ACEP4U: Electronic Health Records (EHR)

ACEP is working to lower your administrative burden

Everyone who works in health care knows electronic health records (EHRs), originally designed to streamline patient records and improve patient care, have dramatically increased the amount of time providers are spending mired in paperless “paperwork.” It’s an industry-wide concern leading to increased burnout and job dissatisfaction, and recent surveys of ACEP membership revealed that no matter your age, years of experience, or clinical setting, EHR frustration and overall “administrative burden” is your #1 pain point.

It’s a complicated issue affected by many different entities and regulations, so our advocacy team is working in multiple channels to push for positive progress. The following is an overview of our efforts:

Appropriate Use Criteria (AUC) Program

Created in legislation in 2014, the AUC program will eventually require physicians ordering advanced imaging for Medicare beneficiaries to first consult AUC through approved clinical decision support mechanisms in order for the furnishing provider to be able to receive payment. While the requirement does not start until 2020, we have heard hospitals are already forcing emergency physicians to consult AUC before ordering advance imaging. We’re hearing these AUC tools are burdensome and not user-friendly, and often do not apply to the cases typically seen in the emergency department. We’ve fought hard to get all emergency physicians exempted from the AUC program requirements, and we recently achieved a significant victory that saves you unnecessary administrative hassle. 

• Our stance: The underlying legislation creating the AUC Program exempts emergency services defined as an “applicable imaging service ordered for an individual with an emergency medical condition” from the requirements. As a result of our advocacy, CMS clarified that this exemption includes cases where an emergency medical condition is suspected, but not yet confirmed. In other words, if you think your patient is having a medical emergency (even if he/she winds up not having one), you are excluded from the AUC requirements in that particular case.
• What it means for EM physicians: This clarification is HUGE for us. Requiring you to consult AUC in potential emergency situations would have put patients’ lives at risk. Seconds matter in these cases, and you don’t have time to consult AUC tools that may not even be applicable to your patients. With this clarification, you can move quickly to treat patients who may have an emergency medical condition.
• How you can take action: Now that we have this clarification to the exemption, we need you to spread the word to your hospital administrators. We drafted a sample letter you can use to let your hospital administrators know about the emergency medical condition exemption and ask them to help make sure the exemption is properly implemented in your emergency department.

Promoting Interoperability Category of the Merit-based Incentive Payment System (MIPS)
The Promoting Interoperability (PI) Category of MIPS replaced the Meaningful Use Program. For the most part, emergency physicians were exempt from Meaningful Use requirements because they worked in hospitals. Most emergency physicians are contracted by hospitals and have little say over the hospital’s EHR. In the PI category of MIPS, there is again an exemption for clinicians who are deemed “hospital-based.” However, current Centers for Medicare and Medicaid Services (CMS) regulations are causing some emergency physicians to lose that exemption. We are advocating for all emergency physicians to be exempt from the PI category of MIPS.

• Our stance: Currently, emergency physicians who report as a group lose the PI exemption status if one of the group members isn’t categorized as “hospital-based.” ACEP has repeatedly educated CMS that the “all-or-nothing” MIPS exemption for hospital-based individual physicians unfairly penalizes clinicians who work in multi-specialty groups. UPDATE: In a major victory for ACEP, CMS is proposing in the Calendar Year (CY) 2020 Physician Fee Schedule and Quality Payment Program Proposed Rule to remove the “all or nothing rule” and exempt groups from the Promoting Interoperability category of MIPS if 75 percent of the individuals in the group meet the definition of hospital-based. We will be strongly urging CMS to finalize this proposal. 
• What it means for EM physicians: Under MIPS, clinicians receive a bonus or penalty based on Quality, Cost, Improvement Activities, and PI. These bonuses/penalties can have a major impact on your revenue. The PI category of MIPS represents 25 percent of a clinician’s total MIPS score. If granted a hardship exemption from CMS, the 25 percent PI allocation is redistributed to the Quality category. It’s easier for you to meet the MIPS Quality requirements, especially if you report through ACEP’s Clinical Emergency Data Registry (CEDR).

EHRs and Data Sharing
CMS and the Office of the National Coordinator for Health Information Technology (ONC) recently proposed policies that would dramatically alter how personal health information is exchanged and used. We are working hard to ensure any policies CMS and ONC actually finalize do not place more administrative burden on emergency physicians.

• Our stance: CMS and ONC say the main purpose of their proposals is to make health care data available to consumers. We support improving access to data, but we don’t support the increasing pressure on providers to invest in and implement new sharing technology. We’re pushing CMS and ONC for more time for everyone to weigh in on the proposed rules and asking to delay any penalties until two years after the rule to give providers more implementation time.
• What it means for EM physicians: CMS is proposing to require health plans to make information about a patient encounter available to consumers within one business day after receiving the data. We are concerned that health plans will impose short, unrealistic turnaround times on you that could potentially increase your administrative costs.

EHR Burden
ONC recently released a draft strategy on how to reduce provider burden while improving EHR usability and information exchange. ACEP submitted comments on this draft strategy and is continuing to work with ONC and other federal agencies on ways to reduce burden around the use of EHRs.

• Our stance: We supported the recommendations included in ONC’s draft strategy on improving EHR usability and information exchange but suggested other ways to reduce provider burden. We expressed disappointment that ONC’s draft strategy does not address the effectiveness of qualified clinical data registries or how to encourage data registries as a way of reporting quality measures.
• What it means for EM physicians: Studies have shown poor EHR usability has led to certain types of medical errors, and there is increasing evidence showing the association between usability issues and patient safety. We know it’s challenging for emergency physicians to provide comprehensive care to patients who arrive without an easily-accessible medical record. We support federal policies that reduce administrative burden while enhancing your ability to receive and exchange patient information.

ACEP's EHR Advocacy Efforts: A Timeline

Here’s an overview of our advocacy timeline related to these EHR issues so you can see where we started, what’s happening now and where we are heading next.

Stay Updated
ACEP is dedicated to giving emergency physicians a strong and unified voice in Washington, speaking out on the issues that matter most to you and your patients. Want to stay apprised of ACEP’s ongoing federal legislative activities? Sign up for the 911 Legislative Network, the premier grassroots network for emergency physicians. Find continual updates about all of ACEP’s advocacy work – EHRs and beyond – on the Federal Advocacy page.