Useful updates from CMS on EHR incentives and penalties for LTC physiciansAugust 28th, 2013 by
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.