EMR meaningful use rules need to be more flexible, doctor groups say

Smaller rural practices are particularly vulnerable to losing out on federal electronic records subsidies, states a letter from the AMA and other physician organizations.

By Chris Silva — Posted March 22, 2010

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More than 90 physician and state medical societies sent a letter to federal officials calling their proposed criteria for the adoption and use of electronic medical records unrealistic and overly ambitious.

Physicians are very supportive of efforts to incorporate EMRs into their practices to improve quality of care and enhance patient safety, stated the March 15 letter, signed by the American Medical Association, the American College of Physicians, the American Academy of Family Physicians and the American College of Surgeons, among many others. Nearly all state medical societies also signed on.

But the 25 proposed meaningful use objectives that the Centers for Medicare & Medicaid Services said physicians would need to meet to be eligible for Medicare or Medicaid bonuses in the project's first stage will deter many physicians from even trying to obtain the incentives, the organizations said. Moreover, the vast majority of physician practices are made up of five or fewer doctors and may not be able to meet the requirements on time.

"Studies of EHR adoption clearly show that it takes more time for smaller practices to adopt and implement EHRs because they have fewer resources and support," the letter stated. "Aggressive timelines and criteria during the initial stage of the incentive program will only serve to undermine this effort."

In late December 2009, CMS proposed the first of three stages of objectives that physicians and hospitals would need to meet to secure Medicare and Medicaid bonuses. At stake is an estimated $14.1 billion to $27.3 billion in net funding over 10 years made available through the most recent economic stimulus package. Medicare eventually would start penalizing physicians who did not adopt and use EMR systems.

Each proposed objective for stage one -- which begins in 2011 -- has a corresponding measure attached to it. For example, an objective for physicians to generate and transmit prescriptions electronically requires doctors to submit at least 75% of all drug orders using certified EMR technology.

But physicians say the criteria are too intense, and the requirements could punish physicians who undertake great efforts to achieve meaningful use only to be denied incentive payments due to complex benchmarks, said AMA Board of Trustees member Steven J. Stack, MD.

"Overall, the proposed reporting criteria require more flexibility," he said. "We'd like to see more help for physicians in identifying the data necessary for accurate reporting."

The organized medicine comment letter suggests a number of revisions, including allowing physicians to secure bonuses if they attest to meeting at least five of the 25 objectives, rather than the "all or nothing" approach outlined in the proposed rule. The groups also call for eliminating certain objectives that don't directly apply to EMR adoption and reducing the number of clinical quality measures that physicians would need to report using their electronic systems.

The Medical Group Management Assn., which signed the joint letter to CMS Acting Administrator Charlene Frizzera, also issued its own comments on the proposed meaningful use rule. In the MGMA letter, the association called on CMS to request a one-year extension of stage one from Congress, a change that only could be done legislatively.

Federal officials said they are trying to strike an appropriate balance between an aggressive timetable and the reality of how few physicians and hospitals are fully capable of using EMRs now.

"What we don't want to do is lose sight of the end goal and the fact that frankly this an area where a lot of American medical practices are seriously behind what's going on in other parts of the world [regarding] adoption of electronic health information to improve patient care, drive quality and lower costs," said Health and Human Services Secretary Kathleen Sebelius.

Speaking during a March 15 media call, along with David Blumenthal, MD, the national health information technology coordinator, Sebelius said she is eager to review the feedback on the proposed meaningful use rule. She said the comments would be taken into account before federal officials issue a final rule later this year.

Sebelius and Dr. Blumenthal also announced during the media call that the federal government was releasing another $162 million in awards to help states facilitate health information exchange and advance health IT.

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