As of January 1, 2017, the EHR Incentive Program was replaced with the Promoting Interoperability (formerly known as Advancing Care Information or "ACI") component of the Medicare Access and CHIP Reauthorization Act (MACRA) Merit-based Incentive Payment Systems (MIPS).
The Electronic Health Record (EHR) Incentive Program is overseen by the Centers for Medicare & Medicaid Services (CMS) for physicians participating in the Medicare component and individual state Medicaid agencies for physicians participating in the Medicaid program. Similar to other quality reporting programs, the EHR Incentive Program uses payment incentives and payment adjustments to encourage the adoption, implementation and use of certified EHR technology.
Under the program there are two categories of professionals: “Hospital-based eligible professionals” and “Eligible Professionals” (EPs). Hospital-based eligible professionals are exempt from current penalties. To be deemed a hospital-based eligible professional, one needs to provide 90 percent or more of their covered services in a hospital inpatient or emergency room setting. CMS determines this by looking at the place of service codes (POS codes) on the codes a physician submits for payment under Medicare (POS code 21 for Inpatient Hospital and POS code 23 for Emergency Room - Hospital). The majority of anesthesiologists do not provide 90% or more of their covered services in the hospital inpatient or ER setting. The majority of the codes submitted by anesthesiologists are for Outpatient Hospital (POS code 22) or Ambulatory Surgical Center (POS code 24).
ASA has compiled a list of resources related to the implementation of electronic health records.
The Hardship Exemption
A majority of anesthesiologists are deemed EPs. Many MU requirements do not reflect the typical practice of anesthesiology, making it difficult for anesthesiologists to achieve meaningful use. As a result of ASA’s advocacy efforts, CMS created a hardship exemption for anesthesiologists as a part of the Meaningful Use Stage 2 Final Rule in 2012. This exemption allowed anesthesiologists to avoid payment penalties that began in 2015. The exemption recognized the state of commercially available EHR technology for anesthesiologists, workflow challenges and the nature of the patient-anesthesiologist relationship. This automatic exemption expired at the end of 2016 along with the EHR Incentive Program.
The hardship exemption is automatically determined and annually based on a physician’s specialty designation under the Provider, Enrollment, Chain and Ownership System (PECOS). Physicians with the Anesthesiology specialty designation of “05” do not need to complete the hardship exemption form. If your specialty designation is not “05” or the other designated specialties, you must participate in the program or complete a hardship exemption to avoid penalties.
Please direct your questions on the EHR Incentive Program or the Promoting Interoperability component of MACRA/MIPS to Quality and Regulatory Affairs at firstname.lastname@example.org.