Every summer my family makes an annual pilgrimage to the beach. As a lifelong runner, I make it a habit to take a jog along the surf early every morning. All of my runs at the beach are special, but on this trip one was particularly outstanding.
On this morning, the ambient temperature at dawn was close to 80 degrees and the humidity was north of 95%. (The runners among you will recognize these as less than ideal conditions.) Luckily there was a gentle sea breeze blowing. Unfortunately it was at my back as I headed out for the end of the barrier island. Adding to my challenge that morning, the wind speed was tantalizing close to my pace — I was running in a vacuum. Within minutes I was drenched in sweat. I actually looked forward to running into the wind when I turned around at the tip of the island.
As I remember from our time in Des Moines, Iowa, in the Midwest one can see approaching storms well before they arrive. The beach is no different. Looming in the distance was very clearly an approaching rain storm. As I got closer to the end of the island, I could not smell the rain, but I could see it. It looked like hazy curtains descending to the sea from the grey clouds above. And the curtains were accompanied by a remarkable rainbow that morning, a complete rainbow, horizon to horizon.
The sprinkles began just as I reached the turnaround point. The wind had shifted and picked up speed. No doubt about it, I was going to get wet. My glasses were soon covered in condensation and rendered useless. Taking them off, I was now running in the rain with substantially reduced visual acuity. It was almost surreal. The wind was blowing hard enough for the rain to fall at a 45 degree angle. The raindrops arrived with a gentle sting, but the water was cool and refreshing. My pace quickened and a grin spread across my face. Only minutes before I felt like I was in a sauna. The run was suddenly cool and refreshing. On the way out I had avoided the surf line, not wanting to get my shoes wet. They were soaked now and I was purposely splashing through puddles on the beach, my grin widening.
In 15 minutes the storm passed. The temperature had dropped slightly; the sun remained obscured behind the clouds. My shorts, shoes and socks were drenched. I finished the run in great spirits. In the span of a few minutes, a sea change, if you will, altered my perspective 180 degrees.
If you are still reading this post, you’re probably wondering what this recap of my memorable beach run has to do with nephrology and health IT? Let’s tie it back to meaningful use, the 50% rule and the associated hardship exception — either a logical transition or a reflection of a lingering “runner’s high.” You can be the judge.
The truth is, I have spent a lot of time discussing the meaningful use hardship exception in a variety of forums, including this blog. In fact I believe some folks are under the impression that I am advocating “opting out” of the meaningful use program. To the contrary, I am suggesting we understand our options as nephrologists and make an informed choice — a choice that is in our collective best interest.
Others, including CMS, are also beginning to see the light. In case you missed the CMS National Provider Call on July 24, the topic was Stage 1 and Stage 2 of meaningful use. One of the speakers was Travis Broome. Travis works for CMS and is currently Team Lead for Policy and Oversight of Health Information Technology Initiatives. In discussing the hardship exception that applies to the provider experiencing more than 50% of his outpatient encounters in a location without CEHRT, where the provider also lacks control over the decision to deploy CEHRT at that location, Travis mentioned nephrologists and “ESRD facilities.” The presentation was very insightful and his portion of the presentation begins on slide 50. Slide 62 displays the hardship exceptions; the fifth one on this list is the one that should be of interest to nephrologists. Travis’ related comments are near the top of page 18 of this transcript.
Like my challenging run out to the tip of the barrier island, the meaningful use objectives will become tougher in the transition from Stage 1 to Stage 2 and later to Stage 3. The financial incentives are rapidly vanishing and being replaced by penalties in the form of a reduction in your Part B book of business. Next year, if more than half of your outpatient encounters occur in the office, you will either report your office-based patient encounters, or you will face the 2% penalty in 2016. As the calendar moves forward, you may feel like you are running against the wind in less than favorable conditions.
However, if, on the other hand, more than half of your outpatient encounters occur outside the office, you might want to take a closer look at the hardship exception. As we head into the home stretch of the meaningful use program, it could be the difference between running in a sauna or a refreshing cool rain.
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