I Bailed Out of Medicare Because of Meaningful Use

April 01, 2011 04:35 pm Pennie Marchetti, M.D.

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.

The government's idea of "meaningful use" and the strings attached to getting the incentive payments are the chief reasons I decided to opt out of Medicare.

I have two main objections to meaningful use. One is bureaucratic interference with EHRs. The other is ideological -- I truly believe the state has no business knowing people's medical data. I don't want information on my patients' blood pressures and drinking and smoking status in the government's hands. It's not such a problem if it's deidentified, aggregate data, but the goal posts for meaningful use will probably move each year. As the criteria change, who knows what they will do with the data?

I started using an EHR in 2005 because I felt it would be an asset to my practice and a better way to keep records. We just updated to a more integrated system that is certified for meaningful use. I use the system for e-prescribing, checking formularies and eligibility checks. Billing is integrated. The EHR interfaces with local labs and one hospital. We're getting our patient portal up and running in the next few weeks. So we're already doing some of the things that meaningful use criteria call for.

But I sit on a hospital quality assurance committee, and I see them jumping through hoops to try to meet similar criteria foisted on them. It's to the point that when you're on the floor taking care of patients, everyone seems more focused on meeting Medicare's bullet points to get maximum payment than on taking care of patients.

Meaningful use looks like the same thing, now transferred to private physicians' offices. I knew I had to decide -- would I spend my time focusing on bullet points and entering data to get paid? Or would I concentrate on caring for my patients and keeping up-to-date? I have only so many hours in each day. The patients won.

I'm concerned for physicians who are hurrying to buy EHRs and qualify for meaningful use. The political landscape is so uncertain that the incentives may disappear by the time the budget wrangling is over.

Furthermore, I think the criteria are designed to be difficult to meet. You might think you're doing it right, but if you don't meet 100 percent of the bullet points for a condition such as pneumonia, you won't get your bonus. The same thing happens in hospitals. I wouldn't put much stock in getting $44,000 for adopting an EHR.

One more thing. Meaningful use is supposed to boost quality, but it could eventually require you to follow guidelines and protocols that may not be based on the best evidence. I've seen it happen -- guidelines adopted by CMS or insurance companies that were promoted by specialty societies instead of based on good evidence. A few years later, everybody had to backtrack.

I wish there were more public discussion about meaningful use, but I suppose the public isn't all that interested. They should be -- their personal health information is at stake.

Pennie Marchetti, M.D.
Solo private practice
Stow, Ohio