In health I.T. circles, David Blumenthal, M.D., is surely by now the most well-known physician in the United States, surpassing in name recognition even the celebrated John Halamka, M.D., the CIO of Boston’s CareGroup. Blumenthal’s very job title, “national coordinator for health IT,” suggests responsibilities of mammoth proportions. And by shouldering the job of administering the federal government’s unprecedented EHR incentive program, AKA “meaningful use,” Blumenthal has taken on a task which makes running a hospital I.T. department seem like mere child’s play (or as some physicians might say, something to hand off to a nurse).
Blumenthal’s peers came out in droves to hear him speak at last week’s Medical Group Management Association annual conference in New Orleans. Hundreds and hundreds of physicians and group practice managers crowded into Blumenthal’s two-hour presentation on meaningful use. It turned into a primer on the government’s incentive program, one of the most intensely analyzed—if not hyped—health care policy decisions in history. The lure of hearing the government’s point man on EHR adoption was so strong the MGMA exhibit hall all but emptied out during Blumenthal’s presentation (much to the dismay of the EHR vendors attending MGMA in hopes of lassoing a ton of new business).
The MGMA group proved to be a tough crowd, way tougher than say academic researchers and policy wonks whose IT devotion rests primarily on theoretical models. MGMA represents, after all, physicians in the trenches, the small to mid-sized group practices that comprise the majority of the industry. These are the same physicians the EHR incentive program is intended to help. It is also a group which has not warmly embraced other federal incentive programs, such as PQRI, which, according to MGMA member surveys, takes too much time and resources to justify a relatively small return. Physicians almost have an innate skepticism when it comes to anything regulatory (during his keynote, retiring MGMA president William Jessee, M.D., quipped that ACO, as in “accountable care organization,” actually stands for “any consultant’s opportunity”).
So this was a critical opportunity for Blumenthal. One of his most difficult challenges is to disassociate the meaningful use program from other cumbersome federal programs whose reputation precedes him. The MGMA rank and file listened politely to him, but at the end of the talk, which traced Blumenthal’s personal journey from EHR skeptic to proponent, members peppered him with questions about practical issues. My EHR is difficult to use, what can I do? How does my participation in Medicare Advantage affect my incentives? Can you give guidance on the kinds of audits that will take place after I file for incentives? How can we attain interoperability between vendors? Can my PA qualify? And, as if to test the left-hand, right-hand scenario of big government, one physician wanted clarity on an obscure Office of the Inspector General white paper pertaining to clinical documentation that he was certain would somehow upend any meaningful use payment.
Blumenthal, who was joined on the podium by his CMS colleague Tony Trenkle, gamely fielded the questions. Many of his answers were direct--he was unfamiliar with the white paper in question, but would look into it. Other answers were less so--the government is “toying with approaches to improve usability” but the vendors will undoubtedly catch up with market demand. Interoperability is technically possible, but standards do need to be tightened.
In fairness to Blumenthal, some of these questions were all but impossible to answer. Railing at Blumenthal about the poor user interface of an EHR program is like assailing the car dealer for crowded highways. He did not invent this program nor create its timelines, which were laid down by Congress on a light-speed calendar for a snail’s pace industry. But when you are the national coordinator for health IT, and you are dealing with physicians, questions like this are inevitable. After all, the beneficiaries of federal funds often have a love-hate relationship with D.C. officials in charge of funds. And, rightly or wrongly, they assign all kinds of mythical powers to the heads of government departments.
After that presentation, Blumenthal invited the MGMA members to join a town hall listening session and offer their input into the incentive program. Only a handful stuck around, however, joining Blumenthal at a table. Within a matter of minutes, the massive room once filled to the gills had all but emptied out.
For now, Blumenthal appears to be in transition: he’s part medicine and part government. I got a good dose of that during my unfortunately brief one-on-one time with him prior to the presentation. The announcement went out that Blumenthal was conducting a press conference prior to the event that would go for 30 minutes. I showed up early with great expectations, only to learn there would be no joint conference, but that we could put our names on a list, and talk to him when our turn came up (several magazines got no time at all). A television crew somehow got first dibs. And the “journalist” up next seemed oblivious to the fact others were waiting. MGMA staffers told me he was asking questions about Blumenthal’s childhood. By the time my turn came, less than five minutes remained, hardly a “meaningful use” of time for either of us.
Blumenthal promptly steered me to Trenkle to answer my first question about the type of audits CMS will conduct on those receiving funds. He then confirmed that recipients of meaningful use dollars would be publicized on the CMS Web site. Short questions, direct answers! But when I asked Blumenthal what keeps him up at night about this meaningful use program, what misgivings might he have, he promptly turned into something other than a straight-shooting diagnostician. “I can tell you what doesn’t keep me awake,” he said, and then launched into a speech about the inevitability of EHR adoption, points he would repeat just minutes later during his presentation before his peers.
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