Providers Say EHR Criteria Are Unattainable

The opportunity to comment on the Medicare and Medicaid electronic health record (EHR) program proposed rule, which defines “meaningful use” of EHR technology and outlines provisions governing EHR incentives, ended March 15. Industry stakeholders, however, continue to voice their concerns about the criteria providers must meet to receive incentive payments, saying they are unrealistic and impossible for even the most sophisticated facilities to obtain.

No one is arguing that widespread EHR adoption would not be advantageous.

“Effective use of electronic health records will greatly improve patient safety, quality and efficiency,” Dr. Thomas H. Lee, president of the physician network at Partners HealthCare, tells The New York Times. The question is: Can providers realistically adopt meaningful use as outlined in the proposed rule in the given five-year timeframe? In Dr. Lee’s opinion, the approach taken by the Obama administration is based on “unrealistic expectations” and “unachievable timelines.”

The American Recovery and Reinvestment Act of 2009 (Recovery Act) authorizes the Centers for Medicare & Medicaid Services (CMS) to provide reimbursement incentives for eligible professionals (EPs) and hospitals who are successful in becoming “meaningful users” of certified EHR technology within a given timeframe.

On Dec. 30, 2009, CMS announced a notice of proposed rulemaking (NPRM) to implement these provisions of the Recovery Act. The proposed rule would phase in more robust criteria for demonstrating meaningful use in three stages.

Stage 1

The proposed Stage 1 criteria for meaningful use focus on electronically capturing health information in a coded format, using that information to track key clinical conditions, communicating that information for care coordination purposes, and initiating the reporting of clinical quality measures and public health information.

The proposed criteria for meaningful use are based on a series of specific objectives, each of which is tied to a proposed measure that all EPs and hospitals must meet to demonstrate that they are meaningful users of certified EHR technology.

For Stage 1, which begins in 2011, CMS proposes 25 objectives/measures for EPs and 23 objectives/measures for eligible hospitals that must be met to be deemed a meaningful EHR user.

In 2011, all of the results for all objectives/measures, including clinical quality measures, would be reported by EPs and hospitals to CMS, or for Medicaid EPs and hospitals to the states, through attestation.

In 2012, CMS proposes requiring the direct submission of clinical quality measures to CMS (or to the states for Medicaid EPs and hospitals) through certified EHR technology.

CMS says it will propose through future rulemaking two additional stages of the criteria for meaningful use.

Stage 2

Stage 2 would expand upon the Stage 1 criteria in the areas of disease management, clinical decision support, medication management, support for patient access to their health information, transitions in care, quality measurement and research, and bi-directional communication with public health agencies.

Stage 3

Consistent with other provisions of Medicare and Medicaid, Stage 3 would focus on achieving improvements in quality, safety and efficiency, focusing on decision support for national high-priority conditions, patient access to self-management tools, access to comprehensive patient data, and improving population health outcomes.

Earned Income

For EPs, the incentive payment is equal to 75 percent of Medicare allowable charges for covered services furnished by the EP in a year, subject to a maximum payment in the first, second, third, fourth, and fifth years of $15,000; $12,000; $8,000; $4000; and $2,000, respectively. For early adopters whose first payment year is 2011 or 2012, the maximum payment is $18,000 in the first year. The Medicare incentive payment formula for hospitals is a bit more complicated.

According to the Times, even leaders in health information technology (HIT) like Kaiser, Intermountain, the Mayo Clinic and Partners HealthCare System have their doubts that these goals are obtainable.

“The criteria for achieving meaningful use of electronic health records are too aggressive,” Dr. John R. Maese, a leader of the New York chapter of the American College of Physicians, tells the Times. “The time frame to adopt the technology is unrealistic.”

Congress also has been pressing the Obama administration to ease off on the all-or-nothing approach to offering incentives for meaningful use of an EHR system, according to the Times, but no assurances have been given.

“We want to strike a balance,” said Jonathan D. Blum, CMS deputy administrator. “We will provide flexibility for doctors and hospitals, but push them to elevate their performance. Final rules will be out in early summer.”

The New York Times has more on this story.

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8 Responses to “Providers Say EHR Criteria Are Unattainable”

  1. Jean Bayer says:

    I think the medical professionals in this country should fight to reverse obamacare. We have one of the greatest healthcare systems in the world. A few revisions could be made but not a complete overhaul. Socialistic medicine which is the final goal of this administration is not benficial to America or any other country for that matter. I think the push on the electronic medical records and the time frames required is an excuse for the obama administration to claim it is not working and go with a one payer system.(Socialized Medicine)

  2. CS says:

    The way I see it, EMR will be a great thing for the healthcare industry. BUT the timeline truly is unrealistic. One aspect of this that I don’t see being talked about is the fact that this plan pushes alot of money into the pockets of one set of companies in a very short amount of time. The companies providing this EMR/EHR technology are going to make money hand over fist from physicians and facilities scrambling to meet the 5 year deadline. You can’t tell me there isn’t a lobbyist behind this somewhere. (Conspiracy theorist in me. haha!)

