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SHM Wins Some Hospitalists an Exception to CMS’ Compliance Rule


A concerted effort by SHM members has helped win some hospitalists an exemption to the Centers for Medicare & Medicaid Services' (CMS) final rule on Stage 2 compliance for meaningful use [PDF] of electronic health records (EHR).

The "hardship exception" frees hospitalists who round at nursing homes and other post-acute-care facilities from being subject to penalties for not being "meaningful users." SHM successfully argued that it isn't fair for HM clinicians working in such institutions be held accountable for records they can't fully control.

SHM Public Policy Committee member Kerry Weiner, MD, chief clinical officer of IPC: The Hospitalist Company Inc. of North Hollywood, Calif., says about 30% of hospitalists are involved in care delivery at nursing homes, skilled nursing facilities, or other post-acute-care settings. Those physicians need to be aware of how CMS views their job in relation to new regulations.

"Once the physician leaves the hospital, they're generally considered an outpatient doctor by CMS, even though leaving an acute-care facility and going into a step-down unit like a skilled nursing facility is not really going into a primary-care or outpatient practice," Dr. Weiner says. "There are a number of regulations coming down, and hospitalists have to be sensitive to the differences in reimbursement and accountability they'll be held to. Just because you're a hospitalist doesn't mean the government considers you a hospitalist for their regulations."

CMS initially proposed that "eligible professionals" (EPs) needed to meet three criteria to be granted a hardship exception: a lack of face-to-face or telemedicine interaction with patients, a lack of follow-up need with patients, and the "lack of control over the availability" of certified EHR technology. After SHM voiced concern, CMS agreed that EPs who practice at multiple locations can be granted the exception solely for lack of control over the availability of the technology. Dr. Weiner says that CMS' willingness to make changes before finalizing the rule shows the agency understands how difficult the new rules can be.

"CMS has realized they may not get it right the first time," he adds. "This is a dynamic process, and even if they do get it right exactly, it's only right for a particular moment. Medicine is transitioning and changing all the time."

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