During a presentation at the MGMA Conference, Travis Broome, a health insurance specialist at the Centers for Medicare and Medicaid Services, responded to the worries of practice administrators who insisted their patients are not interested in using patient portals necessary to meet Stage 2 meaningful use patient access measures. Broome said practices would have to push the use of portals.

I ask Mr. Broome, is this meaningful use or meaningful coercion?

Secretary Sebelius' insistence on physicians' provision of portals, whose ostensible purpose would be to enable patients to have freer access to health information, clearly reflected the desire to serve patients better.

The underlying assumption behind imposing such a litmus test based on the percentage of all patients who use portals must have been that if the service were offered, a certain number would flock to it. Apparently, however, no one bothered to determine the normative number before establishing the requirement, and the 5 percent threshold has a distinct shoot-from-the-hip flavor to it.

Now, Mr. Broome's advice to physicians is likely to REDUCE patient services by encouraging physicians to make certain services, which are customarily delivered interactively via telephone or an office consultation, available only online for the sole purpose of bumping up portal usage numbers, thereby favorably influencing the calculus of meaningful use.

This is medical policy gone terribly awry. The HHS Secretary and her policy advisors should change the requirement such that it lays out what should constitute the minimum expected functionality of a patient portal without at the same time prescribing any specific percentage of users.

Demanding patients, whom neither HHS regulates nor physicians control, to use portals and simultaneously holding the threat of failing meaningful use tests over the heads of physicians for not succeeding as social networkers is not only bad policy; it is also amazingly unintelligent and high-handed.

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