http://www.aaos.org/Govern/public/HIT/HIT.asp and www.aaos.org/pracman [login required].

AAOS Position Statement on Electronic Health Records

Letter to ONC [PDF]

Interoperability Roadmap [PDF]