  3. L G says:

    Jean do you really have any idea what you are talking about? Can you give me even one example where any part of the healthcare reform bill has anything to do with socialized medicine? The best thing that could have happened in healthcare reform would have been a public option. This was taken off the table because most people don’t know how our healthcare system works. A public option would have made the insurance companys compete to be less costly and more efficient. I work in healthcare, the most efficient least costly insurance company out there is Medicare. If people would do there research on how insurance companys and the health care system work maybe we could actually solve some of our problems. Quit listening to “Buzz” words and “catch phrases” and spouting the same rhetoric. WAKE UP! Start doing your research and truly understand what it is you stand against or stand for! Don’t be a sheep or a lemming.

  4. Chill says:

    LG, by nature of the beast, a government controlled health care program is socialized medicine. So, is Medicare a form of socialized medicine? Yes. However, it was meant to benefit a specific demographic, not the whole population of the country, and with limitations. Federal Government control of healthcare leads to a level of centralized control over the population not provided for in the Constitution. Federal mandates do not provide for individual state values and sensibilities. When providers start opting out of Medicare or being a “Public Option” participant — do you not think that would impact access to healthcare? Would then the Federal Government then state that for “national interest” physician would be required to participate. Of course that’s speculation on my part, but how else would the Government be able to guarantee access healthcare? Oh that’s right — it’s not the Federal Government’s job to provide healthcare. Check the Constitution. The Federal Government should focus on something it’s supposed to manage — like upholding the Constitution and National Defense, protecting us from all enemies foreign and domestic. The Commerce Clause does not give the Federal Government the right to control healthcare — check it out. And before you tell someone not to be a sheep or a lemming, make sure you’re not drinking the proverbial kool-aid of a Progressive’s ideology! Or at least be honest about it. Jean’s opinion is just as valid as your own.

  5. CONCERNED BOOMER says:

    Jean and Chill are dead on!

  6. Brock says:

    A couple of quick comments:
    1. We’ve had a government (state or federal) insurance option since the Johnson Administration. So even IF there was a “public option” in the Reform Bill, how is this any different that what we’ve had for the last 45 years.
    2. With no public option, all the Reform Bill is doing is increasing the availability of PRIVATE insurance.
    3. If the government can pass regulations so large companies cannot contaminate the air and water…and if the government can pass regulations so Wall Street cannot (easily) steal money from the pockets of small investors…they the government can pass regulations so middle class can have decent affordable health care.
    Still waiting for someone besides the Obama Administration to come up with a way to help out the now 43 million without health insurance.

    4. As a billing manager, I help bankrupt about 30 patients a year due to pre-existing conditions, incredible high deductibles, retro-active terminations, etc.

    5. People complain about government involvement when things are good, but once disaster happens everyone looks to the government for help. You can’t have it both ways.

    6. Ironically, I find the people who are most vehemently opposed to Healthcare Reform have insurance.

  7. Ruchir Bhatt says:

    Government is forcing me to buy insurance, when I do not want any because I have the radical/fringe idea of saving and staying healthy and getting my checkups done in India (at 3rd the cost counting airfare’s and just an amazing time).
    “Insurance” = A hedge against an unlikely event/A measure of risk. But, when people are seriously obese and choose to enjoy Dollar meals, donuts, pizza’s, steak, KFC, etc. on a regular basis are prone to spend a sometime in the hospital, hence the RISK of INSURING such screw ups is quite high. If you are fat(that includes me and my family), if you smoke, drink like there is no tomorrow then you have to either pay a risk premium or save or borrow, but no one has the right to STEAL another person’s money. I do not want to fund anyone’s healthcare apart from me and my family, nor do I want anyone to do that for me.
    The only way I support government run healthcare of any kind or degree is when all the senators + congressmen/women + The president fund that from their own salary and assets for 1 year. OK, I know I am being harsh, I will knock it down to 6 months! And I forgot – I should be allowed to take pictures of their faces, when their money is taken away from them.

  8. Burgster says:

    Right on, I so agree with you Ruchair!! Americans need to stop thinking that everything is free and that everyone should be equal. Whatever happened to the American Dream? We have lost all focus of that in believing that everything should be split with your neighbor regardless who works harder. What happened to awarding those who work harder in life and who seek to do better?? I work in the medical field and each day we see families that are on welfare continuing to have more children than they can afford, not to mention giving welfare to all the unwed, underage moms who could have prevented the pregnancy! A high percentage of these people abuse the system by using up scholarships, work training and free education that they NEVER intend to use. One of the comments I have heard several times in the 18 years that I have worked in the medical field is “why work hard when I can stay home and get better benefits”. This is where change needs to be done! Lets start with our thinking first!

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