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 spend mired in paperless “paperwork.” It’s an industry-wide concern leading to increased burnout and job dissatisfaction. 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 number-one 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, and the table provides more information about our stance on each aspect and how the outcomes could affect your daily practice.

1. 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. 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. 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, plus often do not apply to cases typically seen in the emergency department. See Table 1 for details.
2. Promoting Interoperability Category of the Merit-based Incentive Payment System (MIPS): The Promoting Interoperability (PI) category of MIPS replaced the Meaningful Use program. We are advocating for all emergency physicians to be exempt from the PI category of MIPS. For the most part, emergency physicians were exempt from Meaningful Use requirements. 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 & Medicaid Services (CMS) regulations are causing some emergency physicians to lose that exemption.
3. 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 increase administrative burden on emergency physicians.
4. 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.

The Timeline

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

(click for larger image) Table 1

Sept. 2018

PI Category of MIPS: We strongly advocated for a change to the “all-or-nothing” MIPS exemption for hospital-based individual physicians in our official response to a major Medicare proposed regulation impacting physician payments.

AUC Program: ACEP implored CMS to clarify the exemption for emergency medical conditions in our response to this same regulation.

Oct. 2018

AUC Program: ACEP met with the Office of Management and Budget, the final decision-maker for regulatory policies, on our concerns related to the exemption for emergency medical conditions.

Nov. 2018

AUC Program: In response to ACEP’s comments, CMS clarified in the final Medicare physician regulation that the AUC exemption for emergency medical conditions includes cases where an emergency medical condition is suspected but not yet confirmed. Examples include severe allergic reactions and pain.

Dec. 2018

PI Category of MIPS: We sent out an action alert to ACEP members recommending physicians apply for a hardship exemption to the PI category of MIPS. If granted the exemption, the 25 percent PI allocation is usually redistributed to the Quality category, giving physicians more control over meeting the necessary requirements so they can avoid negative impacts on revenue.

Jan. 2019

EHR Burden: We responded to ONC’s draft strategy on ways to reduce burden for providers using EHRs.

Feb. 2019

EHRs and Data Sharing: We summarized two rules released by CMS and ONC related to interoperability and data blocking.

May 2019

EHRs and Data Sharing: We submitted detailed comments on both CMS and ONC interoperability and data blocking proposed rules.

What’s Next? Help Us Help You!

CMS acknowledges that providers are having trouble keeping up with its regulations and has launched “Patients Over Paperwork,” a new initiative to streamline its regulations to reduce provider burden while improving patient experience. CMS is seeking comments on how to further streamline documentation and reporting requirements and better align them across Medicare, Medicaid, and other insurers. The agency also wants to know how to simplify current rules and policies to make them easier to understand and implement.

ACEP has submitted ideas for reducing emergency physician burden in the past, but we’d love additional input and ideas from ACEP members. If you’d like to weigh in on this issue and brainstorm more ideas for reducing administrative burden that we can submit to CMS, contact Jeffrey Davis, ACEP’s director of regulatory affairs, at jdavis@acep.org.

Stay apprised of ACEP’s work to reduce your administrative burden and access clinical resources to help you reduce your daily clicks.

Ms. Grantham is ACEP’s communications manager.
Mr. Davis is ACEP’s director of regulatory affairs.