Dialysis Encounters
Finally, before the heavy lifting occurs we need to consider the “50% rule” and its impact upon nephrology. In an effort to not penalize providers practicing in multiple locations, some with a certified EHR and some without, CMS created what I have come to call the “50% rule.” Simply stated in order to participate in the meaningful use incentive program at least half of the providers patient encounters during the reporting period must occur in a location or locations equipped with a certified EHR. CMS has made it clear the encounters we have with patients in a hospital setting are not part of this calculus; however, the encounters within the dialysis facility are counted. The implications here are important. If the majority of your patient encounters during the reporting period occur in the dialysis facility, you can either use a certified EHR in the facility or you are not eligible for the program.

How will this impact the typical nephrologist? There is no easy answer here. In large part the answer ultimately depends on your response to the following questions:

• How busy are you in the office?

• How many times per‐month do you see your in‐center dialysis patients?

• Do you utilize mid‐level providers in the dialysis facility?

The math here can only be performed by the practice, but the results will have a significant impact upon how one approaches the meaningful use framework.

If you are compelled to include the dialysis encounters, an interesting nuance in the meaningful use framework ensues. This eligibility question examines actual patient encounters, whereas the vast majority of the meaningful use objectives measure “unique patient encounters”. The unique patient encounter recognizes that most of the meaningful use objectives must only be satisfied one time for the patient during the reporting period regardless of the number of times the patient is seen by the provider. The dialysis patient seen four times each month during the 90 day reporting period is counted as a single unique patient encounter. As you will see later this nuance within the framework has important implications for the requirements within the dialysis facility.