Good News: The 2015 Hardship Exception Arrives!

Last week, the moment we’ve all been waiting for arrived. Not the first snowfall of the year many of us experienced thanks to a winter storm named Jonas. No, I am talking about the latest rendition of the Meaningful Use Hardship Exception.

Background

As most of you are aware, the “glory days” of MU are behind us. Most of you have completed Stage 1 and collected the bulk of the incentive dollars CMS put on the table. Through the end of November, CMS paid hospitals and eligible professionals like you almost 32 billion dollars for attesting to the fact that they “meaningfully used” a certified EHR. As we have mentioned before, this program has an odd inverted incentive scheme. In the early days, the hurdles were low and the payoff was high. Today, however, the hurdles are high and the payoff is low. In fact, for many this is no longer about chasing an incentive, it’s about running from a penalty.

For example, take a look at last year. With rare exception, the work you did in 2015 will determine whether or not you incur a 3% penalty in 2017. If you successfully dotted the “i’s” and crossed the “t’s” for the MU program in 2015, you will avoid a 3% reduction in your 2017 Medicare physician fee schedule. Of course CMS was late to the table in 2015. All year long we were told changes were coming that would make our lives easier. The biggest change promised was a shortening of the reporting period in 2015 to 90 days. Amazing when you think about it, but a year ago the rules of engagement stated that if you were going to attest for MU in 2015, you needed to count the entire year as your reporting period. Of course that all changed in early October with the delayed publication of the final rule. With about 85 days left in the year, we learned the reporting period would indeed be shortened to 90 days. Makes you wonder if the folks in charge of this program have access to a calendar.

Relief arrives

In the face of a massive ground swell of complaints, at the 11^th hour Congress created the Patient Access and Medicare Protection Act which Diana Strubler nicely described in detail last month. With President Obama’s signature, this puppy became law just before the end of 2015. As a result, and with unprecedented speed, last week CMS announced the release of the new hardship exception process. This process does two very important things for nephrologists. First, it makes it remarkably easy to file for a hardship exception. Check out the instructions for completing the application here and the application itself here. Second, the delayed release of the meaningful use final rule last October has created the opportunity for nephrologists (and every other provider across the country) to legitimately file for a hardship exception because no one knew what the MU rules were until the first week in October. If you started your reporting period on the day the final rule was published you would run out of runway because there were not enough days left in the year to capture a 90-day reporting period. What were these people thinking?

Options

Many nephrologists will likely have two hardship options to choose from. As we have noted before, the “50% Rule” hardship exception is still available. We have reviewed that one before and if it applies, you are looking for Section 2.3 in the hardship application referenced above. The difference this year is you simply check the box in 2.3 and no longer need to add location names, etc. Talk about a walk in the proverbial park. The second option is the one I mentioned above. If the fact that CMS released the final rule so late in the year created a hardship for you (as it did for practically everyone in the country), the appropriate hardship is in section 2.2 (Extreme and Uncontrollable Circumstances). Specifically you are looking for 2.2.d which I have captured in the image below:

What’s a bit ironic, is they expect you to pick 2.2.d above to let them know you could not attest because CMS was late to the table. However, notice the title of this exception. In spite of the fact this was a problem created by CMS, you have to point the finger at your EHR vendor. If I were a cynical man I might accuse CMS of dodging responsibility…perhaps another day.

Do not delay

The other important piece of information related to this hardship is timing. Unlike in years past when we had until July 1, the deadline for this one is the Ides of March. You must file this Hardship Exception Application by March 15, 2016. CMS is anticipating a massive number of hardship applications this time around. If I were you, I would not put this off. Send it in as soon as you can. A 3% haircut on your Medicare Part B book of business would be a most unpleasant surprise in 2017. Don’t delay, file today. Are you planning on filing for the hardship? Join the conversation and drop us a comment.

Terry Ketchersid, MD, MBA, practiced nephrology for 15 years before spending the past seven years at Acumen focused on the Health IT needs of nephrologists. He currently holds the position of Chief Medical Officer for the Integrated Care Group at Fresenius Medical Care North America where he leverages his passion for Health IT to problem solve the coordination of care for the complex patient population served by the enterprise.