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| The Health Record Review by Patty Enrado |
Will the Meaningful Use journey become the road not taken?
Posted on Thu, Dec 31, 2009 - 02:52 amYesterday, Dec. 30, CMS released a tome of proposed regulations for achieving Meaningful Use of EHR systems by providers and hospitals. For those who have been closely following the discussion of meaningful use by health IT industry analysts and experts, the list of requirements is likely not a surprise.
For providers who have EHR and EMR systems in place, many may already meet the objectives but have to work on raising the percentages of the objectives' measures. Depending upon the maturity of their systems and capabilities, this task may be an easy one.
For the majority of providers out there, however, the list of requirements is overwhelming. The question is: Will the list turn them off and induce providers to reach the conclusion that the status quo is better than having to disrupt and add to their clinical and administrative workflow?
The Dept. of Health and Human Services announced on Dec. 18 the designation of $60 million to fund "breakthrough" healthcare IT research that addresses the barriers to adoption. Awards for the four-year program will be dispersed in March 2010. While a great idea, the program certainly won't help today's providers achieve meaningful use for the upcoming milestones, notably 2011.
Now that the proposed requirements are out, what happens next is critical. HHS and other health IT leaders will need to reassure providers that the requirements are not insurmountable. They also need to make resources available to help providers take that first step.
I have to admit that one of my first thoughts was: This is going to be a boon for consultants. Many providers don't have the time or expertise to go through the checklist. Those who have the financial ability will reach out to consultants. But for those who don't have the financial will, the journey may be either painful or simply not taken.
Many physicians have said that they aren't making any EHR plans until the criteria are released. Now that they're out, what is your next move? Let us know.
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Most of the funding allocated for healthcare go directly to states, territories and tribes, which will then distribute the money through grants, loans and other mechanisms. Check with your state's dept. of health and human services (or equivalent). Hope that helps.
How do we apply for the funding?
I've actually read the whole 550+ page CMS document and I was surprised by the breadth of the recommended metrics, especially as they relate to clinical quality of care.
CMS is asking for 90 ambulatory care measures (admittedly grouped into bundles by specialty) and 40 in-patient measures. They're also asking for the reporting denominator to be "all" patients, not just the ones paid for by Medicare or Medicaid.
Given what's already been said about the Stage II and Stage III measures, it's clear that CMS is trying to move the needle on the quality of medical care delivered to all Americans--and that's a very laudable goal.
Do you think it's too much too soon? Are these realistic metrics that all providers who implement EHRs/EMRs can potentially achieve? This seems to be one of the biggest issues with the proposed regulations.
I think the provider community will generally say that almost anything along these lines is "too much too soon." See the MGMA's comment for an example in that regard. However the proposed rule states that providers need only report on the quality parameters by attestation for 2011--essentially an honor system. While CMS expects that by 2012 things will have advanced to the point where automated reporting can occur directly from the EHR, they leave the door open for alternatives if the technology doesn't advance fast enough. The portion of the proposed rule that estimates the burden of compliance also suggests that CMS doesn't see this quality reporting as a particularly difficult, expensive, or time consuming process. Maybe they're wrong, but the supporting documentation seems to be pretty thorough.
The real problem may be that the quality reporting required in the proposed rule looks like a fairly substantive effect to finally "bend the cost curve" in health care. It's axiomatic in health care that "one man's waste is another man's revenue. Bending the curve, via HIT (or any other means for that matter) means less money in providers' pockets over the long term. That probably speaks to the need for fundamental changes to provider payment systems (away from fee for service and toward more outcomes-based prospective methodologies) to occur in tandem with the deployment of clinical HIT. However, that would be very big nut to crack and might be the real version of "too much too soon."