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Tuesday Sep 01, 2015

Hit the Pause Button on Meaningful Use

Sometimes the best idea gets lost in translation or implementation. I'm sure history is riddled with examples of this, but I can think of no greater example in health policy than the meaningful use program.  

What started as a simple idea of developing and implementing an interoperable health information system that would encourage physicians to transition from paper-based medical records to electronic health records (EHRs) has, in reality, turned into a labyrinth of regulations that has actually resulted in discouraging physicians to the point of revolt. How did something so straightforward go so wrong?   

There are plenty of reasons why this occurred, but I am going to focus on four.

The regulations regarding the implementation of meaningful use are too complicated. The goal was simple -- transition from paper to computers and share information among physicians and health care settings. The concept of providing financial incentives to lessen the economic impact on the purchase and implementation of EHRs was a good one, but the hoops and hurdles that come with that money are not. Our government has developed a set of regulations that are so confusing, so complex, and so numerous that most physician practices face significant challenges complying.     

The sequential implementation of the regulations was misaligned. In retrospect, the regulations governing interoperability should have been put in place prior to ramping up efforts to implement EHRs on a widespread basis at the physician and hospital level. This small, yet meaningful, change in sequence would have prevented many of the challenges we face today. Primarily, it would have prevented the proprietary cannibalism that EHR companies and major health systems have engaged in since 2009.

The sphere of influence at the regulatory development level was too dominated by the vendor community which, not surprisingly, protected its self-interests versus advancing the interest of patients, physicians and the health care system.

Finally, the meaningful use program should have been an on-ramp for physicians, setting them on a path toward a fully functioning and interoperable EHR system that promoted quality care. Instead, the program is a pass/fail puzzle that is followed by the threat of penalties for non-compliance and heavy-handed audits for those who are successful in securing incentive payments. The program is not an on-ramp and, instead, is viewed as a cliff that physicians are afraid of being pushed over.

I am going to pause for a second to state that I unequivocally think our health care system will be better at providing high quality and cost-appropriate health care with an interoperable health information system. Additionally, I think electronic records, if re-designed to better support the work flow of a family physician and operating on a platform that allows for interoperability that facilitates the real-time exchange of relevant patient information, will improve the performance of individual physicians and allow for better care to patients at a more appropriate cost. The key to salvaging the simple goals of the meaningful use program may be as simple as saying, “we need to hit the pause button.”

As noted in my post last month, the AAFP is aggressively pursuing modifications to the meaningful use program. Specifically, we have been working to create changes in regulation that would delay meaningful use stage 3 until regulations implementing the Medicare Access and CHIP Reauthorization Act (MACRA) have been drafted, thus allowing alignment of the meaningful use program with the requirements of MACRA. We also have been pursuing changes to meaningful use stage 2 that would lessen the administrative burden it places on physicians, thus allowing greater participation and a lower percentage of physicians facing penalties for non-compliance. Finally, we are determined to change the pass/fail nature of the program and return to a process that encourages progress towards the ultimate goal of every physician and hospital using an interoperable EHR.

In my July posting I assured you that the AAFP would lead in developing legislation that would reform the meaningful use program and launch a grassroots campaign aimed at enacting those reforms into law. I am pleased to report that, in July, Rep. Renee Ellmers, R-N.C., introduced the Further Flexibility in HIT Reporting and Advancing Interoperability (FLEX-IT 2) Act (HR 3309), that captured reforms promoted by the AAFP and outlined above. 

The FLEX-IT 2 Act(www.congress.gov) would:

  • Eliminate the current “all or nothing” assessment and replace it with a standard allowing physicians to be evaluated based on the proportion of MU measures they meet.
  • Delay meaningful use stage 3 regulations.
  • Allow physicians to attest for MU based on a 90-day reporting period instead of a burdensome 365-day reporting period. Physicians reporting at all MU stages would be allowed this 90-day flexibility, and it would remain in place for all subsequent years.
  • Expand the allowable conditions for MU hardship exceptions. Under the bill, physicians will be allowed to claim a hardship exception in several scenarios, including a change in technology vendors, unforeseen circumstances (like becoming the victim of a cyber-attack), being at or near retirement or working in certain specialties with limited patient interaction outside the hospital.
  • Require that all certified EHRs undergo interoperability testing.
  • Harmonize CMS quality reporting standards across all programs.

The AAFP communicated our strong support for this legislation in a July 30 letter to Rep. Ellmers. We also have launched an aggressive Speak Out campaign(bit.ly) aimed at building support for the important reforms included in H.R. 3309. I urge each of you to send a letter to your representatives urging them to support this legislation and, more importantly, these much needed reforms to the meaningful use program.

Posted at 07:00AM Sep 01, 2015 by Shawn Martin

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Shawn Martin, AAFP Senior Vice President of Advocacy, Practice Advancement and Policy.

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