By mid-May, the first payouts to physicians who had attested to stage 1 of meaningful use had begun to be sent out by the federal government. The physicians receiving the first payouts had attested to stage 1 within the first week that attestation was open (the week of April 18). One example was the Childs Medical Clinic in tiny Samson, Alabama. Jule Childs, the practice’s office manager, had facilitated the attestation process for the clinic’s solo practitioner, Hayden Childs, M.D., during that first week that attestation was open. The clinic received its first $18,000 check from the federal government on May 19.

Erica Drazen, Sc.D., managing partner in the Waltham, Mass.-based Emerging Practices division within the Falls Church, Va.-based CSC, recently discussed with HCI Editor-in-Chief Mark Hagland the implications of the timing and fact of the first meaningful use payouts on the overall MU process. Below are excerpts from their interview.

What do you think about the timing of the first meaningful use payouts? Many in the industry were actually surprised that the checks were sent out when the government said they would be. Perhaps some didn’t believe it would really happen.
They’ve actually been pretty good [at the federal Office of the National Coordinator for Health IT, and at the federal Centers for Medicare and Medicaid]; they’ve pretty much stuck to their schedule for everything. They said the proposed rule for stage 1 would come out in December and it came out on December 31, but still, it was December. And they said you could apply in April, and they did, and they said the checks would come out in mid-May, and then they did. And I do believe, especially among the docs, that there has been skepticism.

I think it’s good news that we have docs qualifying and getting their money; and we’ve been through PQRI [the Physician Quality Reporting Initiative program, created by federal legislation in 2006 for CMS, and now known as the Physician Quality Reporting System]—and it’s not that you couldn’t get the money at all, but it turned out to be harder than expected; and they missed some deadlines on e-prescribing.
And there was that whole hoo-ha when the Advisory Board urged people not to attest early. But our attitude has been, get to meaningful use as quickly as you can, and you can attest at any time. But people interpret that as saying, oh, we’ve got another year. But one of things to keep in mind is that there has been absolutely no discussion about moving the penalty deadline in 2015, and that’s in the law.


Erica Drazen, Sc.D.

There’s talk that they might delay the timeframe around stage 2, but you don’t believe that?
What they’re talking about is that they might allow people who first qualified in 2011, to attest under stage 1 for three years. Initially, it was set up that if you attested in 2011, you had to be at stage 2 in 2013, and if you attested in 2012, you only had to be at stage 1 in 2013; so that essentially would penalize early adopters.

So the proposal would be that you could essentially stay in stage 1 until 2014?
Correct.

Have there been any formal proposals around this?
Yes, the Meaningful Use Subcommittee of the ONC Policy Committee made that an option for the Policy Committee to consider. They discussed it on May 11, and at that time, they made a draft recommendation was that the best option was this one, to allow people who had qualified in 2011, to remain under stage 1 through 2013. There were a bunch of options they considered, and this is the one they came up with. The Policy Committee discussed this, and didn’t come up with any others. The final recommendation from the Meaningful Use Workgroup about stage 2 requirements and timing will be made on June 9.

So then the Policy Committee could accept or reject these, but this will be the third time this workgroup has presented and gotten feedback; and in the past, once you get to the third time on something, it’s likely to be approved.

So this is likely to be approved, then?
Yes, and if that happens, the Policy Committee needs to make recommendations to CMS. And then CMS will release the proposed rule for stage 2; they’ve said it would be before the end of 2011, though they’ve never said whether that would be calendar or fiscal year 2011. And then the final rule for stage 2 is due by mid-2012, and again, it’s not clear whether that means calendar or fiscal year.

I do think people were skeptical that money would begin flowing.
I think the docs were skeptical; I think the hospital people knew the money would begin flowing. I think a lot of people were hoping the requirements would go away, because of threats in Congress about the stimulus money and about the repeal of healthcare reform. But one of the good things about the payouts is that clearly, you can do it, right?

I mean, the fact that they have 400-some certified products now is a clue that the capabilities of the products weren’t a problem, right? And we know what it takes to make an EHR work, and there are lots of benefits, and lots of choices, and you can pick a product that meets your needs and wants, and I think this is a good thing, because a lot of people were saying, we’ll never be able to achieve stage 1. And now, people are saying, we’ll never be able to achieve stage 2, of course!

And if the government hadn’t created this program, this wouldn’t be happening now, right?
Exactly. And it’s an incentive program. And though it may cost more to implement than they’ll get back in the incentive money, it still is an incentive.

And in the case of the Childs Clinic, whose office manager I interviewed, that office manager said they’ve spent $100,000 on their EHR, but the $44,000 really made a difference; otherwise, they wouldn’t have done this. So the bottom line is, Chicken Little is wrong, and the sky isn’t falling?
Right, and this is a doable transition. And really, this is becoming the standard of practice and patients are expecting this, and if you do have a medical error that could have been prevented had you had an EHR, you’re not in a very good position legally. So you’re either going to put in your own EHR or have someone do it for you, or retire. And some are going to choose to retire, I’m sure.

Any other thoughts?
I think it is another validation, not only that it’s real and the money’s coming, but that it’s doable. And people who thought that the money wasn’t going to be there, should now have an extra incentive to do this, because if you think the program’s going to go away because they might run out of money, get in now and get the money, right? And the guys who started in 2011, if they can go through 2013 on stage 1, they’ll get 90 percent of their money. So you’ll miss 10 percent of the money if you wait until 2014. So there are a lot of reasons to get your money now. And if you get your money from stage 1, you’ll have more money later on.