Physicians working in ambulatory surgery centers could finally participate in the federal electronic health-record incentive payment program, thanks to a bipartisan bill in Congress.
A vote is expected Wednesday on H.R. 877, the Electronic Health Fairness Act of 2015, sponsored by Rep. Diane Black (R-Tenn). An identical version, also entitled the Electronic Fairness Act of 2015, was introduced in the Senate in May by Sen. Johnny Isakson (R-Ga.).
Both bills address a fairness issue in the $31.7 billion EHR incentive payment program, which excluded payments to ASCs.
In 2015, physicians became eligible for a piece of the $30 billion EHR incentive pie if they performed at least half of their outpatient procedures in a setting with a certified EHR. Failure to meet the meaningful-use requirements could mean reduced future Medicare reimbursements of 1% up to 5%.
ASCs were excluded from qualification for EHR incentive payments. As a consequence, many of the EHRs used by physicians in ASCs have not been tested and certified for use in the program, a requirement for their use in the incentive payment program.
Nevertheless, in calculating the meaningful-use requirement that 50% of patient encounters must be documented on a certified EHR, the current rules require physicians and other “eligible professionals” who actively or exclusively use ASCs for surgery to count patient visits at ASCs in the denominator of total patient visits on which the 50% fraction is obtained.
As a result, “Physicians with patient encounters in an ambulatory surgical center are at a disadvantage when attempting to meet meaningful-use requirements,” the legislation said.
“Until such time as EHR technology is certified specifically for use in the ambulatory surgical centers, patient encounters that occur in such a center should not be used when calculating whether an eligible professional meets meaningful-use requirements, unless an eligible professional elects to include those encounters,” the bill concludes. This exemption is to sunset three years after HHS certifies through rulemaking that EHR technology “is applicable to the ambulatory surgical center setting,” it said.
Black serves on the House Ways and Means and Budget committees.
“This is a simple bill, but it solves a pesky problem for some percentage of EPs, mostly surgical folks, that practice medicine part of the time in ASCs,” said Robert Tennant, health information technology policy director for the Medical Group Management Association.
According to the group Advancing Surgical Care, ASCs are paid 55% of the amount paid to hospital outpatient departments. They give an example of outpatient cataract surgery, where Medicare pays hospitals $1,670 while paying ASCs only $964.