Pathologists, EHRA push for more meaningful use flexibility

Another day for the health care industry means that another group of physicians has fallen on hard times within the meaningful use program. On average, these practices are on the smaller size, often with less than 50 beds and located far away from metropolitan areas with fast, reliable Internet access. Large health care systems can afford the price tag of the most expensive electronic health record systems, but small offices need to consider the financial ramifications of such a large purchase.

In light of these challenges, several Congressional representatives and health care provider groups have called for the Centers for Medicare and Medicaid Services to extend its already popular hardship exemption to pathology specialists and other HCPs who have been unnecessarily affected by the meaningful use program. In a renewed pushback against meaningful use requirements, several members of the House of Representatives and the Health Information Management Systems Society's Electronic Health Records Association penned open letters to Marilyn Tavenner, administrator for the CMS.

Fighting for flexibility
A 2013 study conducted by researchers from Weill Cornell Medical College and published in the journal Applied Clinical Informatics stated that specialty physicians, such as psychiatrists, dermatologists and ophthalmologists, were between 44 and 94 percent less likely to purchase and implement an EHR system than general practice physicians.

This can be explained in part due to the smaller number of patients doctors working in specialties usually see. With fewer appointments, specialists often do not make the money necessary to purchase EHRs, and pathologists in particular do not often work in a manner that integrates well with the technology. Rather than meeting patients and troubleshooting diagnoses, pathologists work behind the scenes testing patient samples. This work requires analytical skills rather than data collection.

In a letter addressed to Tavenner and signed by 89 members of Congress on behalf of pathology specialists across the country, the Congressional coalition urged the CMS to adjust its requirements for stage 3 of meaningful use. The group cited concessions made to the specialty in stage 2, including an extension to 2015 for practices subject to potential reimbursement adjustments. Now, the co-signers are calling for the maximum five-year exception allowed under the American Recovery and Reinvestment Act.

Pathologists are joined by the HIMSS' EHRA, which penned a letter to both Tavenner and Karen DeSalvo, M.D., M.P.H., M.Sc., National Coordinator for Health Information Technology. The group first criticized the CMS' decision to release a proposed rule for attestation requirements in 2014 in late June, giving health care professionals only months to determine a proper course of action. 

In keeping with the EHRA's wish to reduce wasted effort by health care organizations, the group called for the CMS to relax eligibility restrictions for organizations considering applying for a hardship exemption. The letter also mentioned complex and unclear language in the CMS' most recent rule proposal, and the EHRA urged for clarification in future updates so organizations can craft detailed plans off of those requirements.

The CMS will keep the proposed rule open for public comment until July 21, when it will be taken down for analysis and review. The agency will then issue official guidelines, but as the EHRA pointed out, there is no concrete timeline for that either.

Small practices may be behind the eight ball when it comes to EHR adoption and implementation rates, but these advocacy groups pledged to continue lobbying for an extended hardship exemption until the last opportunity. It is up to specialists to optimize their practice workflows as much as possible until they reach a point where EHRs become an intuitive tool or the CMS relents.