Meaningful Use Confusion: Revisited

In his article from March 30, 2011 “Meaningful Use Authority maps the Path to Stage Two in Speech to Health IT Summit” Frank Irving outlines Dr. Tang’s speech addressing the timeline for qualifying for ARRA Medicare/Medicaid payments. In short, there is significant effort towards getting practices to reach compliance as quickly as possible.

Are they pushing too fast for some practices? Much of this effort will require practices to re-tool their workflow. From what I have seen, most practices are not considering the risks of an IT conversion and the impact it will have on their practices. Nor have I seen rhetoric from support organizations addressing the economic hit most practices will face during this transformation. While it is generally accepted that adding HIT to practices will help efficiency in the long term (as well as increase public health reporting), the short term financial hit threatens to eat 10-15% of revenues immediately. In many practices, that is the profit fuel that keeps the practice running.

So, it appears this transformation process won’t put the better doctors ahead of the pack, but it will put the doctors with better businesses there. Time will tell.

Moving fast to capture the incentive monies may be the right thing for some practices, but the monies will be just the same a year from now. The real decrease in incentives doesn’t begin until 2013 and 2014, and penalties begin in 2015. The basis of whether you are rewarded or punished all comes down to Meaningful Use.

Meaningful Use definition keeps coming. The comment regarding the Stage 2 criteria closed on March 25th. The Office of the National Coordinator for Health IT (ONC) is still in the process of analyzing and summarizing the received comments. Dr. Tang asserted that the comments he and his colleagues have viewed so far suggest a ‘pushback’ on the speed of the timeline, and that The Meaningful Use Workgroup is working on getting vendors to produce the software both to fulfill Meaningful Use and staff training—both options which we, Clinic Service, provide. The Meaningful Use Workgroup will meet again April 5 to discuss a draft of comment-based recommendations for the Stage Two criteria and timeline. The Workgroup will present their final recommendations to HITPC by June, and then on to ONC and the Centers for Medicare & Medicaid Services (CMS) for their consideration.

The Workgroup will also consider how specialists can get involved, which Dr. Tang noted is ‘gnarly’ problem because a bunch of quality measures don’t exist for specialties that do for primary care—at least for now. In some interesting twist, the incentive program in theory starts in 2013—they’re trying to fix that. Dr. Tang nevertheless asserted that the process has been a positive force in the medical industry:

“The fundamental thing that is going to carry us way beyond 2015 is that we’re changing the way we’re going to assess ourselves, which in turn will affect the way we’re going to pay ourselves. CMS and all the payers are looking at this as a way to get out of the paper transaction model. We all want that, too, but we want a fair shake at measuring things that are important to us. I would encourage everyone to look at the quality measures, because they are the ticket to the future.”

We agree with this perspective.

The idealism intended by Meaningful Use is that sharing data and knowledge with patients and their families adds to the ability for medical professionals to made well-informed choices about a patients care. As Dr. Tang concludes, “we’re going to be on equal turf in advancing health for individuals and health for the community.”

We live in a world where organizing and managing data is the key theme of our time. And it only works if everyone plays…

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