Healthcare providers need additional time and greater flexibility to meet criteria of the Centers for Medicare and Medicaid Services' proposed electronic health record rule published earlier this year, a coalition of 51 groups told Health and Human Services Secretary Kathleen Sebelius in a May 3 letter.
They wrote that while they "fully support" the purpose of the American Recovery and Reinvestment Act of 2009 to "encourage the adoption and use of EHRs," they are asking that it be done "in a manner that will remove barriers to and promote the widespread adoption of health information technology.”
The groups signing the letter included the American Hospital Association, the American Medical Association, the American Academy of Family Physicians, the American College of Physicians, the American Psychiatric Association, the Association of American Medical Colleges, and the Medical Group Management Association.
The proposed rule currently "takes an 'all-or-nothing' approach where failure to meet any one of the requirements means the provider will not receive an incentive payment," they say. This approach fails to acknowledge that providers have made "enormous progress in creating and maintaining EHRs to improve patient care and safety."
These requirements are asking for too much, too soon, they added. Specifically, the healthcare organizations say the requirements include advanced functions such as computerized provider order entry, clinical decision support, and electronic medication reconciliation, which generally occur at the end of a multi year transition to EHRs.
The proposed phase in period for this "aggressive set of requirements is unrealistic," and it fails to acknowledge that "providers adopt EHR functions incrementally and are in different places in their adoption process," according to the letter.
If the current rule is finalized, it would likely result in providers with advanced HIT systems not meeting requirements in fiscal 2011. For those physicians in small practices and rural providers, the letter notes, "the unrealistic timeframes are even more problematic because they have further to go in their implementation of EHRs compared to larger providers."
The coalition's letter parallels many concerns expressed by both House and Senate members in letters sent in March to the acting CMS administrator. Like Congress, the groups are asking to extend the transition to meaningful use to 2017—consistent with the stimulus legislation.
The groups also are asking for a less-restrictive definition of hospitals. Of concern is CMS's proposal to use Medicare provider numbers to distinguish hospitals for EHR incentive payment purposes. "There is no standard approach to exactly which facilities a Medicare provider number encompasses and, in many hospitals, a single provider number can include multiple sites of a hospital system," say the healthcare organizations.
The groups are therefore calling CMS to define a hospital "as a discrete facility of service, so that individual sites of hospitals are eligible to separately qualify for the incentives." Since CMS does not currently collect data by individual hospital sites, it would have avenues by which it could do so—such as through cost reports.
The organizations also are calling for less burdensome reporting requirements on providers. To do this, they are asking for CMS to require reporting of only "HIT functionality measures that can be generated directly from EHRs"—with no need for manual chart reviews. Also, they say CMS should postpone requirements on quality metric submissions until the "means to capture the data from EHRs and submit the data to CMS is validated."
Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at jsimmons@healthleadersmedia.com.