The California Medical Association (CMA) and the American Medical Association (AMA) are urging the U.S. Department of Health and Human Services (HHS) to delay implementing stage 3 of the electronic health record (EHR) meaningful use program, as it is fraught with problems that need to be fixed before the next stage is implemented. CMA and AMA are also pushing for an automatic hardship exemption for physicians who were unable to successfully report in 2015. To that end, at AMA and CMA’s urging, Congress sent a bipartisan letter to HHS Secretary Burwell, asking her to delay stage 3 until the program can be reformed and tested, and the new Medicare payment system is implemented.

Recently, the Medicare program made a stunning announcement that while 78 percent of physicians are using EHRs, more than 50 percent of eligible physicians will face meaningful use penalties under the EHR Incentive Program in 2015. The program was intended to increase physician use of technology to improve care and efficiency. Unfortunately, the program's unrealistic and unnecessary requirements are hindering participation in the program, forcing physicians to purchase expensive EHRs with poor usability that disrupt workflow, interfering with patient care and imposing administrative burdens.

"Stage 2 requirements were adopted with untested standards and the (medical community has) learned the hard way that it was not ready," CMA and AMA wrote in the letter to HHS. "Thirty-eight percent of hospitals and only 11 percent of physicians who signed up for the EHR program met the stage 2 requirements in 2014. This low rate of success (even among California’s sophisticated early adopters) demonstrates the problems in the program.” It is a program problem, not a physician problem. Therefore, CMA is asking HHS to not move forward until it tests the unproven technology that stage 3 depends upon.

Unfortunately, the proposed stage 3 rule, currently under review at the Office of Management and Budget, exacerbates current problematic policies of stage 2. "We should incentivize technology that enables interoperability and improved health outcomes rather than incentivizing technology that counts how many times a provider performs an activity," the letter says.

AMA and CMA are also arguing that the stage 3 rules are premature. Under the new Medicare payment system that Congress enacted earlier this year, there are substantial changes to the quality reporting programs and meaningful use. CMA believes that the Centers for Medicare and Medicaid Services (CMS) needs to implement the new payment framework and meaningful use changes before moving to meaningful use stage 3. Otherwise, physicians could be forced to make EHR changes that could have been prevented if Medicare payment reforms were implemented first.

CMA urging automatic hardship exemption for 2015

In April, at AMA and CMA’s request, CMS proposed modifications to stage 2 of the meaningful use program that would reduce the reporting period from a full calendar year to 90 days. Stakeholders believed this was necessary since many physicians could not update systems, change products, or accommodate Internet outages or other disruptions under a 365-day reporting program. The draft rule also reduced the number of measures and will only require one patient vs. 5 percent of patients to access a physician’s patient portal.

Because CMS has yet to issue the final rule that would implement this change for the 2015 meaningful use program, many physicians who were counting on this flexibility will be subjected to financial penalties under the rules currently in place. Therefore, AMA is calling on the agency to create an automatic hardship exemption for physicians who did not have the opportunity to report successfully this year.

Contact: Elizabeth McNeil, (800) 786-4262 or emcneil@cmadocs.org.