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4/14/2011
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Healthcare Providers Find Options Narrowed For Meaningful Use

Exemptions in the electronic health record incentives program may not be available to some providers, depending on how prepared their state is for accepting data.

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Physicians getting ready to attest for meaningful use of electronic health records (EHR) in order to earn Medicare bonus payments, take note. Depending on where you practice, you may not be able to claim exemptions from some of the required measures.

In Illinois, for example, a new report says that the state isn't able to accept electronic data from EHRs on syndromic surveillance, which is one of 10 measures--of which providers must meet five--in Stage 1 of meaningful use. But the federal rules require eligible providers (physicians and other health professionals who qualify for the subsidies) to report on at least one of the two measures related to population health: syndromic surveillance and immunization registries.

"A Medicare EP [eligible provider] may defer 5 of the 10 menu set measures, but only one of the population health measures, without giving a reason why they did not report the measures that they deferred," says the report, written by internist Dr. Stasia Sands-Kahn, in conjunction with the Illinois Department of Public Health and the federal Centers for Medicare and Medicaid Services (CMS). Deferring a measure isn't the same as claiming exclusion, the report says. A provider can claim exclusion for certain measures but will have to attest to the exception. In the case of the population health measures, an exemption must be verified by the state in which the provider practices.

"For population health, you have to do one," Sands-Kahn explained in an interview. And a state's inability to accept electronic data for one of the measures won't get you off the hook for the other, she said. "The only way to get out of [the reporting requirement] is if you don't do immunizations at all," Sands-Kahn said.

Sands-Kahn, a health IT consultant who practices in the three-provider Fox Prairie Medical Group in St. Charles, Ill., posted the report Wednesday on her EMR Survival site, which offers advice on electronic medical records to small and midsize practices.

Medicare eligible providers can claim exclusion from submitting electronic syndromic surveillance data to public health agencies, since the Illinois Department of Public Health doesn't currently have the infrastructure in place to accept the data from EHRs, the report says. However, providers won't meet the meaningful use population health measure requirement "simply by claiming an exclusion from the syndromic surveillance objective. EPs must select at least one of the population health options," the report says.

In Illinois, that means they must use the state's immunization registry, even though it's essentially in beta. Sands-Kahn reported that Illinois has run two pilots with provider groups, but hasn't widely tested the system.

Based on conversations with technical specialists at CMS, Sands-Kahn said she believes similar problems exist in other states, and that could create a lot of headaches for small practices like hers.

"My practice must send a test of the immunization report," Sands-Kahn said, "and that means getting our EMR vendor involved. I don't have an immunization interface. It's an add-on. And of course, the question is, do I have to pay for it?"

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