Bill would offer meaningful-use exemptions

A Republican congresswoman from Tennessee has introduced legislation that would exempt solo practitioners and physicians nearing retirement from the upcoming Medicare reimbursement cuts for physicians who do not meet meaningful-use requirements for electronic health-record systems under the American Recovery and Reinvestment Act.

Rep. Diane Lynn Black, a former nurse and member of the House Budget and Ways and Means committees, re-introduced her Electronic Health Records Improvement Act last month.

Physicians who don't meet meaningful-use targets this year under the Medicare version of the EHR incentive payment program face a 1% cut in their Medicare reimbursements in 2015.

Black's bill provides a three-year exemption from the penalties for payment years 2015 through 2017 if physicians or other eligible professional, collectively known as EPs, are "solo practice” or are “at or near retirement age,” defined as eligible for Social Security on the last day of Dec. 31, 2015 or attain early retirement age “during the 5-year period following” that day.

The bill also would rebate the amount of a reduced payment in 2015, and in years thereafter, if the eligible professional meets the meaningful-use criteria that year.

According to a legislative summary (PDF), the legislation also shortens the current, two-year gap between the performance period and the application of the penalty to no more than one year.

“This two year look-back period unfairly accelerates the date by which physicians must meet meaningful-use requirements to avoid penalties,” the summary said. “Considering the vast amount of resources needed to make this investment, the two year look-back period forces physicians to rush this important decision; potentially with a system that doesn't meet their needs; accept a damaging penalty for not making the investment.”

This bill also includes rural health clinics as “eligible professionals” under the program with the aim of increasing participation among rural healthcare providers and expanding “access to quality care for patients living in rural areas,” the summary said.

It also would require the CMS to add a formal appeals process before the application of penalties.

Congress, in drafting the ARRA, was well aware of a digital divide between urban and rural, and large and small providers, mandating the creation from scratch a network of regional health IT extension centers modeled after the nation's century-old agricultural extension service, to specifically provide IT educational and support services to these underserved providers. So far, $677 million has been allocated under the ARRA to fund them.

Both versions of Black's bill gained the support of the MGMA, and contain “reasonable requests,” according to Robert Tennant, its senior policy adviser. The MGMA “recommended a whole slew of these hardship exemptions.”

“The older physicians who wouldn't want to invest the considerable money it would take to become a meaningful user” should not be penalized, he said.

“It's hard to say where this whole bill is going,” Tennant said. To pass, he said, it's likely it would have to be amended onto another piece of legislation, since stand-alone bills have slim chances of passage. But this is the only legislation out there to amend the ARRA and “there is a lot of interest in this,” he said.