As registration began early this month for providers to participate in HHS’s meaningful use electronic health record (EHR) program, CAP leaders began a dialogue with agency officials to not only clarify the impact of this final rule on pathologists, but also to ensure that members are not penalized for not meeting meaningful use requirements when the program is fully implemented in 2015.

Because meaningful use eligibility is such a concern, the CAP has formed an HIT Policy Workgroup comprised of members from the Council of Government and Professional Affairs (CGPA) and the Diagnostic Intelligence and Healthcare Information Technology (DIHIT) Committee. This Workgroup’s co-chairs—David Booker, MD, FCAP, and Richard Friedberg, MD, PhD, FCAP—met with HHS officials on Jan. 7 to launch a discussion about these concerns.

“The meeting clarified for CMS and ONC [Office of the National Coordinator for Health Information Technology] that pathologists cannot comply with the meaningful use rules,” said Dr. Booker. “However, the meeting also underscored that pathologists are supportive of interoperable electronic health care IT systems, have long been the leaders in clinical HIT, and must be involved in ensuring that lab and pathology data are correctly incorporated into the EHR.”

Formidable Compliance Challenges

Despite being at the forefront of HIT adoption, pathologists—regardless of their practice setting—will have difficulty qualifying for incentive payments authorized through the Health Information Technology for Economic and Clinical Health Act (HITECH) portion of the American Recovery and Reinvestment Act (ARRA). According to this law, a maximum of $44,000 in incentive payments is available for Medicare physicians who demonstrate “meaningful use” by meeting the definition of an eligible provider (EP) while using “certified” electronic health record software.

However, the CAP is concerned some details of the “meaningful use” regulation prevent pathologists from becoming fully compliant. Therefore, questions surround whether or not CAP members will be subjected to penalties starting in 2015. Beginning in 2015, CMS will reduce Medicare payments to EPs who do not meet the rule’s requirements. Penalties range from 1% of Medicare fees in 2015 and would grow to 5% beginning in 2017.

One example of the confusion: the meaningful use rule requires pathologists to maintain 80% of patient records in certified EHRs; however, pathologists typically use LIS or APIS systems rather than the full EHR. A whole host of additional “meaningful use” requirements are outside of pathologists scope of practice and usual interaction with patients.

In addition, CAP members are confused about how—and if—they fit into this rule’s definitions of eligible providers (EPs). Since the HITECH Act provides federal funding to both physicians and hospitals to help offset the cost of purchasing health information technology, the regulations are specifically written to prevent hospital-based physicians from “double dipping.” While a substantial portion of pathologists practice in hospital-based settings, the passage of the Continuing Education Act of 2010 designated most pathologists as non-hospital based EPs. Therefore, many CAP members who practice in hospital-based are uncertain about whether they need to comply with meaningful use rules.

CAP is closely monitoring this issue and remains committed to working with key Congressional stakeholders and federal agencies to address our concerns. Keep watching to Statline for continuing coverage of this issue.