Useful updates from CMS on EHR incentives and penalties for LTC physicians

August 28th, 2013 by Rod Baird

August is proving to be a very good month for LTC physician practices, particularly those of us who

mainly cover nursing homes.


To recap the situation: LTC physicians are classified as “ambulatory” under rules for CMS’s EHR program.

That means physicians are eligible for incentives if they can demonstrate Meaningful Use. Conversely,

they are subject to penalties if they fail to achieve 90 days of Meaningful Use by October 2014.


Hardship exemptions from the statutory penalties are written into the regulation, but weren’t

previously defined. That changed during a CMS National Provide Call on Aug. 15, 2013, which detailed

the criteria for requesting a hardship exemption.


At the end of that call, there was the normal Q&A session. While the transcript of that call is not yet

posted, Alex Bardakh, AMDA’s Senior Manager of Public Policy, recorded the following:


Question: A group of geriatricians go to skilled nursing facilities and some serve as the medical director

of the facility. Does their role as the medical director change the no control over availability of CEHRT

since the medical director could be part of the decision-making on whether or not to acquire the


Answer: Although CMS can’t say for certain because all hardship exemptions are reviewed, it is likely

that these eligible professionals would still be eligible for the exemption. Could depend on how much

decision-making about HIT the medical director has.


Question: A group of nurse practitioners who provide wound care services in nursing homes, would they

be eligible for the incentives?

Answer: They are not eligible for the Medicare incentive program but they are eligible for the Medicaid

incentive program. They would have to contact someone in their state (information available on

CMS website) to figure out who they should contact for more information about the specific state



Question: Can an eligible professional still meet the 50-percent hardship exemption if that provider

can bring his or her own CEHRT technology into the facility?

Answer: Yes, such eligible professionals could meet the hardship exemption because the facility does

not have CERHT technology. However, they can also earn the incentive payment if they would like to

bring a portable CEHRT technology (laptop) and do dual recordkeeping. Essentially, the rule is that

there is a hardship exemption one can qualify for but if they can overcome that exemption, they are

eligible to receive the incentive payment.


I highlighted the last Q&A because this is critical to LTC physicians – assuming this is official policy. It says

that physicians working in nursing homes (and presumably other LTPAC settings) qualify for the hardship

exemption because the facility doesn’t provide a certified EHR. At the same time, if the physician has

access to portable EHR technology and can overcome the hurdles to demonstrate MU, he/she is eligible

for the incentive payment.


Sometimes, I wake at night with the fear that our group’s efforts to bring our EHR into the nursing

facilities would be like putting a noose around our own necks (since we had EHR available, it was our

fault that we couldn’t achieve threshold measures to satisfy MU). Now that worry is laid to rest.

Rod Baird

About Rod Baird

Rod Baird is the Founder and President of Geriatric Practice Management (GPM). Since 1977, he’s led provider and management organizations that deliver care to Medicare/Medicaid beneficiaries. Past programs he’s overseen include home health, personal care, hospice, rehabilitation hospitals, adult and psych daycare, alcohol/drug rehabilitation, industrial medicine and primary care practices. The Centers for Medicare and Medicaid Services (CMS) selected Baird as one of only 73 individuals to serve with its InnovationProgram. His educational background includes a Master’s Degree in Physical Chemistry from the American University, Washington, D.C.

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