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The HITECH Act of 2009 is the basis of meaningful use which encompasses using certified electronic health record (EHR) technology to improve quality, safety and efficiency, reduce disparities, engage patients, and improve care coordination.  While the HITECH Act of 2009 created certification standards and incentives for physician offices and hospital settings to adopt EHR technology, it did not include EHR use in ambulatory surgical centers (ASCs).

This exclusion has left physicians like gastroenterologists, who routinely perform outpatient procedures like endoscopies in ASCs, in a dilemma on how to satisfy meaningful use requirements.  ASCs are a crucial part of the healthcare picture in maintaining quality while also controlling costs.  The cost of procedures like endoscopies is, on average, half in an ASC setting as compared to a hospital setting.  The Catch-22 for doctors working in the ASC environment is that there is a lack of IT certification processes for EHR in this setting, but to satisfy meaningful use requirements, Medicare patients treated in ASCs need to be documented on a certified EHR system.  Without a certified EHR in place, patients treated at ASCs get accounted for in the denominator total of the physician’s beneficiary population, but excluded from the numerator total that counts towards meeting the percentage threshold of meaningful use requirements.  This lack of certification in EHR products in ASCs creates an unhealthy incentive to treat patients in a more costly hospital setting.

The Electronic Health Fairness Act (EHFA) – a bill that is currently making its way through Congress – could address this gap.  This bill will allow for a three-year window during which procedures performed at ASCs will be exempt from meaningful use requirements until a certification process can be put into place for EHR use in ASCs.  This legislation, if it becomes law, will help promote higher efficiency and quality of care at a lower cost that the ambulatory care setting offers.  The advantage is not only of cost, but also from a clinical point of view in terms of patient preference.

The EHFA bill is especially important when we look at the current health landscape.  The trend is for physicians to move away from independent private practice to an employed physician model with large hospital systems.  This makes the issues of doctors practicing independently less relevant and less influential.  If the bill does not become law, large practices, where the total pool of Medicare beneficiaries is big enough, will be able to meet the threshold, but smaller practices may have to direct beneficiaries to more expensive hospital settings to avoid being penalized on meaningful use requirements.

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