The Centers for Medicare and MedicaidServices (CMS) on August 23, 2012 (forgive medscape for their date error) released the final version of itssecond-generation criteria for "meaningful use" ofelectronic health records (EHRs). This will supposedly make iteasier for physicians to earn bonuses and avoid penalties; however,little in the final version will benefit patients and their abilityto view online their medical records. Again, the resistance of theAmerican Medical Association has reared it ugly head to continue tomake it difficult for patients to have transparency of their EHRs.
Two areas where physicians were able todelay aggressive implementation are the electronic transmission ofprescriptions and delay of ability of patients to have access totheir EHRs. Neither of these should have been that difficult toaccomplish, but the AMA in their infinite wisdom have lobbied forslowing the progression of e-prescribing and wanted to junk theprovision for patient online access.
On the topic of electronic prescribing,Stage 1 required physicians to transmit more than 40 percent of theirscripts to the pharmacy. CMS in the proposed rules wanted toincrease the threshold to 65 percent. The AMA and other medicalgroups held out for 50 percent and the CMS settled on 50 percent inthe final regulations.
I am not surprised that the AMA andorganized medicine is so opposed to letting patients view theirhealth data online – they have something to hide. They wanted thisentire part of Stage 2 thrown out. CMS had proposed a rule allowingmore that 10 percent of patients to have access to their EHRsstarting with Stage 2. Organized medicine says that CMS should nothold physicians accountable for patient behavior beyond theircontrol. Thank you CMS for keeping this provision as part of Stage2, but you should not have lowered it to 5 percent.
CMS did regrettably give fourexceptions to meaningful use penalties to Stage 2 in 2015 for notachieving meaningful use and they are:
1. Infrastructure: Clinicians must prove that they practice in anarea with inadequate Internet access or "insurmountablebarriers" to obtaining it. 2. New practitioners: Clinicians who begin practicing in 2015 wouldbe exempt from the meaningful-use penalty in 2015 and 2016, but theywould have to demonstrate meaningful use in 2016 to avoid the penaltyin 2017. 3. Unforeseen circumstances: Physicians may be able to avoid apenalty if natural disaster or some other unforeseeable eventprevented them from meeting EHR meaningful-use criteria. CMS willconsider this exception on a case-by-case basis, and sparingly so. 4. Scope of practice: Medicare will refrain from penalizingphysicians who cannot achieve meaningful use by virtue of how theypractice. They may not routinely see patients face to face, forexample, or they may practice in multiple locations where they haveno control over the availability of EHR technology.
However, CMS is not afraid to tread inareas they maybe should not have. CMS did deny a proposed exceptionfor physicians nearing retirement. AMA and its cohorts wanted toexempt physicians if they are currently eligible or would be eligibleby 2014 for Social Security benefits. CMS simply stated that apractitioner's age does not constitute a significant hardship.
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