What physicians need to know about the new EHR regulations


More than 1,300 pages of new regulations released earlier this month outline requirements for the electronic health record (EHR) meaningful use program, with several changes applying this year. We’ve gathered some of the most important changes that will affect your practice.

The regulations fall under two new rules—one that modifies Stage 2 of the meaningful use program and finalizes requirements for Stage 3, and one that establishes technological parameters for the new edition of certified EHR technology.

On the upside, the first rule eases and streamlines some of the requirements for Stage 2. But the rule simultaneously ignores clear calls from Congress and physicians to hold off on Stage 3 until the program is reassessed for practicality and alignment with new payment and delivery reforms.

Immediate improvements to Stage 2 include several that the AMA had urged the Centers for Medicare & Medicaid Services (CMS) to make:

  • Physicians have a shortened reporting period for 2015. Instead of the full calendar year, physicians will be required to report on any consecutive 90 days.
  • The overall number of measures physicians must report on has been reduced.
  • The measure threshold for the requirement for patients to view, download or transmit their records has been cut down from 5 percent of patients to just one patient in 2015 and 2016. (This threshold goes back up to 5 percent in 2017.)
  • The threshold for the secure messaging requirement has been scaled back from 5 percent of patients to simply having the capability to send secure messages in 2015 and doing so with at least one patient in 2016. (This threshold also goes back up to conducting secure messaging with at least 5 percent of patients in 2017.)

And while these are positive modifications, CMS didn’t release the final regulations until Oct. 6—several days into the final 90-day period of the year. Equally as concerning, the regulations now require a public health and clinical data registry reporting objective that previously was optional.

So far, only 12 percent of physicians have met Stage 2 requirements. Read a summary (log in) of modifications made in the new regulations.

Fortunately, physicians will have some recourse for avoiding penalties. Responding to requests from the AMA, CMS has said that physicians who are unable to meet meaningful use requirements this year as a result of the delayed publication of the regulations can apply for a hardship exemption.

The AMA is encouraging physicians to apply for a hardship exemption under the “extreme and uncontrollable circumstances” category, even if they are uncertain whether they will meet the program requirements this year. Doing so will not preclude physicians from receiving an incentive if they do meet meaningful use requirements this year, but applying can serve as a safety net in staving off a penalty. The exemption application will be available early next year.  

“In the past, CMS has considered these applications seriously and, in fact, has approved over 85 percent of hardship exemptions,” the agency said in a recent FAQ.

Under the rule, all physicians will be required to meet Stage 3 requirements beginning in 2018. The finalized rule as currently written would be very burdensome for physicians, to put it mildly. Among the many mandates will be upgrading to EHR products that meet the new certification requirements. Read a summary (log in) of the main requirements for Stage 3 outlined in the new regulations.

While CMS is allowing a 60-day comment period for feedback on the final rule, a groundswell of physician responses will be needed to change the proposal, given the complexities of the lengthy regulations already issued.

The AMA is intensifying its efforts to engage lawmakers and other stakeholders to reset the direction of the meaningful use program.

Physicians can visit BreakTheRedTape.org to easily submit their comments on the new rule to CMS and ask the agency to take action so that critical problems with the program are addressed before moving forward.

Also, physicians can join their peers in sharing their stories about how meaningful use regulations are affecting the patient-physician relationship.

It’s time to break free from the EHR red tape.