House bill would stop EHR penalties for more medical practices

Solo practices and physicians approaching retirement age could become exempt from Medicare pay reductions if expanded hardship exemptions for EHR adoption are enacted.

By Charles Fiegl amednews staff — Posted June 17, 2013

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Lawmakers have introduced legislation that would require the federal government to offer more hardship exemptions to physicians to stop Medicare payment cuts for failing to meet electronic health records meaningful use standards.

The House bill, introduced by Rep. Diane Black (R, Tenn.), would create additional hardship exemptions for single-doctor practices and physicians approaching retirement.

The 2009 law creating the Medicare and Medicaid EHR incentive program established payment reductions that begin in 2015 for eligible physicians and other health professionals. The incentive structure pays Medicare bonuses of up to $44,000 over five years, although bonus payments sent after April 2013 are reduced by 2% because of the recent federal budget cuts known as sequestration.

Physicians must adopt EHRs and begin to meet meaningful use requirements by July 2014 to stop the penalty from taking effect in 2015. The penalty would reduce Medicare pay by 1% for the first year and grow to 3% by 2017.

The existing list of hardship exemptions would extend to physicians in solo practice, the proposed legislation states. The other hardship would be an option for physicians who are 62 or older by the last day of 2015, or who would reach age 62 by 2020.

The American Medical Association wrote a May 30 letter voicing support for the proposal. The AMA particularly approved of the provisions adding hardship exemptions for solo physicians and those nearing retirement.

“While the Medicare/Medicaid meaningful use program has helped jump-start the use of EHRs, we are still in the early stage of progress due to technological, regulatory, as well as other challenges,” the AMA letter stated. “These challenges must be overcome in order to increase physician participation rates and maximize the benefits of this technology for our nation’s health care delivery system.”

Solo, older physicians lag behind

The National Center for Health Statistics at the Centers for Disease Control and Prevention has studied EHR adoption rates for physicians. Doctors who are the subject of the new proposed exemptions are struggling, data show.

A July 2012 NCHS Data Brief reported that 29% of solo practitioners had adopted EHRs by 2011. Larger practices had higher adoption rates, with 60% of physicians at two-doctor practices and 86% of those at practices with 11 or more physicians implementing the paperless systems.

Older doctors use EHRs at a lower rate, too. Nearly 50% of physicians 50 and older adopted the technology, and 64% of physicians younger than 50 said they used EHRs.

Other organized medicine groups also have written letters in support of the Black legislation. The cost of EHR implementation for a five-physician practice is more than $233,000, wrote 21 organizations representing physicians, practice administrators and other health professionals.

“For small practices, the high cost of EHR adoption is not offset by existing financial incentives,” the March 19 letter stated. “To the contrary, practitioners face uncertainty regarding the value they will receive. This is because the initial financial benefits of adoption, if they even exist, are difficult to quantify.”

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What EHR hardships are available now?

Physicians will face a 2015 federal electronic health record penalty unless they attest to meeting meaningful use by Oct. 1 during the 2014 reporting year. Hardship exemptions are available for doctors who can demonstrate circumstances preventing them from achieving meaningful use. Exemptions are for physicians and health professionals who:

  • Have insufficient Internet access or who face insurmountable barriers to obtaining infrastructure, such as high-speed or broadband Internet.
  • Begin practicing in 2015.
  • Encounter unforeseen circumstances, such as a natural disaster or other unforeseeable barrier.
  • Lack face-to-face interaction with patients or follow-up opportunities with patients.
  • Practice in multiple locations and do not control access to EHRs during more than 50% of patient encounters.

Source: “Payment Adjustments & Hardship Exceptions Tipsheet for Eligible Professionals,” Centers for Medicare & Medicaid Services, August 2012 (link)

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External links

‘‘Electronic Health Records Improvement Act,’’ H.R. 1331, March 21 (link)

“Payment Adjustments & Hardship Exceptions Tipsheet for Eligible Professionals,” Centers for Medicare & Medicaid Services, August 2012 (link)

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