Representative Diane Black (R-Tenn.) introduced a bill into Congress on March 21 that would provide significant exemptions from the meaningful use rules. While the bill isn't expected to go far legislatively, it may help draw the attention of regulators to persistent problems faced by specific groups of physicians.
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The EHR Improvement Act would provide meaningful use exemptions for solo practitioners and physicians who are at or nearing retirement age. Other provisions would provide rebates for payment adjustments made against physicians who subsequently meet the requirements of meaningful use, allow specialty physicians to satisfy meaningful use provisions by participating in registries, and bring rural health providers into the meaningful use program after 2014.
Jennifer Brull, M.D., a solo practitioner in Plainville, Kan., said some of these changes would bring welcome relief to small family physicians. She implemented an EHR system in her own practice in 2007, before the meaningful use program started, and has seen many benefits in her own practice. While she said she feels implementation is worth the effort, she is a member of the American Academy of Family Physicians (AAFP) Working Group on Rural Health, and in this capacity she has heard from many small rural practices that struggle to implement EHR systems.
Brull said the regional extension center in Kansas was very helpful to her practice, but acknowledged that RECs in other states may not be as engaged with rural providers. She said she has talked to rural providers in the Southeast who have said the RECs in these states tend to focus more on supporting physicians in urban areas. Solo doctors in these areas could benefit the most from a hardship exemption.
It's important that the administration, in particular the ONC and CMS, hear from policymakers at multiple levels, because we think the steps the bill would take are very reasonable.
Rob Tennant, Medical Group Management Association
The meaningful use exemption for doctors nearing retirement age could also be beneficial. Brull said she has talked to a number of older physicians who say they may not continue practicing up to or beyond retirement if they are forced to implement an EHR system. "There is a group of folks who say, 'You know what, this is going to worsen the primary care shortage in rural areas because we're going to quit,'" Brull said. "If it's a choice between, they're going to quit in two years or they're going to keep helping us out providing care to rural Americans for 10 years, what's the better option? Obviously, having a physician in your community is a better option."
But not everyone believes the provisions of the EHR Improvement Act would have significant benefits as it is presently worded. Jason Mitchell, M.D., director of the Center for Health IT at the American Academy of Family Physicians (AAFP), pointed out that several provisions have confusing wording and could lead to unintended consequences.
For example, the exemption for doctors at or nearing retirement specifically states any doctor who will be eligible for early retirement by 2015 or five years after may apply for the exemption. That means that any doctor who today is 54 or older would be eligible. That works out to about one-third of the AAFP's total membership. "That's a big chunk of people," Mitchell said.
The provision including rural health providers could also be misleading. As the bill is written, these providers wouldn't be eligible to participate in meaningful use until after 2014. But Mitchell points out that this is after the incentive money is scheduled to expire. This could mean rural health providers are brought into the program just in time to be hit with payment adjustments if they don't meet all the requirements of the program, without making them eligible for any of the incentives.
Still, Mitchell said the proposed legislation does raise some important issues. He said doctors who are truly nearing retirement age should be given some flexibility in deciding whether to implement a costly system. They shouldn't have to choose between facing payment reductions and implementing a system they aren't comfortable with.
"There are a lot of docs who think it's not worth the hassle for them," Mitchell said. "We want to encourage them, but applying penalties -- that's a different thing. Making them either change or close their doors because they can't keep the doors open, that's a different proposition."
None of those interviewed for this article feel there is much of a chance for the bill to become law, given the political realities in Washington today, but it may draw the administration's attention to changes it can make on its own that would benefit providers.
Rob Tennant, senior policy adviser at the Medical Group Management Association, said it wouldn't take an act of Congress to put in place the changes proposed by the bill. The Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC) could make these changes on their own. These agencies may be more likely to take these issues into consideration when they hear concerns from Congress.
"Whenever Congress acts by putting the bill in the hopper, it sends a message to the administration," Tennant said. "It's important that the administration, in particular the ONC and CMS, hear from policymakers at multiple levels, because we think the steps the bill would take are very reasonable."