On March 7, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule: Medicare and Medicaid Programs; Electronic Health Record Incentive Program—Stage 2. This rule is more commonly known as “Stage 2 of meaningful use.” At more than 130 pages, the rule builds upon Stage 1 of the program mainly by increasing measurement thresholds and requiring higher levels of system functionality.
Although there are no major surprises within the proposed rule, there is always one very basic yet very important question that surfaces when meaningful use makes headlines: Are hospitalists eligible for health information technology (HIT) incentives and thus subject to the meaningful use requirements?
“No” is the short answer to this question. Although physicians, including hospitalists, are considered eligible professionals (EPs) under the HIT incentive program, a subset of EPs are defined as hospital-based EPs and, therefore, are not subject to the program’s requirements. CMS defines a hospital-based eligible professional as an EP who furnishes 90% or more of their covered professional services in either the inpatient division or ED of a hospital.
While some may call this an exemption for hospitalists, it is not that definitive. Hospitalists are still “eligible,” and the determination is not made by specialty, but by pattern of practice. This means that hospitalists could find themselves on the hook for future penalties if their practice patterns expand beyond CMS’ 90% threshold.
An example of this would be a hospitalist who spends time doing rounds at a nursing home. Today, this might constitute only a small percentage of a hospitalist’s practice, but with an increasingly aging population, it is not inconceivable that this small percentage could exceed 10% within five or 10 years.
With this in mind, and a similar scenario also present in the Electronic Prescribing Incentive Program (eRx), SHM has consistently pointed out the issue to CMS and is working to find an acceptable solution.
Although hospitalists are not currently subject to physician meaningful-use requirements, the program has another category of eligibility that will certainly affect hospitalists: the eligible hospital, or EH. Many hospitalists are directly involved with HIT implementation efforts at their institutions or are indirectly working with these systems as they are implemented and expanded in hospitals across the country.
Given the 90% eligibility threshold and the role of HIT in hospitals, it is important for hospitalists to stay current and informed on meaningful use and HIT policy. Involvement with one of SHM’s HIT related committees is a clear way to stay informed in this ever-evolving area, and SHM’s efforts can be reviewed on the Advocacy page of SHM’s website: www.hospitalmedicine.org/advocacy.
For the most up-to-date information on what is being done at the federal level, the Office of the National Coordinator (ONC) has a wealth of information available at www.healthit.gov/.
SHM will continue to monitor and analyze developments and changes to EHR policy, but it also looks to you, its members, for experience and insight.