When it Comes to Federal Mandates, Have Physicians Reached Their Boiling Point? | Rajiv Leventhal | Healthcare Blogs Skip to content Skip to navigation

When it Comes to Federal Mandates, Have Physicians Reached Their Boiling Point?

February 28, 2014
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At times this week at HIMSS14, talking to various CIOs and healthcare providers from a myriad of patient care organizations brought me back to my childhood when my parents would assign me with chores that had to be done.

Take out the garbage. Clean your room. Shovel the driveway. Set the table for dinner. "But Mom, I haven't even finished my room yet," I would say in a whiny voice. "These are your responsibilities," she would respond. "Otherwise, no dessert!" Hearing that would make me want to stomp my feet and scream to whomever would listen.

That feeling is similar (albeit maybe on a little different level) to the one I've gotten from people here at HIMSS. Meaningful use, ICD-10, PQRS, HIPAA, one federal mandate for clinicians comes right after the other, and most occur simultaneously. No doubt, physicians want to know—is there any relief?

At the ONC Town Hall on Feb. 24 at HIMSS, such a question was asked by a member of a Kentucky regional extension center about any effort to align all of the regulatory requirements on physicians so it’s not one on top of the next. "When can we simply practice medicine?" the attendee asked in frustration.

More than one ONC official said that Stage 3 of meaningful use may provide an opportunity to harmonize some of these regulatory initiatives. "That is something that HHS [the Department of Health and Human Services] is working on—harmonizing its various programs to create a more seamless and streamlined way to capture the information," Karen DeSalvo, M.D., new National Coordinator of Health IT, said at HIMSS.

Furthering the point made by the Town Hall attendee, Micky Tripathi, Ph.D., founding president and CEO of the Boston-based Massachusetts eHealth Collaborative (MAeHC), said in a recent interview with Healthcare Informatics that there are too many things hitting the industry at once. "I think it’s a good thing to give people the flexibility they need. The reality is that none of us could have predicted that you’d have meaningful use Stage 2, ICD-10, OCR [HIPAA data security audits under the auspices of the Office of Civil Rights at HHS], the ACA [Affordable Care Act], all at once. And it’s pretty miserable being a hospital CIO right now—it’s not a fun job!"

It's hard to disagree with Tripathi. It's an unprecedented time in healthcare right now, and CIOs are feeling the heat. Statistics say that a CIO's responsibilities have increased, in terms of both scope and complexity, by 25 percent to 50 percent since the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act. At the core of their responsibilities are these federal mandates, which possess long-term benefits for the industry, but at the same time, may make some clinicians wonder in the short term if these extra burdens are what they signed up for.

On the exhibit hall floor this week, the CIO of a 200-bed medical center in the Midwest asked me my thoughts on aligning requirements, and what the media thinks about the future of the industry, in regards to these mandates. After a few minutes of conversation, I could tell he was getting more and more frustrated. "All of these [mandates] are one after the other, and the thing is, everyone is interpreting them differently," he said.  “Doesn’t that just make everything more complicated? And oh yeah, [the government] is also saying, 'Hurry up!'"

What's more, I asked Howard Landa, M.D., CMIO at the Oakland-based Alameda County Medical Center and vice chairman of AMDIS (Association of Medical Directors of Information Systems) if physicians are growing increasingly frustrated and just want to go back to practicing medicine, which happens to be their expertise. "I think they hit that point around 1992,” he told me. “If physicians see value, that's one thing, and they will get on board. But no one sees value in ICD-10. I want to believe that better data will lead to better care—I've staked much of my life on that. But I'm starting to get more and more cynical. ICD-10 is a big reason why,” he said.

Don't get me wrong—personally, I see value in these mandates that individually, possess aspects that have enormous potential to improve a broken system and make healthcare more accountable. The transition from volume to value is a necessary one, but it really does look like that these requirements are having a snowball effect on the industry.

At the CHIME-HIMSS forum this week in Orlando, Robert Tagalicod, director of the Office of E-Health Standards and Services at the Centers for Medicare & Medicaid Services (CMS), said relief would only come in the form of tweaks to the programs—not massive overhauls—and how regulations are interpreted. He went on to say that they are not in the position for another ICD-10 delay. CMS Administrator Marilyn  Tavenner, R.N., confirmed that in her keynote on Thursday at HIMSS, saying "It's time to move on."

And per meaningful use, Tavenner said in the keynote, "We do expect all Stage 2 providers to meet all requirements by 2015. There are no timeframe adjustments." This despite a recent plea from CHIME (the College of Healthcare Information Management Executives) and 47 other healthcare organizations who co-signed a letter to HHS Secretary Kathleen Sebelius, calling for more flexibility in meeting meaningful use requirements.

Tavenner did say, though, there would be more flexibility in meaningful use for hardship exemptions. But to be honest, much of the response from the federal government this week at HIMSS was littered with the usual, "we're listening," “we understand,” and “we’re using every lever that we have.” The classic “saying a lot without really saying anything” move.

So as HIMSS14 ends, while there are plenty of reasons to have hope for the future of health IT, it’s not hard to feel for the clinicians who are getting hit with mandates left and right. Perhaps the most frustrating part of it all is that despite these requirements, the future hardly holds any guarantees.

Just like most of you, I don’t have an answer or a way to ease the burden on physicians. But I do have a feeling that if it all does work out in the end, their dessert will taste a lot sweeter than mine did. 

Questions or thoughts? Feel free to add a comment here or on Twitter by following me at @HCI_RLeventhal

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