As U.S. physicians continue to embrace electronic health records (EHRs), data on CMS' EHR incentive program holds both positive and troubling news regarding family physicians' participation and success in achieving meaningful use of their EHRs.
According to CMS' recently published EHR meaningful use attestation data(healthdata.gov), 23,636 family physicians became first-time meaningful users in 2012. The number represents a 180 percent increase compared to 2011 EHR statistics.
In an interview with AAFP News Now, Jason Mitchell, M.D., director of the AAFP's Center for Health IT, said the latest report confirms family medicine "still has the greatest participation both by percentage and by the numbers."
However, the report also revealed a drop in the retention rate of attesting physicians. In fact, of the 11,578 family physicians who attested to meaningful use in 2011, only 9,188 did so in 2012, a 21 percent drop in participation.
Mitchell and Steven Waldren, M.D., the center's senior strategist for health care IT, crunched the raw numbers -- buried deep in the April attestation data -- and determined that the overall meaningful use dropout rate among all physician specialties was 20 percent.
- Recent EHR meaningful use attestation data published by CMS show family physicians participate in the program at higher rates than physicians in other specialties.
- Among all specialties, about 20 percent of first-time meaningful use attesters in 2011 did not attest to meaningful use in 2012.
- Reasons for the tumble in numbers could include a change in the reporting period from 30 days to one year and misunderstanding about -- or lack of attention to -- the two-month attestation period in early 2013.
Why the Tumbling Numbers?
The new data raise a key question: Why were a good number of physicians unable to maintain meaningful user status, especially since no changes were made in the meaningful use stage one requirements from 2011 to 2012?
Although there's no way to know for sure, Mitchell and Waldren cited some possible reasons for the decline.
Looming large on their list is the length of the reporting period. In 2011, physicians only had to report on measures for 90 consecutive days and could start, stop and shift dates to make that happen. However, during year two, the reporting period stretched to a full year. The extra reporting burden may have discouraged physicians. Others simply may have lost track of their progress during the year.
"For some physicians, the issue likely was a lack of ongoing monitoring of their meaningful use numbers throughout that entire year," said Mitchell.
And unfortunately, some physicians simply missed the two-month attestation window for 2012 reporting that ran from Jan. 1 to Feb. 28, 2013. "A physician could have been a meaningful user the whole year and then missed the attestation deadline," said Mitchell.
"Don't be that guy in the next round," said Waldren. "It's very important to check the timeline for 2013(www.cms.gov) and understand the deadlines for meaningful use."
In addition, 2012 saw a decrease in function of the federally funded regional extension center (REC) programs. According to Mitchell, the state-based organizations were designed to sign physicians on with a REC, assist physicians with EHR implementation, and then help them become meaningful users and successfully attest to MU.
The first year, the RECs were offered incentives to get physicians on board, but there was no built-in incentive for RECs to maintain physicians through the second year, and many of the RECs already were running out of funding to sustain their work, said Mitchell.
Tell the AAFP Your Stories About Meaningful Use
The AAFP wants to hear from family physicians who are among the 21 percent of FPs who failed to qualify for a meaningful use bonus in 2012 even though they successfully attested in 2011.
If that sounds like you, send a quick e-mail to Steven Waldren, M.D., with details of your particular situation. Identifying meaningful use barriers will help the AAFP in its work with CMS and other stakeholders to resolve those issues in the future.
AAFP Working to Resolve Issues
To help ensure family physicians' future success with the meaningful use program, the AAFP already is working with CMS and the Office of the National Coordinator for Health IT to investigate, find answers and fix problems.
"Is there one particular measure that is tripping up physicians? If so, let's look at changing that," said Waldren. "Is the 12-month reporting period an obstacle? Do physicians need software that provides a 'dashboard' to enable them to track their progress?
"Let's work on identifying the problems and see what corrections can be made, because we want to be sure that 20 percent of our 2012 meaningful users don't drop off in 2013," said Waldren.
Mitchell and Waldren said physicians could ease the meaningful use burden by taking a few steps. For example, they encouraged members to
- plan ahead by checking requirements and deadlines and then stay on top of those obligations,
- crank out electronic meaningful use reports on a continuous basis to show progress toward meeting standards, and
- ensure that an EHR's internal tracking mechanism for certain measures, such as the drug formulary and interaction features, are turned on for the entire reporting period.
"Such features could inadvertently be turned off by the vendor during a routine system update," said Waldren.
Mitchell expressed concern about physicians' desire to stay in the game when meaningful use two rules are applied in 2014. "The rules do change significantly, and technology has to be more sophisticated," said Mitchell.
And although the reporting period window collapses back down to three months for the first year of meaningful use two, the reporting must be done quarterly, so there can be no "shifting and shuffling" of dates to attain a consecutive 90-day reporting period. In 2015, meaningful use stage two will once again shift users to that full year of reporting, said Mitchell.
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