Stage 3 of the electronic health records Meaningful Use program will impede rather than aid physicians in moving toward value-based accountable care, the American Academy of Family Physicians recently told federal policymakers.
In a comment letter to the Centers for Medicare and Medicaid Services on Stage 3, which was finalized in October but with a comment period that could result in modifications, AAFP noted it agreed with moving toward a three-part goal of improving health and improving medical treatment while at the same time lowering costs. “However, we still have significant concern that this final rule does not allow for continued successful transformation toward the three-part aim, but rather places further obstacles in the path to this goal,” according to the letter.
Citing dismal provider participation in Stage 2, AAFP expects Stage 3 in its current form will only exacerbate meaningful use defections because current EHRs are built to comply with MU provisions, not to support population health management and value-based reimbursement.
“The functionalities that are critical for value-based payment have been put on the back burner,” the association tells CMS. “Additionally, while we have seen progress on interoperability regarding continuity of care (i.e., transport of data), the healthcare system has not seen enough progress in care coordination (i.e., semantic exchange) interoperability, which is an essential capability of health IT for value-based payment and was part of Meaningful Use.”
What that means is that interoperability to physicians remains viewing documents on their computer screens and rekeying information into the patient record. In short, AAFP calls for a pause in Stage 3 as sufficient progress in interoperability is unlikely to be made by 2018 when value-based payments begin. Vendors and providers need time to design and implement functionality and workflows covering population health management, analytics, care coordination, shared care planning, and management of cost and quality, to support value-based payment.
When Stage 3 is resumed following the recommended pause, Meaningful Use should focus on interoperability and support capabilities necessary for value-based payment and have complete alignment with the multitude of federal reporting programs, according to AAFP.
Robert Wergin, M.D., chair of the AAFP board of directors and with a small family practice in Milford, Neb., worries that if vendors aren’t ready for value-based payments and Stage 3, he and other providers—many of whom want to move to value-based care—will be the ones facing financial penalties because they won’t be able to report quality indicators under MU and value-based care.
Wergin worries that policymakers do not understand just how ill-prepared Meaningful Use is to support value-based accountable care. MU is all about filling in boxes, not functionality, and not about collecting and using payment data. “I see potential for the EHR, but it hasn’t been an asset to me, it’s been a barrier.”
According to Wergin, he cannot electronically exchange data with other providers using his Stage 2-certified EHR and has to call a provider and get information faxed over, which then is scanned into the EHR but is not searchable. In addition, he is unable to analyze which diabetic patients need more oversight and which female patients need a mammogram.
And when Wergin attested for Stage 2—before the measure for patients communicating with physicians was substantially eased—it was a struggle. Among other issues, his region has a high population of Mennonites who don’t have computers.
Faced with getting 5 percent of patients to communicate with him via a patient portal, Wergin thought he had reached that final goal and was ready to attest until an information technology professional at the local hospital giving assistance informed him that he was three patients short of hitting the 5 percent mark. He had to call patients and ask them to send him a question over the portal, and got the last one at 4:30 p.m. on the last day to attest.
AAFP advocates a 75 percent passing grade on Meaningful Use rather than the 100 percent all-or- nothing approach of CMS, and Wergin says the poor level of Stage 2 compliance demonstrates that physicians are frustrated and see taking the financial penalty of not being a meaningful user as a more attractive option. “We see the potential of EHRs, but we also want true meaningful use.”
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