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
| Reprints

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."




I have a little sympathy for providers facing all these mandates – just a little. The HITECH act was passed in 2009. And ICD-10 was underway before that. HIPAA is essentially over and really shouldn't have been that big a deal to most providers in the first place. While meaningful use, in my opinion, was rolled out sort of bass-ackwards, there have been relaxations along the MU way AND don’t forget these providers did get pretty healthy incentives.

The PQRS and Value-based Purchasing stuff is needed if providers want to move into the new world of pay for performance and quality. FFS won’t be around much longer. Do they not want to exist? Also, hospitals do have some transparency reporting they’ll need to do. No business is free from governmental and societal pressure to change and comply.

That leaves ICD-10 and, if you believe all the surveys (which I don’t,) most providers haven’t even started on it. So I wonder…is all this consternation and moaning such a big deal that it can’t be surmounted with some focus and teamwork? It seems to me there’s more grousing and moaning going on that positive activity towards getting work done.

I think if providers and their ‘supporting organizations’ channeled their energies toward progress vs. complaining about everything; and re-kindled the excitement of getting those MU incentive checks into and toward completing their remaining compliance activities, they’d be better served.

I agree that physicians should be more willing, motivated, and prepared to meet these requirements that have been around for some time, as you point out. But to me, it's still an increased burden when they all seem to pile on top of one another, without much flexibility. Plus, the difference in which everyone interprets them makes it all the more difficult.

Regarding ICD-10, even if you don't believe all the surveys, those who I have talked to seem just as skeptical as the studies suggest. In fact, I can't really think of confidence being expressed by anyone when it comes to this mandate, with just a few exceptions.

Your last paragraph I agree with, and is where I think much of the problem lies. "I think if providers and their ‘supporting organizations’ channeled their energies toward progress vs. complaining about everything; and re-kindled the excitement of getting those MU incentive checks into and toward completing their remaining compliance activities, they’d be better served." Well said!