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Curbside Consult with Dr. Jayne 1/18/16

January 18, 2016 Dr. Jayne 3 Comments

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.

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Currently there are "3 comments" on this Article:

  1. Thanks Dr. Jayne for this perspective, I especially appreciate your recommendation for post-acute settings, which were never eligible for receiving MU incentives. Post acute healthcare organizations are very committed to the triple aim that MU was intended for. Your suggestions are pragmatic approach to the glass that is still half empty. I am a CIO for post acute services organization that has IRF, SNF, Home Health, and Outpatient rehab settings, and we have put some level of EHR into all of our care settings, Timely information is now a cornerstone of our IT strategy and key to helping our clinicians provide excellent outcomes at a lower cost. Quality of transitions, analytics, quality metrics, avoiding readmissions, and the overall triple aim has become a data driven exercise of capturing and analyzing data that only EHRs can support.. Unfortunately, we have also experienced the meaningless use of information as a result of our acute care partners wanting to check off their MU box. HIE, DSM, and conventional faxing continue to fail us as a “sharing” & referral process that is not supporting what transitions in care really need. DSM gets us some nicely secure clinically pertinent info, only it comes 2-3 days after we have started caring for the patient.

    I can hope that MACRA is gets us all in a risk management mode to assess our patients quickly and monitor those areas that need attention in order to deliver the quality patients expect. Post acute has small margins, but big aspirations in getting the patient to the highest level of recovery we can. We are willing to partner on MIPS & APMS, but we need acute care to inform us better in order to transition the patient safely, and avoid readmissions. Informed transitions in care is a good start. Tell us if a patient has had a MDRO anytime before in their history, are they going for surgery for that second knee any time soon? What medications are they on? Are they a risk for a fall, UTI? Timely & accurate information will lead to agility in transitioning the patient. Longitudinal care planning, which engages the patients & clinicians sooner in their recovery, can lead to a more enhanced experience. All PAC software vendors with HIS solutions should be mandated to adopt interoperability and nomenclature standards. If we can get our IT vendors to focus on interoperability for timely patient access, data accuracy, along with process agility then maybe we can win, win, win the triple aim.

    Post acute care has been an last minute invite to the continuum “party”, but we have been at the party all along, just waiting to be asked to dance. We are experts at coordinating care for the chronically ill and injured, making sure the patient is working towards their goals and highest level of recovery. We may not have the best dressed EHRs, but we have actionable insight that allows us to dance quite well with our acute care partners. I am excited for any opportunity that MACRA may bring to measuring quality in terms that the patient relates to.

  2. Though I emailed you this directly Dr Jayne, I think asking for other entities to be forced into participating in MU is like asking for someone else to get cancer because you got stuck with it.
    Speaking as one of the thousands of abused front line providers, I doubt that CMS and Andy Slavitt will do anything to improve MU as their prior attempts to make it better only made it 1000x worse. Sometimes you need an excision not a reconstruction. To leave MU going or its probable awful “better” alternative, will only cause further pain and problems.His big worry was losing the hearts and minds of physicians…Andy, you have lost us already. The question is how to get us back. And its not by implementing your or AMA’s idea of yet another disastrous program, or your idea of improved discreet data entry, complicated reimbursement schemes, alternative payment models, numerator and denominator counting and attestation and auditing, paying out incredible amounts of money for terrible unusable inefficient unsafe software, but at the same time blaming physicians for the ills of the entire medical system. Yes we are angry. But its like asking why the dog is biting you and ran away after you have beat it continuously for not listening to your incomprehensible rules.

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