With U.S. physicians feeling more and more squeezed these days by multiple policy-, payment-, and industry-driven pressures—including healthcare reform-driven mandates, the upcoming transition to the ICD-10 coding system, and of course, the meaningful use process under the HITECH (Health Information Technology for Economic and Clinical Health) Act, it should have come as little surprise that MGMA (the Medical Group Management Association) would advocate for the idea of giving doctors something of a break.

Thus, on Aug. 21, MGMA president and CEO Susan Turney, M.D., authored a letter to Health and Human Services (HHS) Secretary Kathleen Sebelius, asking Sebelius to broadly rethink the penalties and requirements facing physicians under the meaningful use process. As Turney wrote in the letter, “HHS should immediate institute an indefinite moratorium on penalties for physicians that successfully completed Stage 1 meaningful use requirements.”

Turney pleaded for several other adjustments from HHS, including “extending the reporting period for Stage 2 incentives,” “conducting a comprehensive survey of vendors,” to determine their readiness to meet MU requirements, and “building additional flexibility into the Stage 2 reporting requirements.”

What’s of particular interest here is the timing of this request. As everyone knows, HHS revealed earlier this month that Farzad Mostashari, M.D., is stepping down this fall as National Coordinator for Health IT; whoever succeeds Dr. Mostashari in that position will need to sort through  whole lot of priorities and issues, including just how hard to press physicians and hospitals to meet the requirements of meaningful use in Stages 2 and 3. And now comes this request from MGMA; and this request will need to be addressed by Dr. Mostashari’s successor (unless Dr. Mostashari were to immediately approach Dr. Turney about it).

And what a sticky wicket that will be. As I’ve said in previous blogs, Dr. Mostshari is leaving ONC at a particularly tricky juncture, just as we steam ahead through Stage 2 and towards Stage 3. Already, his successor will have to walk a fine line between rigor and relaxation, with all the challenging implications of falling to either side going forward. In other words, the next National Coordinator will already need to be judicious in considering requests such as MGMA’s, lest acceding to them unravel the entire meaningful use process like pulling on a stray thread in a cable-knit sweater.

And that’s where things are most complicated here, because the dialogue between the new National Coordinator at association leaders like Dr. Turney will inevitably play out on two levels: the policy level and the pragmatic level. On the pragmatic level, there is the question of the inherent value of the MGMA proposal: is it legitimate to give practicing physicians the breaks that Dr. Turney is advocating, in order to better support their eventual adoption of the full spectrum of IT that will be needed? At the same time, the new National Coordinator will have to look at such proposals through a broader prism of federal healthcare policy.

The danger that acceding to one proposal such as MGMA’s is that doing so could lead to the unraveling of the program altogether. But refusing to make any concessions could also endanger the ultimate success of the program.

I do not envy the next National Coordinator; this is a very difficult, tangled set of issues. In the end, managing requests like these could prove fatal to the program. Only time will tell how this all turns out. Stay tuned: there will be no shortage of developments, some potentially dramatic, in the coming months.