My inbox lit up last week after Andy Slavitt’s comments about the end of Meaningful Use. My clients were asking for immediate analysis of “the new rules,” but among friends, the emails were more along the lines of, “Did I miss a memo somewhere?”
I think Slavitt is overly optimistic in stating that MU will be replaced by “something better,” because ONC and CMS haven’t done such a great job of making things better in the modifications and revisions we’ve seen already. Frankly, I’m not sure they even understand the definition of “better” as it might be applied by a practicing physician.
Some of the emails had links to articles which either took the comments out of context or overly simplified the situation. That’s not surprising given the fact that we live in a society driven by sound bites, tweets, and Snapchat. Even if CMS wants to make the program go away, it may not be able to do it without a little bit of legislative assistance. MU is tied into the MACRA law, with MU being one of the elements contributing to the physician performance score that will drive payment adjustments.
I also take issue with his comments that, “We effectively have technology in virtually every place where care is provided.” That’s not really true – I know of quite a few primary care practices that still haven’t made the leap, largely because they’re in rural areas and are too busy actually caring for patients to deal with what they consider government nonsense.
One of my best friends from residency is one of those physicians, who has been in solo practice for many years and just splurged on the “luxury” of hiring a physician assistant to help support the practice since she’s been on 24×7 call for nearly a decade. We’re still lacking EHR in many care settings (home health, and nursing homes, anyone?) Not to mention that even though we may have computers in offices, that doesn’t mean that they’re used effectively or that they’re doing anything actually improve patient outcomes.
In my consulting practice, I see dozens of clients who may be meeting the letter of the law through workarounds and administrative processes, but who aren’t using their expensive EHRs to do anything truly meaningful. The ways in which vendors exploit vagaries in the requirements are often shocking. The CMS Frequently Asked Questions are sometimes confusing and occasionally contradictory, so I imagine it’s tempting to use what loopholes you can find.
I spend a lot of time counseling clients that, although they may be able to check the box for attestation, they’re cheating themselves and their patients out of the improvements that systems were intended to drive.
Some of my correspondents had conflicting thoughts on what the end of MU as we know it might do to the EHR industry. One was adamant that it would cause market consolidation since there are too many products out there that are certified but not terribly useful. Another felt that it would cause the return of diversity to the market, as vendors could focus less on certification and more on functionality and the ability to deliver improved patient care outcomes.
I tend to think that we’re headed for more consolidation due to economic and other factors. It won’t be easy to tell whether the proposed demise of MU really played a part.
It’s unclear how this will impact vendors who aren’t at risk for consolidation. Will this allow them to shift some of their development dollars back to usability and needed enhancements that were placed on the back burner due to certification requirements? Or will they still be dealing with regulations and calculations, but just in different forms? My physician friends that work in the vendor space share horror stories about the number of people vendors have dedicated just to keep up with ever-changing regulations. It’s not only federal, but state and payer regulations, too. The burden is endless, just as it is for providers in the trenches.
Personally, I’d like to see the regulators go after other parts of the health delivery system and spend some time regulating them in a way that will help all of us. Want to mandate that physicians include lab data with LOINC codes in their EHR? Then maybe you should require the lab vendors to transmit LOINC codes with their results. I spend a lot of time helping clients manually code around this issue because the lab vendors refuse to send codes.
That to me seems unconscionable — to force providers to clean up after other vendors who are in a better position to do something to make things better for patients. Want interoperability and portability? Force nationwide or multi-state lab vendors to standardize their various business units onto a single lab compendium rather than forcing EHR vendors and customers to code around it.
Let’s mandate that home health agencies, therapy providers, and other ancillaries also adopt electronic records and start communicating with us in a way that fits our new workflow. I still receive handwritten, barely legible reports from home health and PT providers, yet I’m held to the standard of doing everything in discrete and codified data.
While we’re at it, let’s also look at extended care facilities, nursing home providers, and everyone else that touches patients. Let’s back off on the providers and invite everyone else to the party, whatever ONC and CMS decide it should be.
What do you think of expanding Meaningful Use to other entities? Email me.
Email Dr. Jayne.