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What Does the Number Four Say About Meaningful Use?

May 9, 2014
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This week, it was revealed that only four hospitals and 50 eligible physicians have so far attested to Stage 2.  According to Healthcare Informatics Senior Contributing Editor David Raths, who reported on the Health IT Policy Committee meeting where this was announced, Committee co-chair Paul Tang, M.D., said that hospitals attesting before October 2014 are comparable to “students who turn their homework in early.”

I’m sure this is true. It’s a bit concerning, however, that seven months in, a lot more providers (72 hospitals so far) have applied for hardship exemption for meaningful use rather than attest to either stage. When most of your class is asking for an extension and not turning in their homework, what does that say about the assignment?

Thanks to an article from Bloomberg BNA, I can tell you that 3,000 hospitals participated in meaningful use Stage 1 in 2011 and thus have to attest to Stage 2 this year, apply for the exemption, or face a penalty. I’m not a math whiz, but four out of 3,000 is a pretty measly percentage.

I had an interesting conversation recently with one of the IT leaders at one of the four that HAVE attested to Stage 2. Linda Nolton, who is the health information exchange (HIE) project manager at Citrus Valley Health Partners (CVHP), talked about the various struggles and difficulties the healthcare provider had to overcome to attest to Stage 2 of meaningful and overcome the transitions-of-care and view/download/transmit requirements.

Toward the end of our interview, she said something on the meaningful use program that I didn’t put in the article, but thought was worth mentioning in this space. For context, I asked her if the Stage 2 requirements were attainable for most providers. Here’s what she said:

“Depending on the technology they have implemented that they may not be able to do it. So then it’s a question of the revenue and the penalty. What does that mean to your organization? Even if you are talking about a solo practitioner, and whether they should do MU2 or not, you have to come back to the dollars. You can’t ignore that. You have to find out here’s what it will cost you to do, what the incentive is, and what the penalty is if you don’t meet it. They have got to make that decision of is this worth it? What’s the bottom line?”

Keep in mind this is a person who has attested. I wouldn’t categorize her comments as being overly negative or positive. Instead, it’s a very even-keeled, realistic perspective on what’s happening.

And to me, it speaks volumes.   

We are in Stage 2 of this process, and one of the few people who have gone through with it, says that it might not be worth it. Just to clarify, she’s not saying definitely, yes or no. She’s just making a point that the requirements of Stage 2 might not be worth it for a provider. Stage 2! That has to be a bit disconcerting if you are the government.

Over the past year, there have been a lot of cries from the industry that added flexibility for Stage 2 is necessary. We’ve seen advocacy groups like the College of Healthcare Information Management Executives (CHIME) say that a “strict adherence to current program requirements endangers overall success of the EHR program.” We’ve seen Intermountain Healthcare CIO Marc Probst, a veritable giant in this industry, say that his organization will likely not attest to Stage 2 for patient safety reasons. And other large health systems, reportedly, are saying the same thing as Intermountain. Many providers, including CVHP, are pointing to numerous challenges with the transitions-of-care requirements.

The number of overwhelmed providers is striking. The fact that we only have got four hospitals that have attested so far says a lot.  Even the most blindly optimistic meaningful use supporter would agree that we could be facing a situation where a lot of providers don’t believe attesting is worth it. If that’s the case, meaningful use may very well be considered a failure.

Or maybe it’s just that those other 2,996 hospitals are like me. When I was in school, I always waited until the last minute to pass in my homework.  

Please feel free to respond in the comment section below or on Twitter by following me at @HCI_GPerna