Oh, we long-suffering Chicago Bears fans; we grasp at any fleeting ray of hope.
Last year, the team’s coaches seemed incapable of making halftime adjustments. If a strategy didn’t work in the first half of a game, very little seemed to change in the second half. This year, new coaches seem better at adjusting strategy on the fly, and while the team’s record isn’t much improved, the Bears now are noticeably better at reacting to in-game situations.
Life requires that, and so, too, does the Meaningful Use program. Despite the recent flexibility given to providers with Stage 2 requirements, there is growing concern that it is not reacting to current realities and struggles that providers face, and that it doesn’t anticipate changes in reimbursement approaches and quality measures.
Providers got a stop-gap halftime breather with the passage of the Patient Access and Medicare Protection Act, which brings immediate relief for eligible professionals and hospitals that were rushing to try and attest to Stage 2 of the Meaningful Use program. The legislation reduces the risk that providers will be hit with financial penalties for failing to achieve Stage 2 in 2015.
But the angst regarding the program remains high. Despite all the good it’s achieved in accelerating adoption of EHRs, it’s clear that provider perception of the program has degraded. That indicates a need to tinker with the strategy. The enemy is not the technology, the government, the program’s vision, the vendors or the providers who are resisting. It’s the mix, the need for strategy to be reassessed at this point, with the new game that’s in front of everyone.
Stage 1 of the program was challenging, but achievable – get EHR technology in place, and start using it. Attesting to achieving a set of objectives was time-consuming, but possible. Stage 2 has proven much more difficult, as objectives have become more challenging and have sought to show that providers are beginning to use the technology to integrate care and information, while engaging patients with technology as well. Fewer providers are able to attest, even under relaxed objectives and time periods.
Stage 3 looms, and providers worry even now, because many are still in the throes of making the leap from Stage 1 to Stage 2. This is hard, and the next leap will be higher, harder—and perhaps pointless. Even as the program pursues a similar matrix to what was developed six years ago, the game in front of the healthcare industry in the U.S. is changed dramatically.
Providers universally are calling for a time out to assess where the program is going, and the pieces that are being proposed as representing measures of progress.
“No further Stages (like Stage 3) should be contemplated or set in stone before we have large-scale adoption of Stage 2,” says Pamela McNutt, senior vice president and CIO for Dallas-based Methodist Health System. “Stage 3 needs to be significantly watered down to be successful and must have a 90-day reporting period, no matter when you start. All requirements that are based on actions of others need to be removed.”
McNutt is a veteran at analyzing federal policy involving health IT and has been deeply involved in policy position formulation for the College of Healthcare Information Management Executives. She’s not alone in her beliefs; Chuck Christian, outgoing board chair of CHIME, is quick to echo her thoughts.
“We really need to get an idea of the impact that the first two stages has had on quality and safety before we jump into another,” says Christian, vice president of technology and engagement at the Indiana Health Information Exchange. “Stage 2 had to be modified to ease some of the pressure points in order for many providers to continue in the program.”
Christian also mentioned other hot buttons that other providers have raised – holding providers accountable for whether patients access records electronically, the use of APIs without valid standards and experience using them, the lack of a lock-down way of matching patients with their records, among others. He also offered the following observation, which is telling:
“I'm not hearing or reading a lot about the topic of the content and many formats of the CCDAs and the lack of interest that physicians have in receiving them or the difficulty they have had incorporating them into their clinical workflow,” he says. It’s sad, because the ultimate vision for the program should not be to build technology, systems and approaches that are resisted and resented.
The disconnect is also evident in the comments that the Massachusetts Medical Society offered to the Centers for Medicare and Medicaid Services earlier this month, commenting on final regulations for Stage 3 of the program.
“Over 80 percent of [state] physicians currently use EHRs, with a significant percentage having used them for nearly 10 years. Despite this fact, only 20 percent of these same physicians have been able to meet Meaningful Use Stage 2, including some of our most tech-savvy and enthusiastic providers,” the comment letter by MMS stated.
“We believe the inherent problems with the design of the Meaningful Use program must be acknowledged and corrected before going forward. The problems and frustration with the MU program are so great, that many physicians in our membership would strongly urge the Department to completely abandon the current approach, which focuses on the number of tests completed as opposed to clinical relevance or usefulness. It is also difficult to conceive how final Meaningful Use regulations could be issued at this time without having the overall framework of the MIPS program in place.”
It’s time to acknowledge that the game in front of the industry is changing, and rapidly. Value-based care, population health and quality measures will consume the industry, and IT systems must support this radical shift, not seem to be out of touch with the new game that’s appeared on the field.
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