American Osteopathic Association

Advancing the distinctive philosophy and practice of osteopathic medicine

Meaningful Use

​​Meaningful Use Hardship Exception

All DOs who participate in Medicare should consider applying for an EHR Meaningful Use hardship exception, unless they are certain they can successfully attest to Meaningful Use Stage 1 or Stage 2 for the 2015 performance year. To help with the process, the AOA created a step-by-step guide to apply for a hardship exception.

Applications for a hardship exception are due to CMS by July 1, 2016. This is an extension of the previous deadline (March 15, 2016).


CMS Finalizes New EHR Meaningful Use Requirements Impacting All Physicians

On Oct. 6, the Centers for Medicare and Medicaid Services (CMS) released a long-awaited regulation, which finalizes proposed changes to Stage 1 and Stage 2 for the Electronic Health Records (EHR) Meaningful Use program, and sets out the requirements for Stage 3. The modifications and new requirements will impact all physicians.

Earlier this year, CMS released proposed rules on changes to the Meaningful Use program, and the AOA provided extensive comments to the agency which emphasized that the program:

  • Is too complicated.

  • Is not focused on clinical reality and workflow.

  • Has redundant reporting requirements.

More recently, the AOA expressed concerns that requiring physicians to meet Stage 3 by 2018 will significantly interfere with transitions into the new payment system in 2019 created under the Medicare Access and CHIP Reauthorization Act of 2015, which was passed earlier this year to repeal the SGR.

The AOA, along with other physician organizations and a number of members of Congress, urged CMS to postpone finalizing the Stage 3 rule until details of the new payment system are established. Unfortunately, CMS did not oblige and has released its final rule – a summary of the key changes and requirements are below.

Key Modifications to Stage 1 and 2 Under the Final Rule

  • In 2015, providers must attest to use of their EHR for any continuous 90-day period instead of a full year by Feb. 29, 2016. Physicians who are unable to do so for reasons related to their certified EHR technology, situations involving technology upgrades, switching products during the year or the decertification of their EHR product, may apply for a hardship exception. Additional situations, such as switching employment or practicing in multiple locations in a reporting period, may be considered on a case-by-case basis as well.

  • For 2016 and 2017, providers who are new to the EHR incentive program continue to have a 90-day reporting period, while providers who are already in the program must report for a full calendar year.

  • Beginning next year, the number of objectives providers must meet in Stages 1 and 2 has been reduced from 18 to 10 in order to streamline and simplify participation in the program.

  • CMS acknowledged difficulties providers were facing with Patient Engagement measures that depend on patient cooperation in certain activities, such as reviewing their own health records, exchanging secure messages with physician practices and generating their own patient data. The threshold of a provider’s patients who must view, download or transmit their electronic health records was decreased from 5% to a single patient. Similarly, instead of attesting that 5% of patients have exchanged secure electronic messages with their provider, physicians must only attest that they have the capability to do so.

  • Providers may continue to use 2014 Edition Certified EHR Technology to attest to meaningful use until 2018.

Key Stage 3 Requirements

  • All physicians must participate in Stage 3 beginning in 2018 or they face a penalty, regardless of whether they have achieved Stage 1 and Stage 2 of the program.

  • Physicians can choose to begin Stage 3 early in 2017, and if they do so will only have to attest to a 90-day reporting period instead of a full year.

  • Physicians must meet eight objectives to succeed, five of which rely on interoperability.

  • Allow the use of application programming interfaces (APIs) to support patients’ ability to access their health information in more flexible ways than just a patient portal of the EHR, including via mobile devices.

  • Beginning in 2018, providers must upgrade to using 2015 Edition Certified EHR Technology to attest to meaningful use.

While CMS has now finalized the rule, the agency did provide an additional 60-day comment period to collect feedback on ways to transition from the meaningful use program to the new payment system. The AOA will be providing comments, and will continue to work with the agency to advocate for a Meaningful Use program that allows osteopathic physicians flexibility to provide high quality care to the patients, and that minimizes burdens.

Additional details on requirements under this final rule and resources for AOA members will be forthcoming. For additional information, please contact


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