Doctors' Group Says Changes Needed To Meaningful Use Program for EHRs

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By Kendra Casey Plank

Oct. 14 — The American Medical Association Oct. 14 made recommendations to federal regulators for improving the meaningful use program, saying changes are needed to ensure physicians make the best use of electronic health record technologies.

In a letter to Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner and National Coordinator for Health Information Technology Karen DeSalvo, the AMA outlined its vision for the future of the meaningful use program, specifically the next phase—Stage 3—which is set to begin in 2017.

Among recommendations the AMA made were to remove the meaningful use program's “all-or-nothing approach” by allowing participants who meet half the program's requirements to avoid Medicare penalties for not participating. The AMA also said participants meeting 75 percent of the requirements should be eligible for incentives.

The physicians' group says “the Administration should make optional the measures that have been the most challenging for the vast majority of physicians.”

“[A]t the very least, the Administration should make optional the measures that have been the most challenging for the vast majority of physicians,” the letter stated.

The AMA also called for the CMS to expand hardship exemptions for all meaningful use stages, including an exemption for physicians who successfully participate in the Physician Quality Reporting System (PQRS). In addition, the category of “unforeseen circumstances” should be expanded for hardship exemptions, according to the letter.

After three and a half years of provider participation, the AMA said “we are at a critical crossroad where we believe it is important and necessary to pause and fully assess what is working and what needs improvement before moving ahead to Stage 3 of the program.”

The Medicare and Medicaid EHR incentive program provides financial incentives for the meaningful use of certified EHR technology. In 2015, providers in Medicare that don't comply will face financial penalties.

Quality Reporting

The AMA's letter also echoed long-standing concerns about quality reporting requirements for the meaningful use program, and recommended changes that include:

• better aligning quality reporting requirements with the CMS's PQRS, which also includes incentive payments and will initiate penalties in 2015;

• ensuring public input for new electronic clinical quality measures; and

• developing a process for eliminating outdated measures.

The AMA addressed physician concerns about EHR usability, saying the ONC should “revamp” its certification program to focus on top issues such as EHR interoperability and privacy.

The AMA acknowledged in its letter that the meaningful use program has been a chief driver of EHR adoption among doctors. But, the group said there is too little compelling evidence that the program has improved patient care.

Physicians also face high costs to purchase and maintain EHR systems and to electronically exchange health data from those systems because of a lack of interoperability among systems.

“We are concerned that neither CMS nor ONC has studied the cost of purchasing and maintaining an EHR, multiple interfaces, and the expense incurred to exchange data,” the AMA said.

The AMA said that without changes to the federal EHR program, patient safety could be jeopardized, physicians would face growing administrative burdens, access to patient information could be interrupted and access to innovative technologies could be disrupted.

To contact the reporter on this story: Kendra Casey Plank at

To contact the editor responsible for this story: Patty Logan at

The letter is available at


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