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The American Society of Anesthesiologists is an educational, research and scientific association of physicians organized to raise and maintain the standards of the medical practice of anesthesiology and improve the care of the patient.


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N. Martin Giesecke, M.D., Chair



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February 1, 2013 Volume 77, Number 2
Practice Management: Important Developments on Electronic Health Records Grant Couch

In the past few months there have been a number of important developments related to the Electronic Health Record (EHR) Incentive Program, both regulatory and legislative. Here is what you should know.

Hardship Exemption
Beginning with the regulatory side, in May 2012, ASA submitted formal comments on the EHR Incentive Program Stage 2 Proposed Rule and urged the Centers for Medicare & Medicaid Services (CMS) to create a hardship exemption for anesthesiologists. Subsequently, in September 2012, CMS published the EHR Incentive Program Stage 2 Final Rule. I am pleased to report that as a direct result of ASA’s advocacy efforts, the Stage 2 Final Rule created a temporary hardship exemption for anesthesiologists, pathologists and radiologists from the penalties associated with the EHR Incentive Program. The hardship exemption is an important step forward, considering that these penalties could total up to 5 percent of Medicare allowed charges. The exemption is not yet a permanent fix. The exemption prospect may last up to five years, but CMS could revisit this exemption before then. ASA will continue to advocate that anesthesiologists be exempt from the penalties until the criteria to qualify for the incentives are more broadly applicable to anesthesiologists. ASA understands the value of having EHRs in as many areas of care as possible, particularly in the perioperative setting; however, we remain very concerned that the current requirements for meaningful use have little relevance for anesthesiology practice.

How Does the Hardship Exemption Work?
This hardship exemption will be determined automatically and annually, and it is automatically determined by your specialty designation under the Provider, Enrollment, Chain and Ownership System (PECOS).1 For anesthesiology, the specialty designation under PECOS is 05. This hardship exemption only applies to penalties. The Stage 2 Final Rule still allows anesthesiologists to participate in the EHR Incentive Program. For more information on the hardship exemption and the EHR Incentive Program, please review the EHR Frequently Asked Questions document on ASA’s website.2

Department of Health and Human Services Office of Inspector General (HHS-OIG) report
In November, HHS-OIG released a report that criticized CMS’ oversight of the Electronic Health Records Program. The report criticized the EHR Incentive Program as “vulnerable to paying incentives to professionals and hospitals that do not fully meet the meaningful use requirements.”3 Notably, the HHS-OIG recommended that CMS obtain and review supporting documentation prior to payment to verify accuracy and that CMS issue guidance with specific examples of documentation health care professionals should maintain to support their compliance. As increased oversight of the program is likely to occur, it is important that those who choose to participate be diligent in ensuring compliance with the program’s requirements. Congress Takes Notice of Anesthesiologists’ Concerns Switching gears from the Administration to Capitol Hill, in November, and as a direct result of ASA’s advocacy efforts, Congresswoman Diane Black (R-TN) introduced the Electronic Health Records Improvements Act. If enacted into law, this legislation would exempt anesthesiologists from three criteria to demonstrate meaningful use including: exempting anesthesiologists from providing clinical summaries to patients; exempting anesthesiologists from being required to provide patients with an electronic copy of their health information; and exempting anesthesiologists and other eligible professionals from implementing drug to drug and drug to allergy interaction checks.

Also on Capitol Hill, the House Committee on Science, Space and Technology, Subcommittee on Technology and Innovation discussed anesthesiologists’ concerns in a hearing titled Is “Meaningful Use” Delivering Meaningful Results?: An Examination of Health Information Technology Standards and Interoperability. Of note, Chairman Ben Quayle (R-AZ) and Congressman Andy Harris (R-MD), M.D., an anesthesiologist, directed pointed questions to Dr. Farzad Mostashari, the National Coordinator for Health Information Technology about the criteria required to demonstrate meaningful use and about the hardship exemption. More information about the hearing can be found on the ASA website.4

ASA will continue to educate Congress and the Administration on this issue to ensure that your voice is heard. We are pleased that the Administration and Members of Congress are working to improve the program for patients and physicians.

Grant Couch is Federal Affairs Associate for the ASA Washington Office.

1. Centers for Medicare & Medicaid Services. Medicare enrollment for providers and suppliers. Medicare Provider Enrollment, Chain, and Ownership System website. Accessed December 4, 2012
2. ASA releases frequently asked questions on electronic health records. American Society of Anesthesiologists website. Published November 8, 2012. Accessed December 4, 2012.
3. Levinson DR. Early Assessment Finds That CMS Faces Obstacles in Overseeing the Medicare EHR Incentive Program. Washington, DC: Department of Health and Human Services; November, 2012.
4. In busy week, house considers anesthesiologists’ concerns on electronic health records. American Society of Anesthesiologists website. Published November 20, 2012. Accessed December 4, 2012.