EHR Incentive Program


Published 3/1/2016

Meaningful Use Update

Deadlines to apply for hardship exemptions
On Dec. 28, 2015, President Obama signed the Patient Access and Medicare Protection Act into law. The Act was established to address payment adjustments under the Electronic Health Record (EHR) Incentive Program (meaningful use program) for the 2015 reporting period.

In an effort to allow physicians to avoid a meaningful use penalty in 2017, the law allows the Centers for Medicare & Medicaid Services (CMS) to consider hardship exceptions for categories of Eligible Professionals (EPs) and hospitals in a new, more streamlined process. Physician groups, including the American Association of Orthopaedic Surgeons (AAOS), lobbied for the legislation due to the delayed publication of the program's modifications.

If you or your organization did not successfully meet meaningful use for an EHR reporting period in 2015 and would like to apply for a hardship exception, the deadlines are as follows:

  • An application including only EPs must meet the EP deadline on July 1, 2016.
  • An application including EPs and eligible hospitals must meet the EP deadline on July 1, 2016.
  • An application including only eligible hospitals must meet the deadline of July 1, 2016.

For the first time, physicians will find both an individual hardship exception as well as a group option that allows multiple providers to apply for a hardship exception on a single application. The individual filling out the information may be the physician applicant him/herself or it may be another individual filling out the information on behalf of the physician group. The hardship exception categories are the same for both groups and individuals—AAOS urges members to use the exemption category, "EHR Certification/Vendor Issues (CHERT Issues)" (option 2.2.d in the application), which will be open to ALL physicians because of the delay in publication of the program's modifications and will not be audited by CMS.

The application and additional instructions are available on the CMS EHR Incentive Programs website (

About the EHR Incentive Program
CMS's EHR Incentive Program was established in the American Recovery and Reinvestment Act of 2009 to promote the adoption and meaningful use of interoperable health information technology (HIT) and qualified electronic health records. The penalty for not participating in the EHR Incentive Program began in 2015. The penalty started at 1 percent in 2015 and increased to 2 percent in 2016. Penalties increase to 3 percent in 2017 and can go up to as much as 5 percent of your total Medicare Part B allowed charges.

  • Stage 1 set the foundation for the EHR Incentive Program by establishing requirements for the electronic capture of clinical data, including providing patients with electronic copies of health information.
  • Stage 2 expanded upon the Stage 1 criteria with a focus on ensuring that the meaningful use of EHRs supported the aims and priorities of the National Quality Strategy. Stage 2 criteria encouraged the use of HIT for continuous quality improvement at the point of care and the exchange of information in the most structured format possible.

In April 2015, CMS released a proposed rule to ease some of the reporting burdens and give more flexibility to hospitals and physicians to meet federal targets for meaningful use for 2015 through 2017. The final rule with these adaptations was released in October 2015.

  • Stage 3 is still in effect, despite upcoming changes under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The Stage 3 requirements are optional in 2017. Physicians who choose to begin Stage 3 in 2017 will have a 90-day reporting period. All physicians will be required to comply with Stage 3 requirements beginning in 2018 using EHR technology certified to the 2015 version of the EHR requirements. Objectives and measures for Stage 3 include increased thresholds, advanced use of health information exchange functionality, and an overall focus on continuous quality improvement.

AAOS urged a delay of Stage 3 in a recent comment letter to CMS.

"Due to the shortcomings in Stage 2, we urge a delay in implementation of Stage 3," wrote AAOS President David D. Teuscher, MD. "[W]e are concerned that the requirements will not be achievable by January 1, 2018, the date given by CMS, given technology limitations outside of physician control. … We support the common goals of improving quality and providing appropriate documentation of patients' medical care, but we are concerned the complete set of objectives remains more relevant to primary care physicians, while disadvantaging specialty care physicians."

For more information about the Patient Access and Medicare Protection Act, email

For more information on AAOS advocacy efforts related to meaningful use, visit

Additional Information: