The Centers for Medicare & Medicaid Services may have given physicians and hospitals a more flexible time frame to participate in the next phase of the EHR incentive program, but the backlash against the federal program and EHRs in general continues.
Just as the health IT meaningful use program was scheduled to take a greater step towards requiring the exchange of patient records, among other goals, a number of health IT companies were having trouble upgrading software to the 2014 certification standards in time and providers felt they were about to face too much complexity.
So CMS and the Office of the National Coordinator for Health IT have tentatively decided to let eligible providers use the previous 2011 certified technologies, the new 2014 ones or a combination to meet the program’s rules.
The change would bring some relief to doctors, hospital staff and health system CIOs, although it’s not clear how it bodes for the rest of the federal government’s health reform agenda.
Preliminary data for 2013 suggests that as many as 20 percent of physicians have dropped out of the EHR incentive program and many more likely will continue to stop participating unless “significant changes are made,” the American Medical Association maintains. Dissatisfaction with the current generation of EHRs is now a genre of its own on the likes of the popular physician blog KevinMD.com, where Kevin Pho, MD, himself recently weighed in with a piece titled “Electronic medical records obstruct patient interaction.”
Part of the EHR incentive program’s problem may be its timing — with American healthcare going through some of the biggest changes in half a century, as primary care practices take on millions of new patients getting insurance and as Medicare moves away from what federal regulators see as the “untenable” fee-for-service reimbursement system. Part of the problem with a number of current EHRs may be that they’ve been designed for that untenable fee-for-service system; thus Dr. Pho’s lamentable 50 clicks to document treatment for a common sinus infection.
With CMS leaders seeing the meaningful use program as a foundation for implementing new payment policies and a way to consolidate clinical quality reporting mandates, the question does arise: where does the program go from here?
Onward through the second phase — extensions, hardship exceptions, last-minute regulatory tweaks and all — and then onto the third phase in the latter years of this decade? Or, with the remaining EHR incentive funds and mighty regulatory power, might CMS chart a new course entirely in helping physicians adapt to the digital age and post-FFS era?
So wondered Sherry Reynolds, a patient-centered design advocate and former ONC staffer. Since a good deal of docs and hospitals “don’t like MU,” she suggested recently on Twitter, “lets redirect the rest of $38 billion to patients and fix their pain points.”
With anywhere from $5 billion to $15 billion left, CMS would have some discretion to redesign the program and its spending, Reynolds wrote.
That could mean any number of possibilities — eliminating the payment decrease while increasing incentives for those meeting certain goals, seeding new clinician-centered technology through design competitions, or saving the funds to help providers procure new technology to comply with new payment systems.
To build on what meaningful use has succeeded on, the adoption of initial digital documentation, others see an opportunity for CMS to transition toward more market-based policies for incentivizing population health and health information interoperability.
It’s “now at a point where federal policy needs to take a back seat to market forces,” argued John Moore, the founder and managing partner of the consultancy Chilmark Research.
“The move to value-based reimbursement will force healthcare organizations of all sizes to adopt some aspect of population health management,” Moore wrote. “Interoperability, the big sore point today is not so much a technology issue as it is a market issue — and population health management is impossible without interoperability.”
