AMA Wants Major Overhaul of Meaningful Use

Warning that many physicians will not be able to advance to Stage 3 of the electronic health records meaningful use program, the American Medical Association is suggesting radical changes to all three stages.

Absent significant changes, more physicians--already struggling with the first two stages--will drop out of the program or be unable to move to Stage 3, the association contends in a letter to Centers for Medicare and Medicaid Services Administrator Marilyn Tavenner and National Coordinator for Health IT Karen DeSalvo, M.D.

The AMA advises:

* Replace the all-or-nothing approach to achieving meaningful use with a 75 percent pass rate to receive an incentive payment. “At a very minimum, this threshold should be used for at least the first year of each new stage.”

* Enable providers who meet at least 50 percent of a stage’s requirements to avoid a financial penalty. This encourages participation and demonstrates good faith efforts towards making strides to adopt and use certified EHRs.

* Remove the concept of “Menu” vs. “Core” meaningful use requirements and let providers implement the measures they believe are relevant to their practice and patient needs.

* Substantially streamline requirements for achieving meaningful use. The HITECH Act gives only three key requirements: Using certified EHR technology, including electronic prescribing in a meaningful manner; electronically exchanging health information; and submitting information on clinical quality measures and other measures selected by the Department of Health and Human Services. “The AMA strongly urges CMS to revisit the law and focus on requirements that adhere to the statute’s original intent.”

* Remove mandates outside of the control of physicians. Some technologies, such as patient portals and patient engagement tools, are not mature and the tools may pose a threat to the security of a practice’s EHR. Furthermore, successfully meeting requirements for patient use of the tools “lies squarely with the patient, not the physician.” Many patients prefer to speak directly with their physician rather than communicate electronically.

* Better align quality reporting for the meaningful use and Physician Quality Reporting System programs to avoid conflicting deadlines and reporting requirements. “To streamline reporting, physicians who successfully participate in PQRS, regardless of the reporting mechanism, should be deemed as successfully meeting the MU quality measure requirements.”

* Meaningful use mandates should be evidence-based before being put in the program. Requiring the meeting of criteria with little or no documentation and well-established evidence is wasteful and detracts from other well-documented methods of treating patients.

* Tie mandates to high-performing standards and implementation guides. Some requirements are not supported by tested or agree-upon standards, or have no implementation guides.

* Consider cost among the factors when requiring physicians to meet a particular meaningful use mandate.

The AMA letter to federal officials also details numerous problems with the EHR certification program in the areas of interoperability, data synthesis, emerging technologies and testing. The association in its letter concludes: “The course that is charted now for EHRs will have a significant impact on the future state of technology and the adoption of new care delivery and payment models.”

AMA sharply criticized a HIT Policy Committee certification workgroup last week for being "unwilling to make a recommendation on making the overall program more manageable for physicians." Mari Savickis, AMA's assistant director for federal affairs, told the workgroup about 40 percent of eligible professionals have never participated in the meaningful use program and, of the 60 percent that have, 20 percent have dropped out. "The way to keep physicians from dropping out today or keeping them from making a decision to not participate is to make the program criteria more flexible," said Savickis.

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