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Meaningful Use hardship exceptions: Two steps forward, one step back?

This article originally appeared on Practice Fusion’s blog. As part of the American Recovery and Reinvestment Act of 2009, Congress mandated that payment adjustments should be applied to Medicare eligible professionals who aren’t “meaningful users” of certified Electronic Health Record (EHR) technology under the Medicare EHR Incentive Program (Meaningful Use). However, health care providers who are […]

This article originally appeared on Practice Fusion’s blog.

As part of the American Recovery and Reinvestment Act of 2009, Congress mandated that payment adjustments should be applied to Medicare eligible professionals who aren’t “meaningful users” of certified Electronic Health Record (EHR) technology under the Medicare EHR Incentive Program (Meaningful Use). However, health care providers who are eligible for the Meaningful Use program may be exempt from these payment adjustments if they can show that demonstrating meaningful use would result in a significant hardship.

In general, hardship exceptions are good when they’re applicable; it’s unfair to penalize a provider for not taking action in a program when they are being faced with significant and real barriers to successful participation.

However, the Centers for Medicare and Medicaid Services (CMS) took these hardship exceptions a step further when it announced that they’re now accepting hardship exception applications for reasons categorized as “2014 EHR Vendor Issues.” This means that if a Meaningful Use eligible health care provider’s EHR vendor was “unable to obtain 2014 certification or the eligible professional was unable to implement meaningful use due to 2014 EHR certification delays.”

Creating new hardship exceptions because a portion of the EHR technology industry lacks capabilities is not the answer. Allowing providers and EHR companies to use and promote products that don’t meet current standards actually stalls progress in health IT development. Delaying implementation of certified EHR technology in the market delays the goals of the Meaningful Use program in general: increased interoperability, quality reporting, improved data quality, and patient engagement. After delivering more than $21 billion dollars to providers under the Meaningful Use program, can we really call these new hardship exceptions a step in the right direction?

Moreover, these new hardship exceptions create situations where companies that aren’t meeting health IT standards are able to lock providers into existing contracts, since payment adjustments can be avoided. This essentially disrupts the market, limiting providers’ options for moving to a certified EHR product offered by another company in time to meet Meaningful Use requirements by 2014.

Although hardship exceptions may be appropriate in certain cases, CMS should consider ways to encourage providers to move to a certified EHR in 2014. For example, closely evaluating whether providers who apply for the 2014 EHR related hardship exceptions had the ability to switch to a certified EHR product that met the needs of their specialty prior to the payment adjustment deadlines.

Providers should be able to use the best available health technology in their practices. When it comes to building technology for healthcare, we should be moving the needle forward, not backward.

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