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Electronic Health Record Stage 2 Final Rule Released, Creates Hardship Exemption for Anesthesiologists

Thursday, August 23, 2012

The Centers for Medicare & Medicaid Services (CMS) released the Electronic Health Record Incentive Program-Stage 2 Final Rule.  ASA is continuing to analyze the 672-page rule and will provide a full analysis soon.  

In advance of the release of the final rule, ASA urged CMS to give careful consideration to the practice of anesthesiology as it related to the specialty’s ability to implement EHR requirements. Specifically, ASA  recommended CMS adopt a broader definition of  anesthesiologists as hospital-based physicians thereby being excluded from the EHR requirements, that CMS make changes to create a criteria that would allow anesthesiologists to more readily participate in the EHR program, or alternatively, that anesthesiologists be able to apply for a hardship exemption from the EHR requirements.

As part of today’s final rule, and as a direct result of ASA’s advocacy efforts, CMS created new  hardship exemptions, one of which will temporarily allow anesthesiologists to escape the EHR requirements. 

CMS stated these relevant points:

  • Agreement with commenters that the specialties of anesthesiology, radiology, and pathology lack face-to-face interactions and need to follow up with patients with sufficient frequency to warrant granting an exception to each EP with one of these primary specialties.
  • Anesthesiologists do interact with patients, but not in a manner that is conducive to collecting the information needed for many aspects of meaningful use.

While this is a positive step forward, it is not yet a permanent fix. This exemption is subject
to annual renewal.  We will continue to work with CMS as it begins to address Stage 3 of the EHR Incentive Program. 


The Health Information Technology for Economic and Clinical Health (HITECH) Act, which created the Electronic Health Record (EHR) Incentive Program, was adopted as part the 2009 American Recovery and Reinvestment Act.  The EHR incentive program is being implemented in 3 stages.  Stage 1 began in 2011. This Final Rule implements Stage 2 and will begin in 2014.  Stage 3 is expected to be implemented in 2016. If you have you have any questions please contact Grant Couch at g.couch@asawash.org.

Read the Stage 2 Final Rule.

Read ASA's formal comments on the Stage 2 proposed rule.

Read the CMS Fact Sheet on the final rule.





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