HHS spreads the word about how specialists can meet meaningful use

One way is to claim exceptions because the guidelines don't apply to their specialty.

By Pamela Lewis Dolan — Posted Nov. 15, 2010

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For ophthalmologists talking about meaningful use requirements during the recent American Academy of Ophthalmology meeting, their question wasn't what information technology to buy in order to receive incentive payments. Their question was whether they would have to allow time to routinely weigh patients and check their blood pressure.

David Blumenthal, MD, the national coordinator of health information technology for the Dept. of Health and Human Services, came to the October meeting in Chicago and, responding to written questions about why standards for meaningful use were so focused on primary care, assured the ophthalmologists that there were plenty of ways for physicians outside primary care to meet meaningful use rules.

One way: Claim an "exception" to meaningful use rules because they don't apply to their specialty, which is as good as meeting the objective.

Dr. Blumenthal and his office, as well as other physicians, are trying to spread the word that there are plenty of exceptions that will allow specialists to meet meaningful use guidelines without changing their practices. Though his office issued no formal statement regarding specialists and meaningful use, Dr. Blumenthal has appeared at numerous physician functions to explain how nonprimary care doctors can meet the requirements.

Under meaningful use, physicians could receive up to $44,000 over five years through Medicare, or up to $63,750 over six years through Medicaid. To qualify for payments, physicians and hospitals must adopt and demonstrate meaningful use of certified electronic medical records systems.

Some specialists became concerned about the information that would have to be gathered to meet meaningful use requirements. The American Academy of Orthopaedic Surgeons published a position statement after the preliminary rules were released that supported the use of EMRs for improving the quality of patient care, safety and outcomes. But the statement said, "Orthopaedic surgeons will have great difficulty in meeting the current 25 meaningful use standards."

However, meaningful use rules, released in July, were created to give physicians more flexibility in meeting the requirements, according to HHS. Instead of a list of 25 objectives and quality measures physicians would have to complete, the final rules laid out 15 objectives all physicians must meet and a separate list of 10 objectives from which physicians choose five. Both lists allow for exceptions that count the same as meeting an objective.

Advice for specialists

Dr. Blumenthal, along with Derek Robinson, MD, medical director for the Dept. of Health and Human Services Region 5, and David Silverstone, MD, a Connecticut ophthalmologist, spoke at the AAO meeting to provide guidance on ways ophthalmologists and other specialists can qualify for the incentives. They said physicians can take advantage of exceptions that many seemed unaware of.

Dr. Robinson described some exceptions, including ones that apply to using computerized physician order entry systems and e-prescribing tools for ordering medications. If the physician writes fewer than 100 prescriptions during the 90-day reporting period, they are excluded from those two rules. Another exception applies to the rule that physicians must supply patients with electronic copies of their health records. An exception applies if no patient asks for the records, he said.

When choosing which five of the 10 "menu set" objectives to focus on, those that don't apply to that specialty can be counted as meeting an objective, Dr. Robinson said. In other words, if three of the 10 objectives don't apply, the physician would be obligated to meet only two other objectives that do apply.

The final rules integrated quality reporting measures from the electronic Physician Quality Reporting Initiative. There are three core quality measures for which reporting is required of everyone: blood pressure levels, tobacco status for patients over 13 years old, and adult weight screening.

"You may say that one of these or all three of these may not be part of your scope of practice," Dr. Robinson said. There is a provision that allows physicians to report zero as both the denominator and numerator if the quality measure is not within the scope of practice, he said.

In addition, there is a menu of 38 quality measures from which physicians pick three. The list includes quality measures that could cross several specialties. But if physicians could not find one that fits their scope of practice, they have the option of sending a statement attesting to that fact, Dr. Robinson said. Dr. Silverstone, who plans to apply for incentives, said of the 38 measures he identified four that apply to ophthalmology.

Dr. Blumenthal said he is often asked how physicians who don't meet the minimum requirement for Medicare or Medicaid patients can qualify. Under the rules, physicians applying for Medicare incentives must accept Medicare patients but cannot be hospital-based. Those applying for Medicaid incentives must have a minimum of 30% Medicaid patient volume, or 20% for pediatricians.

"For those of you who are in that category, you will have to do what physicians prior to the bill for meaningful use incentives have done, which is to decide, in the absence of meaningful use incentives, whether you want to acquire an electronic medical record system."

Dr. Silverstone encouraged those who are shopping for an EMR system to first find a system that works for their practice. Meeting meaningful use should come second.

"Remember, what we really want to be doing here is buying a service, not technology," he said. "You want to make sure this is something that can enhance your practice."

However, some specialists said it would be better if there were separate meaningful use rules for them.

"The final rules provided a more reasonable path for physicians to become meaningful users of EMRs, but the AAOS still believes separate meaningful use criteria need to be developed for surgical specialties," said Thomas C. Barber, MD, a member of the AAOS EMR Project Team.

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