Six Republican members of the U.S. Senate have published a report critical of the progress of the electronic health records meaningful use program and calling for a pause to the program and re-examination of its strategies.
“We seek comments on whether it would be in the best interest of CMS, the Office of the National Coordinator for Health I.T., vendors, providers, taxpayers and other stakeholders to hit ‘pause’ while re-examining the current procedures put in place to safeguard and ensure meaningful use of EHRs prior to forging ahead with Stage 2 and 3,” the senators note in the report. “We are not alone in our concern on this issue. For example, the American Medical Association and other health care stakeholders have asked CMS and the Office of the National Coordinator for Health I.T. to hire an outside entity to evaluate the incentive program’s performance before quickly rushing into future stages. We are pleased CMS has effectively announced such a pause by delaying promulgating Stage 3 regulations and seeking to work with stakeholders. We seek comments on what steps CMS needs to take before implementing Stage 3.”
Signers of the report include Sens. Alexander Lamar (TN), John Thune (SD), Pat Roberts (KS), Richard Burr (NC), Tom Coburn (OK) and Michael Enzi (WY). They contend that “while promoting the use of health I.T. is a laudable goal, a growing body of objective analysis and empirical data suggests the program needs to be recalibrated to be effective.” Particular concerns of the senators include:
* Lack of a clear plan toward interoperability and concerns that incentive payments are being made without an adequate plan that ensures the sharing of information;
* Concerns that rather than saving money, use of EHRs is accelerating the ordering of unnecessary care and increased billings for the same procedures;
* Lack of adequate mechanisms to prevent waste and fraud in the EHR incentive program as “money spent” is a metric of success rather than specific program goals and deliverables;
* Lax security policies and procedures within CMS and ONC that may jeopardize patient data; and
* Worries of program sustainability if I.T. compliance and maintenance costs for providers are too burdensome after grant money and incentive payments run out during a time when Medicare reimbursements will continue to fall.
However, the senators may be cherry-picking in some of their own fact-finding. For instance, they cite a Government Accountability Office report of low hospital meaningful use participation levels during 2011, which was the first year of the program.
The GAO report was selected because it was the most recent year data is available from outside the U.S. Department of Health and Human Services. Even with an increase in participation before 2015 when Medicare reimbursement penalties start for non-meaningful users, “one could project a scenario where more than a third of all hospitals are penalized,” according to the Senate report.
HHS data through 2012, after two years of meaningful use, show that 75 percent of hospitals have been paid for meaningful use (Medicare and/or Medicaid), with 55 percent having attested under the more rigorous Medicare criteria.
The 28-page report is available here.
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