New Meaningful Use Hardship Exemption May Give Physicians a Break

May 16, 2014

Afraid you won't be able to meet the Stage 2 requirements in the government's EHR incentive program? A new hardship exemption may help.

CMS may be cutting some physicians a break when it comes to attesting to the second stage of meaningful use - at least, temporarily.

In March, CMS released hardship exception guidance stating that eligible professionals can apply for hardship exemptions in the event of "2014 vendor issues." 

"It basically says if your practice isn't ready for Stage 2 based on IT issues, then you can declare an exemption," practice management consultant Elizabeth Woodcock, founder of Woodcock & Associates, recently told Physicians Practice. "If your vendor hasn't delivered the Stage 2 module or upgrade, I think you can certainly declare that hardship exemption - you've invested all this money and you don't even have the ability to participate in Stage 2. If your vendor did deliver it, however, and you didn't have time to actually install the portal, for example, or another tool required for Stage 2, then you have a legitimate argument to declare that exemption as well."

Woodcock acknowledged that the guidance issued by CMS is very broad, and she predicted that the agency will release more specifics soon - although that may not necessarily be a good thing.

"I actually think that generality is actually better for practices," she said. "... The more detail we get, the more we're going to be constrained by the terms of the exemption. I'm keeping my fingers crossed that the exemption will remain a general one."

Here's more on the CMS guidance most recently released:Stage 1: The guidance states that eligible professionals who "are not able to implement 2014 certified EHR technology for the 2014 reporting year" may apply for a hardship exception for the 2015 payment adjustment.  The application must be submitted by July 1, 2014.

Stage 2: The guidance states that eligible professionals who have met the Stage 1 requirements but are "not able to implement 2014 certified EHR technology for a 2014 reporting period," may apply for a hardship exception for the 2016 payment adjustment. To apply, providers must fill out the "eligible professional hardship exception form" for 2016, which will be available after July 1, 2014, according to CMS. The application must be submitted by July 1, 2015.

It appears that the new Stage 2 exemption will provide physicians with an opportunity to put their meaningful use initiatives "on hold" until they are ready to begin again, said Woodcock.

Essentially, physicians won't experience payment adjustments for failing to meet the Stage 2 requirements if they qualify for the exemption. But, they will still be eligible to receive the EHR incentive payment if they successfully attest later.

"The irony is the penalty likely involves a lot less money than the bonus would be so you want that hold because your bonus payment is going to be much higher than your penalty, which is 1 percent in the first year," said Woodcock. "The exemption is beautiful because it actually holds the program [for you]."

If you are considering pursuing the exemption, Woodcock recommends "bookmarking" the EHR incentive program website, and checking back on a weekly basis to see what new guidance is released. If you find no further guidance by July 1, contact the CMS QualityNet Help Desk for more information. 

While the CMS guidance regarding the new hardship exemption is a positive sign that the agency is willing to work with physicians to ensure all are given a fair opportunity to meet the meaningful use requirements, Woodcock said physicians should not view it as an excuse to avoid the meaningful use program entirely.

"If my vendor delivered an upgrade today, I wouldn't count on this exemption to skip out on the meaningful use requirements," said Woodcock. "... This exemption is certainly not a guarantee."