Sen. Lamar Alexander (R-TN) didn’t mince words last month when he chaired the first in a series of Senate committee hearings focused on the upcoming launch of Meaningful Use Stage 3.
"To put it bluntly, physicians and hospitals have said to me that they are literally terrified of the next implementation stage,” he said, “because of the complexity and because of the fines that will be levied."
Physicians and C-suite healthcare executives aren’t exactly known for their emotional vulnerability. But the next—and last—step of the federal government’s Meaningful Use program has got them rattled. The proposed rule for Stage 3, which outlined eight specific objectives healthcare providers and hospitals must meet by 2018, was released in March and open for public comment through May. The final rule confirming Stage 3 specifics is expected in early fall.
Until then, providers have plenty of Meaningful Use mishaps to mull over. For starters, here are three.
In the experience of many, the Meaningful Use program came in like a lamb. But then it grew into a lion.
All hospitals and nearly all providers who tried to comply with Stage 1 succeeded. What’s more, they scored bonuses for their efforts in the form of higher Medicare reimbursements. To date, the federal government has awarded more than $30 billion in Meaningful Use incentives.
Stage 2, however, wasn’t so smooth. For failing to meet Stage 2 stipulations, the Centers for Medicare and Medicaid Services this year slapped approximately 257,000 physicians with fines in the form of one to two percent cuts from their Medicare reimbursements. Meanwhile, more than 200 hospitals are also incurring reimbursement penalties for their Stage 2 fails.
“The program’s Stage 2 requirements are so complex,” said Sen. Alexander, “that only about 11 percent of eligible physicians have been able to comply so far, and just about 42 percent of eligible hospitals have been able to comply.”
That’s not exactly solid ground for a Stage 3 launch.
In reflecting providers’ concerns, Sen. Alexander quoted conservative columnist and physician Charles Krauthammer, MD, who recently wrote, “The EHR technology, being in its infancy, is hopelessly inefficient. Hospital physicians will tell you endless tales about the wastefulness of the data collection and how the lack of interoperability defeats the very purpose of data sharing.”
Various reasons have been suggested for the failure of EHR technology to live up to interoperability expectations, including vendor competition, differing priorities, lack of a national patient identifier system, and an industry struggling to keep up with the government’s EHR expectations.
To overcome the latter, the American Medical Informatics Association recently recommended an environment that fosters innovation—and not mere reaction—in health information technology, Sen. Alexander noted.
“The brilliant minds working in information technology (IT) should be allowed to innovate new ideas, not just react to satisfying government ideas for health IT,” he said. “Standards are important, but they should support and enable innovations—not stifle them.”
“Today, with a click of a mouse or a swipe on a smart phone, one can see the prices for airplane tickets from competing airlines or mortgage rates from hundreds of banks,” Sen. Alexander said. “But in healthcare, information technology has not made much difference to the patient experience.”
Patients still fill out forms at every office visit, and must phone multiple offices to make various appointments. They also must pull together their health information themselves to provide a more complete picture for every healthcare professional they see, he mused.
“Electronic health records could change that experience for all of us,” Sen. Alexander said, “so that when an individual visits a doctor, his care team can access his information no matter where the patient has been or which doctors he’s seen in the past and deliver more accurate and higher quality care for the patient.”
Sounds nice, doesn’t it? But as the docs and decisionmakers will tell you, getting there is the issue at hand.