The American Medical Association and the Medical Group Management Association have called on the CMS and HHS rule writers to add even more flexibility to the federal electronic health-record incentive payment program for Stage 2 and beyond.
The two groups were responding at the close of the public comment period on modifications to the program contained in a proposed rule released by the feds in May.
The proposed rule, as issued, would give providers having difficulties stepping up to the program's more stringent Stage 2 requirements the opportunity to seek waivers, enabling them to still receive EHR incentive payments and also avoid Medicare reimbursement penalties for non-compliance.
The AMGA, in a four-page letter by Dr. James Madara, its CEO and executive vice president, to CMS Administrator Marilyn Tavenner, said the changes in the proposed rule were “important and necessary,” but also criticized the feds for failing to address the program's “all or nothing approach,” leaving no room for physicians who can meet most but not all of its requirements.
The AMA also said the proposed rule's exclusive focus on early adopters leaves “other participants with little relief.”
The proposed rule also failed to eliminate double reporting of quality measures for meaningful use and the Physician Quality Reporting System, the AMA said. The proposed changes “may be too late to offer significant relief to physicians,” the AMA said.
The MGMA also praised and criticized the program in a 40-page letter from Anders Gilberg, the association's senior vice president, government affairs, to Tavenner and to Dr. Karen DeSalvo, head of the Office of the National Coordinator for Health Information Technology at HHS.
While Gilberg said the association is “very supportive” of health IT adoption, it is “increasingly concerned over the growing government overreach with respect to the Medicare and Medicaid EHR incentive program, which has produced a regulatory environment that is clearly contrary to the intent of the originating statute.”
“We believe that the combination of the more rigorous Stage 2 meaningful-use requirements, lack of available software and many competing federal and private sector initiatives have acted as a clear obstacle for physician practice success in this second phase of the program,” the MGMA letter said.
According to the latest CMS data reported publicly this month, nearly 1,000 physicians and other eligible professionals have attested to having achieved the Stage 2 meaningful requirements of the program this year, compared with more than 300,000 physicians and other EPs who have achieved Stage 1 goals since the program began in 2011.
The MGMA deemed the number of Stage 2 qualifiers thus far “distressingly low,” adding that (w)ithout significant modifications, the EHR incentive program “runs the risk of failure.” Under the proposed rule, waivers can be obtained if a provider attests that 2014 Edition software needed to meeting meaningful-use requirements this year was not available.
The MGMA asked the CMS and ONC to extend into 2015 the flexibilities offered for 2014.
The proposed rule, drafted by the CMS and the ONC, would give office-based physicians, other EPs and hospitals an additional year to use 2011 Edition software and meet Stage 1 meaningful-use criteria, making it easier for them to receive a payment under the program and to avoid a reduction in the Medicare reimbursements if they don't.
The rule also would cement a previously announced delay until 2017 for the start date for Stage 3 meaningful-use requirements now under development.
The EHR incentive payment program has paid out to hospitals, physicians and other EPs $24.4 billion in incentives so far.
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