Practice Management: ASA Efforts to Improve the EHR Incentive Program

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August 1, 2013 Volume 77, Number 8
Practice Management: ASA Efforts to Improve the EHR Incentive Program Grant Couch

ASA has been making a number of inroads to make the Medicare and Medicaid Electronic Health Records (EHR) Incentive Program, commonly referred to as “meaningful use,” meaningful for anesthesiologists. This includes successes with the Administration, gaining a hardship exemption for the specialty, thus protecting anesthesiologists from the penalties associated with the program1, and legislative, with the reintroduction of Rep. Diane Black’s legislation known as the Electronic Health Records (EHR) Improvements Act, which includes important provisions for anesthesiologists.2

ASA Actions

In May 2012, ASA submitted formal comments to the Centers for Medicare & Medicaid Services (CMS) requesting a hardship exemption from the EHR Incentive Program. As a result of ASA’s successful advocacy efforts, CMS created a hardship exemption in the Medicare and Medicaid EHR Incentive Program Stage 2 Final Rule. The hardship exemption is determined automatically and annually based on a physician’s specialty designation under the Provider, Enrollment, Chain and Ownership System (PECOS). Anesthesiology’s specialty designation is 05. The hardship exemption opportunity could last up to five years; however, CMS may revisit the exemption before then. ASA has and will continue to advocate that this exemption be maintained, given the unique challenges the specialty has in meeting meaningful use requirements and the very low success rate to date. Anesthesiologists may still attempt to become meaningful users and receive incentives, as the hardship exemption applies only to whether monetary penalties will apply. Receiving an incentive would override the automatic hardship exemption.

ASA was also successful in advocating for provisions in Rep. Diane Black’s recently reintroduced legislation, the EHR Improvements Act, that, if enacted, would exempt anesthesiologists from providing clinical summaries to patients, being required to provide patients with an electronic copy of their health information and from implementing drug-to-drug and drug-to-allergy interaction checks. Current drug-drug and drug-allergy systems are not effective as currently implemented for the typical anesthesia workflow, as these systems assume that the ordering provider and the administering provider are different individuals. Anesthesiologists often treat, then chart, due to the dynamic nature of anesthesia care. These checks assume that one charts first, then treats.

In January, ASA urged the U.S. Department of Health and Human Services’ Health IT Policy Committee to ease certain requirements on anesthesiologists through the Stage 3rulemaking process for the EHR Incentive Program.3 Additionally, ASA submitted formal comments to key U.S. Senators in response to a recently released report titled “REBOOT: Re-examining the Strategies Needed to Successfully Adopt Health IT” and a request for information from CMS and the Office of the National Coordinator (ONC) on issues related to interoperability.4,5 Both letters advocated for the exemptions sought in Rep. Black’s bill as a way to improve the program for anesthesiologists and highlighted the ways EHR systems could be meaningful for anesthesiologists.

Taxpayer Relief Act

Additionally, Congress passed and the President signed into law the Taxpayer Relief Act, which would allow registry reporting for the Physician Quality Reporting System (PQRS). As that relates to the EHR Incentive Program, PQRS quality reporting is a part of the criteria required under the EHR Incentive Program. However, unlike PQRS, eligible professionals can report zeros in the numerator and denominator and qualify for EHR incentives and avoid penalties because very few PQRS measures have been “e-specified” for EHRs. CMS is likely to address these registry provisions in a proposed physician fee schedule rule this summer. For EHRs, registry reporting could be a possible alternative to reporting zeros as part of the meaningful use criteria.

ASA is closely monitoring this issue and will continue to work with regulators and Congress to improve the EHR Incentive Program for anesthesiologists and the patients they serve.


In order to avoid a negative Value Based Payment Modifier (VBPM) adjustment in 2015 (with performance period of 2013), anesthesia groups of 100 or more eligible professionals must sign up for or “self-nominate” for the 2013 Physician Quality Reporting System (PQRS) program through the Group Payment Reporting Option (GPRO). The Centers for Medicare & Medicaid Services (CMS) has created two self-nomination periods. The second period will run from July 15 to October 15, 2013 and is the most relevant to anesthesiologists because it offers the options anesthesiologists will need to select to avoid the negative adjustment in 2015; the option to select the Administrative Claims reporting mechanism for 2013 PQRS Group reporting and to elect not to participate in quality-tiering.

Groups of 100 or more eligible professionals must:

  • Self-nominate to participate in 2013 PQRS as group;
  • Select the Administrative Claims option (only available during the July 15, 2013 to October 15, 2013 nomination period, and
  • Do not elect quality-tiering.

CMS is providing regular and frequent updates on its website at:

For more information, please see the “Practice Management” column from the April 2013 ASA NEWSLETTER.

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


  1. Medicare and Medicaid Programs; Electronic Health Record Incentive Program—Stage 2 (CMS–0044–F). Fed Regist. September 4, 2012;77(171):53968-54162.
  2. Electronic Health Records Improvement Act, HR 1331, 113th Cong, 1st Sess (2013).
  3. ASA urges federal health IT policy committee to address “Meaningful Use” standards for anesthesiologists. American Society of Anesthesiologists website. Published January 16, 2013. Accessed June 10, 2013.
  4. ASA expresses support for changes to federal HIT initiative. American Society of Anesthesiologists website. Published May 22, 2013. Accessed June 10, 2013.
  5. ASA supports maintenance of anesthesiologists’ hardship exemption and seeks improvements to the EHR Incentive Program. American Society of Anesthesiologists website. Published April 22, 2013. Accessed June 10, 2013.