CMS Asked to Exempt Pathologists from EHR’s Meaningful Use Requirements

A letter to CMS Administrator Marilyn Tavenner signed by 88 congressional representatives is asking CMS to grant a significant hardship exception to all eligible pathologists for the full five years allowed by the American Recovery and Reinvestment Act of 2009 (ARRA) (P.L. No. 111-5). Pathologists maintain that is difficult for them to meet the requirements for the electronic health record (EHR) meaningful use incentive program for Medicare and Medicaid since they do not have direct contact with patients and their work products end up in the EHRs of other physicians.

EHR Program

Hospitals and eligible professionals that fail to implement meaningful use of EHRs will be subject to a reduction in their reimbursement. Physicians, including pathologists, are subject to a 1 percent reduction in their reimbursement if they fail to meaningfully use EHR by 2015. The payment reduction will be increased to 2 percent in 2016 and 3 percent in 2017 and each subsequent year. Under stage 2 of the program, eligible professionals will have to demonstrate to CMS that they met 17 core objectives and 3 menu objectives. The stage 2 meaningful use requirements were designed to increase health information exchange between providers and patients. For example, one of the new core objectives is the use of secure messaging to provide patients with health information (see Stage 2 meaningful use requirements released).


In the Final rule implementing stage 2 meaningful use requirements, CMS granted pathologists a hardship exemption for 2015, exempting them from the 1 percent reduction for failing to meaningfully use EHR. In that Final rule, CMS acknowledged that pathologists face significant barriers in meeting the current meaningful use requirements. The ARRA gave CMS the authority to grant hardship extensions for up to five years to eligible professionals that will have difficulty because of the type of work they do in meeting the meaningful use requirements, and that is what these members of Congress are asking of CMS.

Pathologists argued that it would be difficult for them to meet these requirements since they have little contact with patients. “Pathologists use sophisticated computer laboratory systems (LISs) to support the work of analyzing patient specimens and generating test results. These LISs exchange laboratory and pathology data with EHRs,” said Gene N. Herbeck, MD, FCAP and President of the College of American Pathologists (CAP) in a press release. “The EHR meaningful use program overlooks the unique circumstances of pathology practice,” said Kathryn Teresa Knight, MD, FCAP and Chair of the CAP Federal and State Affairs Committee. “CMS has recognized this difference by exempting pathologists from the 2015 [meaningful use] penalty,” said Dr. Knight. “The circumstances have not changed and CMS must further grant pathologists a hardship exemption for the maximum amount of time allowed under current law,” she continued.

Legislative Fix

In addition, the CAP has endorsed a provision of legislation that would reform the sustainable growth rate (SGR) method to update the physician fee schedule which would remove pathologists from eligibility for payment incentives or penalties under the EHR program. That legislation would give the HHS Secretary the authority to create measures and activities to monitor and encourage the use of the EHR under a merit-based payment system that reflects the way pathologists and other physicians that do not have direct interaction with patients, practice medicine.