Everyone who works in health care knows electronic health records (EHRs), originally designed to streamline patient records and improve patient care, have dramatically increased the amount of time providers are spending mired in paperless “paperwork.” It’s an industry-wide concern leading to increased burnout and job dissatisfaction, and recent surveys of ACEP membership revealed that no matter your age, years of experience, or clinical setting, EHR frustration and overall “administrative burden” is your #1 pain point.
It’s a complicated issue affected by many different entities and regulations, so our advocacy team is working in multiple channels to push for positive progress. The following is an overview of our efforts:
Created in legislation in 2014, the AUC program will eventually require physicians ordering advanced imaging for Medicare beneficiaries to first consult AUC through approved clinical decision support mechanisms in order for the furnishing provider to be able to receive payment. While the requirement does not start until 2020, we have heard hospitals are already forcing emergency physicians to consult AUC before ordering advance imaging. We’re hearing these AUC tools are burdensome and not user-friendly, and often do not apply to the cases typically seen in the emergency department. We’ve fought hard to get all emergency physicians exempted from the AUC program requirements, and we recently achieved a significant victory that saves you unnecessary administrative hassle.
Promoting Interoperability Category of the Merit-based Incentive Payment System (MIPS)
The Promoting Interoperability (PI) Category of MIPS replaced the Meaningful Use Program. For the most part, emergency physicians were exempt from Meaningful Use requirements because they worked in hospitals. Most emergency physicians are contracted by hospitals and have little say over the hospital’s EHR. In the PI category of MIPS, there is again an exemption for clinicians who are deemed “hospital-based.” However, current Centers for Medicare and Medicaid Services (CMS) regulations are causing some emergency physicians to lose that exemption. We are advocating for all emergency physicians to be exempt from the PI category of MIPS.
EHRs and Data Sharing
CMS and the Office of the National Coordinator for Health Information Technology (ONC) recently proposed policies that would dramatically alter how personal health information is exchanged and used. We are working hard to ensure any policies CMS and ONC actually finalize do not place more administrative burden on emergency physicians.
ONC recently released a draft strategy on how to reduce provider burden while improving EHR usability and information exchange. ACEP submitted comments on this draft strategy and is continuing to work with ONC and other federal agencies on ways to reduce burden around the use of EHRs.
Here’s an overview of our advocacy timeline related to these EHR issues so you can see where we started, what’s happening now and where we are heading next.
Appropriate Use Criteria Program: Due to the COVID-19 public health emergency, CMS has delayed the full implementation of the AUC Program until at least the start of calendar year (CY) 2022. The educational period (where compliance is encouraged but not required) which was supposed to run through the end of CY 2020 has been extended through the end of CY 2021.
Appropriate Use Criteria Program: Now that we have this clarification to the exemption, we need you to spread the word to your hospital administrators. Here is a sample letter you can personalize to let your hospital administrators know about the emergency medical condition exemption and ask them to help make sure the exemption is properly implemented in your ED.
Promoting Interoperability Category of MIPS: CMS released the Calendar Year (CY) 2020 Physician Fee Schedule and Quality Payment Program Proposed Rule, which includes a proposal to exempt groups from the Promoting Interoperability category of MIPS if 75 percent of the individuals in the group meet the definition of hospital-based. ACEP’s full summary of the Proposed Rule can be found here.
Appropriate Use Criteria Program: CMS posted instructions about how to claim the emergency medical conditions exemption. The guidance instructs clinicians to use modifier “MA” on the same line as the CPT code for the advanced diagnostic imaging service in cases where the service is “being rendered to a patient with a suspected or confirmed emergency medical condition.”
CMS issued a call for ideas for reducing provider burden as part of its Patients Over Paperwork initiative. ACEP submitted ideas specific to EM, and we asked our members to send their suggestions to Jeffrey Davis, ACEP's Director of Regulatory Affairs, at email@example.com.
EHRs and Data Sharing: We submitted detailed comments on both CMS and ONC interoperability and data blocking proposed rules.
Like other provider groups, we support the goal of improving access to data but are very concerned about the additional pressure being placed on providers to invest in data sharing technology and the speed at which providers would be required to implement these new technologies. Given the magnitude of changes in these rules, we believe that CMS and ONC should publish interim final rules rather than final rules to allow additional opportunity for stakeholder comment. We also recommend that CMS and ONC delay any disincentives and/or penalties until two years after implementation of the rule to allow all stakeholders to have time to address any unforeseen challenges.
EHRs & Data Sharing: ACMS and ONC released two rules related to interoperability and data blocking. These rules are required in part by the 21st Century Cures Act. Read our summary of both rules.
EHR Burden: We responded to the Office of the National Coordinator for Health Information Technology’s (ONC’s) draft strategy on ways to reduce burden for providers using health information technology (IT) and EHRs. In general, ACEP supported the main recommendations included in the draft strategy and appreciated the efforts the Administration has already taken to reduce provider burden and to improve the usability and exchange of information. We also described ways that CMS can further reduce provider reporting burden under MIPS. Lastly, we expressed our disappointment that the draft strategy does not at all address the effectiveness of qualified clinical data registries (QCDRs) or what the Administration can do to continue to encourage these as a way of reporting quality measures.
Promoting Interoperability Category of MIPS: We sent out an action alert recommending that physicians apply for a hardship exception to the Promoting Interoperability of MIPS. If granted the exemption, the 25 percent PI allocation is usually redistributed to the Quality category, giving physicians more control over meeting the necessary requirements so they can avoid negative impacts on revenue.
Appropriate Use Criteria Program: In response to ACEP’s comments,
Appropriate Use Criteria Program: ACEP met with the Office of Management and Budget, the final decision-maker for regulatory policies, on our concerns related to the exemption for emergency medical conditions.
PI Category of MIPS: We strongly advocated for a change to the “all-or-nothing” MIPS exemption for hospital-based individual physicians in our official response to a major Medicare proposed regulation impacting physician payments.
ACEP is dedicated to giving emergency physicians a strong and unified voice in Washington, speaking out on the issues that matter most to you and your patients. Want to stay apprised of ACEP’s ongoing federal legislative activities? Sign up for the 911 Legislative Network, the premier grassroots network for emergency physicians. Find continual updates about all of ACEP’s advocacy work – EHRs and beyond – on the Federal Advocacy page.