Editor's Note: AAFP members are all over the map in terms of how they feel about the federal government's plan for health information technology; electronic health records, or EHRs; and the meaningful use incentive program. Here is the opinion of one AAFP member.
Alan Falkoff, M.D.
Our small group practice participates -- reluctantly -- in Medicare, and since we were early adopters of EHR technology, we currently meet about 85 percent to 90 percent of the meaningful use criteria all the way through to Stage 3. But I'm not sure we will ever see a dime of the incentive money. If we don't meet just one objective because we don't think it's good for the practice or our patients, we won't get anything.
The data extraction is going to be very problematic, given the collection and format dictated by meaningful use. Whole systems for billing, accounting, and knowing who is and who isn't an active patient will all have to be reworked and reevaluated in most medical practices.
It's clear that individuals who are not practicing physicians and active EHR users -- people who don't understand all the complex patient record, scheduling, messaging and billing workflow functions in a primary care office -- have developed the meaningful use criteria. The program, in theory, could have helped us, but the reality will likely be something else. Many of the meaningful use criteria are inappropriate. The whole program is overblown.
EHR users have been entering data in their systems for years, documenting many items now called for by meaningful use criteria -- smoking status, for example. They've been able to extract their data and assess what they're doing. But their data may not be valid and retrievable for meaningful use because the powers-that-be have specified exactly how the data is to be titled and labeled and where it must appear in the chart. Many hours may be wasted re-entering data in the "required fashion" that already exists.
Here's another example of what inappropriate criteria can do. In my practice, we haven't given a handwritten prescription in years, but because the meaningful use criteria state you have to do e-prescribing through a service, such as Surescripts, we were forced to invest $40,000 in a more powerful server, software upgrade and added technology support. In family medicine practices, our small margins make it difficult to handle that kind of expense.
For practices that do meet all the criteria, meaningful use will be a huge investment for little return -- $44,000 is not enough to offset most of the cost. At the same time, large Medicare pay cuts are always looming. This scenario could drive many doctors out of Medicare, and who knows what would happen next? Would states mandate participation in order to get a medical license? Eventually, meaningful use will carry over to the insurance companies because they usually follow Medicare's lead. All of this could drive many doctors out of primary care entirely.
I wish the government would begin again on meaningful use, getting family medicine's thought leaders involved upfront -- actual practicing FPs who can show them how practices work and develop workflow efficiencies that improve care. The government, the insurance industry and the pharmaceutical industry should all coordinate with primary care --not dictate to it -- and then they should subsidize primary care, paying for EHR technology, technology support and education. They should work with the AAFP to set a timeline and guidelines that would be achievable and realistic. Then we could submit documentation to show we meet criteria for continued funding.
That's where I would start, instead of working from the top down with people who don't understand the consequences of their actions and instead of imposing "standards" on those who actually do the work.
But that's just a pipe dream. In reality, I think we're in the progressive death throes of primary medical care and private practice, courtesy of the poor reimbursement we've endured for years and programs like meaningful use.
Alan Falkoff, M.D.
Group private practice