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Does Meaningful Use Criticism Mirror Larger Healthcare Debate?

March 12, 2010
by David Raths
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During a wide-ranging discussion recently with Jeff Bauer, the futures practice leader of ACS Healthcare Solutions, he mentioned that the criticism developing around the CMS meaningful use Notice of Proposed Rulemaking (NPRM) in some ways mirrors the larger political stalemate over health finance reform taking place in Washington.

As Bauer pointed out, in both cases there were some early “kumbaya moments,” when everyone came together and announced their good intentions and spirit of cooperation, and in both cases that spirit has largely dissipated.

I have to admit I hadn’t thought about it in those terms previously, but as I started reading through the comments sent to CMS by groups like the College of Healthcare Information Management Executives (CHIME), the Medical Group Management Association (MGMA) and the American Hospital Association (AHA), I saw some similarities.

Republicans in Congress say they share the goals of President Obama and the Democrats of expanding access and controlling costs. But they say that the Democratic plans are too bureaucratic, impose too many regulations, and would cost too much. They want to start over with smaller, incremental steps such as removing state-based regulations and limiting patients’ ability to sue for medical malpractice.

Similarly, the healthcare organizations share the goal of expanding health IT usage. But they think the ONC approach sets too high a bar for providers too soon and is too prescriptive. They want the meaningful use guidelines to offer more flexibility, to make sure everybody is “getting on the escalator.”

Just as the Republicans have developed key phrases to deride healthcare financing reform, such as “a government takeover of one-sixth of the economy,” the opponents of the NPRM have taken to using the phrase “all-or-nothing approach” to criticize the meaningful use guidelines.

The critics of the NPRM believe their approach is more likely to succeed. AHA, for instance, says its goal “is not to slow down progress toward fully functioning EHRs. Rather, we think our approach will lead to much broader adoption rates of successful EHR systems across the vast majority of hospitals in a sustainable timeframe because hospitals would have more certainty, predictability and flexibility to address both institutional and local community priorities.”

The Republicans suggest scrapping the bill that resulted from a year’s worth of hearings and negotiations and start over; the AHA’s letter to CMS doesn’t go quite that far. But it does basically propose a thorough reworking of the MU framework. Its alternative proposal suggests 33 meaningful use measures for 2011/2012, and that hospitals would qualify for the full EHR incentive payment if they meet 25 percent of the objectives. Hospitals with fewer than 100 beds would receive full payment for meeting only 15 percent of the measures.

In its letter, CHIME fully endorses AHA’s recommendation. “CMS should allow providers to receive incentive payments by meeting fewer requirements in the early years of the program, building toward achieving the full set of meaningful use objectives over time,” it said.

And just as Republicans refer to polls that show health insurance reform is unpopular, the MGMA can point to a survey of its members that found that a majority of them believe physician productivity will decrease due to efforts to meet meaningful use requirements. They say they would find it especially difficult to respond to patient requests for electronic copies of their health information.

A press release from MGMA quotes William F. Jessee, MD, MGMA president and CEO, as saying: “If the final rule mirrors those outlined in the current proposal, there is a significant risk that the program will fail to meet the intent of the legislation, and that a historic opportunity to transform the nation's healthcare system will be missed.”

AHA has polled its members, and found that fewer than 1 percent of hospitals said that their systems are currently capable of performing all 23 meaningful use functions. Fifty-five percent said that they would not be capable of performing all 23 functions in 2015.

CMS and ONC representatives have said all along they will pay close attention to the comments from the provider community as the proposals are finalized. But will the alarms sounded by groups like CHIME, AHA and MGMA be enough to cause the agencies to consider so major a shift in their approach at this late date? If not, what will be the response if those groups are correct in projecting that very few hospitals will become eligible for incentives, and a large percentage instead will be looking at penalties in 2015?

And what will Democrats and Republicans in Congress do if the current legislative effort fails and premiums continue to increase more than 10 percent per year and the number of uninsured continues to rise?

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Comments

David,
Thanks for sharing your (and Jeff's) observations and notes on the relationships between the HCIT proposals and the larger healthcare reform initiatives.

An underlying question or assumption is that the HCIT incentives will motivate the laudable goals. There's a school of thought that incentives for efficiency in straight-forward tasks can be effective, yet, counter-productive for complex or creative tasks that require new learning. See my 'Fast Learning' post here for more on that topic.

Do you agree that classifying healthcare deliver transformation as "Execution-as-Efficiency" versus "Execution-as-Learning" is relevant to attaining meaningful use ?

David Raths

Contributing Editor

David Raths

@DavidRaths

www.linkedin.com/in/davidraths

David Raths’ blog focuses on health IT policy issues ranging from patient privacy to health...