Friday May 18, 2012

A Meaningful Discussion About Meaningful Use

More than 43,000 health care professionals have collected more than $3 billion in meaningful use incentive payments, according to CMS. And I was pleased to learn this week during a May 15 meeting at the Office of the National Coordinator for Health Information Technology (ONC) that family physicians are leading efforts to upgrade medical record technology and are by far the largest recipients of meaningful use funds.

That's not surprising, considering that we are involved with -- and often coordinate -- complex care that requires communication with subspecialists, hospitals and health plans.

Given a few improvements in the regulations -- such as holding electronic health record (EHR) vendors to a standard to ensure interoperability -- even more of us could qualify for meaningful use payments. And that is what we told Farzad Mostashari, M.D., M.S., the national coordinator for health IT (who is pictured with me below) and other ONC staffers during our meeting.

The timing of the meeting could not have been better. ONC and CMS are in the process of reviewing submissions from an open comment period, which ended May 7, regarding proposed stage two meaningful use requirements. The fact that the federal agencies are in the midst of the rule-making process precluded them from talking specifically about meaningful use requirements, meaning it was a listening session for them.

We were happy to do most of the talking.

On May 7, the AAFP sent a letter to CMS asking the agency to show restraint in making changes from stage one to avoid discouraging physicians who are now entering the program. I reinforced the points of that letter during the meeting, including our objections to the following:

  • rules that penalize physicians for the inaction of others -- including patients -- outside the practice;
  • CMS' proposal to allow EHR vendors to opt out of complying with a standard that deals with simplification, interoperability and universality of EHRs; and
  • penalties against physicians who do not demonstrate meaningful use of EHRs.

The meeting with ONC also coincided with the Family Medicine Congressional Conference, so 17 family physicians were able to attend and provide their own perspectives. Those physicians represented a wide range on the meaningful use spectrum. Some had received meaningful use funds, some were close to qualifying and others were not.

Some physicians spoke about the challenges they faced on the way to achieving meaningful use, while others vented their frustrations about obstacles that have prevented them from doing so. For example, Robert Reneker, M.D., of Wyoming, Mich., talked about competing hospitals in his area that don't share patient information. That factor, which is totally beyond a physician's control, hinders his ability to qualify for meaningful use.

Kevin Wong, M.D., of Jeannette, Pa., also spoke of warring hospitals hampering his ability to qualify and the need for interoperability standards and requirements. And John Bender, M.D., of Fort Collins, Colo., told the ONC staff about his partner, who should have qualified for a full year of meaningful use funds but only received partial credit because of a paperwork processing delay by a Medicare contractor.

We also talked about the burden meaningful use regulations put on small and solo family physician practices, which often lack the resources of larger group practices.

And we talked about the fact that meaningful use requirements shouldn't be just a box waiting for a check mark. They should be factors that actually play a meaningful role in the delivery of care.

Family physicians are leaders in the adoption of EHRs and meaningful use of that technology, according to ONC. If CMS and the ONC truly appreciate family physicians and the importance of primary care, they should ensure that their regulations are fair and reasonable so more of us are able to achieve meaningful use.

Glen Stream, M.D., M.B.I., is president of the AAFP.

Comments:

Glenn, thanks to you,Roland, and AAFP BOD for strong activity on this topic. Your comments on Stage 2 are right on target, regarding CMS not penalizing physicians for inactivity of those, including patients, outside of their practice, and also, avoiding limitation of order entry to licensed professionals, as detracting from team-based care. These areas have caused our group's physicians to do more tasks in electronic records, which were previously delegated to medical assistants, office assistants and pharmacists.

Posted by Mary Campagnolo,MD on May 20, 2012 at 08:17 AM CDT #

It was an exciting meeting! Was a good representative of Family Docs from all types of practice profiles expressing our concerns. We felt they were really listening to our issues and willing to help us resolve them. I hope it is the beginning of Family Docs being respected and reimbursed for the hard work we have been doing with EHRs. They all agreed Meaningful use SHOULD be meaningful-- clinically !

Posted by Kevin M Wong,MD on May 24, 2012 at 01:16 AM CDT #

As family physicians we should be at the center of meaningful use. While I agree we should allow our CMA's to enter data for us to co-sign I am not in complete agreement with the rest of the article. We have to be the advocte for our patients. Engaging them is a good thing! We are held responsible for tobacco use in our DM and IVD quality measures. Patient engagement is no different. We can do more than we are to engage patients to manage their care together. 5 or 10% is a low bar to cross if we really believe it will improve care. In my opinion the meaningful use criteria are alligned with better patient care. They do incent us to do the right thing.

Posted by Christopher Tashjian, MD, FAAFP on May 24, 2012 at 12:29 PM CDT #

I'm curious. Now that my organization is trying for meaningful use cash, and I am stretching my office visits from 10 minute slots to 20, is there any data that qualifies (poem level) that this does any good?

Posted by Doug Byers M.D. on June 17, 2012 at 10:16 AM CDT #

You must be logged in to post a comment. Login

Want to use this article elsewhere? Get Permissions