CMS clarifies requirements for meaningful use hardship exemption

Physicians and federal agencies alike hope that the meaningful use incentives program will eventually produce sweeping benefits for the health care industry through the use of electronic health records systems. So far, though, physicians and hospitals have claimed that the Centers for Medicare and Medicaid Services' meaningful use requirements have not been realistic and have caused their workflows undue disruptions.

The CMS has shown some willingness to work with practices and providers, however, through more comprehensive ICD-10 billing testing. Recently, the agency indicated that it would be relaxing its 2015 meaningful use requirements for practices and providers who are unable to attest due to circumstances beyond their control, and now the CMS has clarified the guidelines for that hardship exemption.

Working through meaningful use difficulties
When physicians criticize EHR systems, they usually point to increased workflows and inefficient data entry systems. Rarely, though, does EHR certification factor into the conversation. However, with the CMS' updates to the recently announced meaningful use hardship exemption, physicians and hospitals will be paying much more attention to the certification status of their EHR system than before.

The CMS published updated guidelines on exemptions for professionals and hospitals that clarified what circumstances would make physicians and organizations eligible to skip attestation for the period of one year. The new rules primarily rely on external factors that complicate a health care source's ability to prove that they have satisfied meaningful use requirements to the best of their ability. 

The CMS has laid these external factors at the door of EHR vendors. Physicians and hospitals that use software that has not obtained or recently lost certification according to published CMS requirements would normally not be awarded incentive payments, but with this new hardship exemption, if they can prove that they were unable to obtain the necessary software certification, health care professionals and groups may still be eligible for incentive awards.

EHR Intelligence outlined the various wrinkles to the hardship exemption, some of which allow parties that successfully attested in 2013 to forgo the process for 2015. The rules differ slightly for individual physicians and larger health collectives, though in general, those new to meaningful use and those who have not successfully attested in the past year are eligible for an exemption from the CMS.

Also, EHR Intelligence explained that physicians who practice within the specialties of diagnostic radiology, nuclear medicine, interventional radiology, anesthesiology or pathology will be automatically granted a hardship exemption under the Medicare Provider Enrollment, Chain and Ownership System.

Making the most of the exemption
Though the CMS has extended an olive branch in the form of the exemption to physicians and organizations, some critics are still wary of the meaningful use timeline and their abilities to satisfy the requirements of the program. Russell Branzell, president and CEO of the College of Healthcare Information Management Executives, told Fierce Health IT that many health care professionals are concerned about satisfying meaningful use requirements, and he is not sure if the exemption will be enough to quell those fears.

"I think the hardship helps if it works out for individual organizations, but it doesn't smooth this out for the whole industry," Branzell told Fierce Health IT. "We still think that there's flexibility needed for the whole industry, which is front-end, Stage 2 flexibility meaning, basically, waiving penalty requirements for this year so people can smooth this out with the other big initiatives."

Branzell mentioned troubles physicians and hospitals are having navigating both the meaningful use program and ICD-10 transition, and that the amount of work may still be too much for the industry to handle, even with the hardship exemption. Regardless, however, he admitted that with hard deadlines approaching, the time is now to prepare as best as each organization can.