An old post about meaningful use stage 1 called Hardest Meaningful Use Measure recently was tweeted on @ehrandhit as a way to share from our vault of blog posts. Swithin Chandler saw the tweet and left a really interesting comment when it comes to how challenge meaningful use stage 2 is compared with meaningful use stage 1. Here’s part of his comment (emphasis added):
We’ve had relative success, and I stress relative, in making it as easy as possible in our EHR for our doctors to attest for Meaningful Use Stage 1 as one independent poll showed.
But with MU2 it is getting much harder. There are requirements that demand additional data entry, whether typing, clicking, or dictating that no EHR vendor can help doctors avoid.
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My greatest concern is that doctors look at the changes needed to their workflow and decide the incentive is not worth it. I think there are some MU2 requirements that are very cool from a healthcare technology perspective (and as a patient), but one could certainly argue that giving doctors the features they’re asking for that are not in MU2 may be more valuable to them adopting EHR technology than some features they don’t want that are in MU2.
I think there’s a really good chance that huge numbers of doctors will opt out of meaningful use stage 2. As I recently discussed with our local congressman, the inverted incentives of meaningful use don’t make much sense. Usually when you require someone to do more, you compensate them more. In meaningful use as you are required to do more, they pay you less.
I do think the meaningful use penalties will encourage many doctors to press on through the various stages of meaningful use. However, there will also be a large group of doctors who decide that the cost of meaningful use stage 2 is more than the penalties for not being a meaningful user.
If you still don’t believe this is the case, last I checked only only a small handful of EHR vendors have become MU stage 2 certified. As Swithin says above, it’s not easy (and I suggest might be impossible) for an EHR vendor to make MU stage 2 easy for providers. No doubt this is a huge reason why many EHR vendors are still not MU stage 2 certified (or I think it’s officially called 2014 Edition EHR Products). Certainly all of them could have rushed the requirements for EHR certification, but implementing the EHR certification requirements without making life miserable for the end user is a challenging and possibly impossible task.
That’s a great follow-up, especially on the inverted incentive.
One of the other MU2 related challenges we’re seeing is keeping our doctors educated about the full scope of the program, including penalties. As an EHR vendor, there’s no question; we must be certified through each stage of MU. I know the other EHR vendors, at least those I interact with through the EHR Association, look at it the same way. But doctors do have a choice. Some that choose not to participate, look at it and see only the incentive they’re giving up, but not the penalties that come later.
We need all doctors, especially those in smaller independent ambulatory practices, to have the necessary information to make a reasoned decision about whether or not to participate (or continue participating) in the meaningful use program.
So in the years to come when patients don’t select their practices because they don’t connect to their PHR and Medicare & Medicaid are paying them less every year, will they even have a practice to go to? Front loaded incentives got them on the train, jumping off now seem a little suicidal don’t you think?
Roberta,
I don’t think opting out of MU means that the doctor won’t connect to their PHR or that the doctor won’t use EHR. In fact, I know many doctors who have opted out of MU that are avid users of EHR and PHR. In some ways, they can provide more of those services than an MU user since they’re not distracted by MU.
I expect many will be able to find a way around the Medicare penalties. Some doctors will even opt out of Medicare completely. Some doctors can’t afford to get rid of Medicare completely, but they could shift partially away from it in order to minimize the impact of the penalties.
Some might suggest that doing MU stage 2 and 3 is suicidal.
Right intentions, bad execution. That is what “Meaningful Use” has become. We will see a consolidation of EMR vendors because of Stage 2 and we will also see many providers switching their current EMR for another solution. It is really too bad that the providers are the ones burdening much of this process. I agree with John, the suicide is in attempting to meet Stage 2, not jumping off the wagon. Many of the providers that were undecided about whether to adopt EHR’s now or retire later have made that decision. Stage 2 has shown that retiring around 2017 is the better choice. Patients are not even close to driving the use of EHR’s. Recent studies have shown that patient portals have had an extremely low adoption rate. Especially with small practices. Time will tell….
We agree that Meaningful Use Stage 2 Certification is indeed a difficult and very rigorous process for the vendor. We expect that’s the reason that so few vendors have met MU2 certification so far. Aprima is MU2 Certified (http://aprima.com/company/industry-recognition/) and we are very confident we are going to make it smooth and easy for providers to comply. As a vendor who ranks in the top 5% of all vendors based on number of providers who achieved MU1, we know our methods work.
Hey, that is great news- we can promote our company in the responses for free. Look forward to getting out marketing department on this right away.
I agree with Corey that the intentions behind MU were right but the execution was horrible. There is a lot of potential for improving healthcare by using technology. However, before that can be done, technology needs to help provider get through their daily patient flow. Meaningful Use designers understood this. They realized that before exchanging data or using data to improve healthcare (Stage 2 and Stage 3 of MU), there is a need to simplify the process of collecting the data. This was the challenge for many practices regardless of their size. Stage 1 was focused to help providers adjust and improve their daily workflows as they take the first step toward a digital office. It was a chance for the industry to design innovative ways to help providers document their notes. Meaningful use stage 1 was supposed to happen serendipitously as part of that documentation. The meaningful use money was supposed to be an “incentive” for reaching that goal. It wasn’t the goal. Unfortunately, the marketing focus of all vendors became to show how they can get you 18k by making few extra clicks. Now as Stage 2 is coming closer, everyone is worried about the more number of clicks that they will have to do . No one is talking about the advantages that it can bring.
Pawan, one thing I would like to not is the marketing by the vendors to “get the provider their money” was mostly driver by the providers. 100% of all providers (hundreds per medical conference) would come up to our EMR staff and ask “are you certified and can I get the ARRA money?”
Now we are hearing a different question from providers- they are asking if we can convert the data from their current EMR because they want to switch.
The next year will be very interesting and much different from the last two in the way providers are engaging EMR vendors.
With regards to John’s initial post, Advanced Data Management (ADM) does physician survey work for HHS. ADM’s longitudinal research of several thousand physicians documents quite well the shift in physician perspectives on MU II. It’s a good read.
Here’s the link to their report, which I share with ADM’s permission:
http://www.adm-health.com/sample/
Lucien,
That is an interesting report. I especially like their reasons for many doctors planning to opt out of MU stage 2:
-Front loaded incentives and back loaded effort
-EHR vendor not ready for MU stage 2
-Low or Free EHRs make little need for practice to offset EHR investment
-Smaller practices don’t value emphasis of MU 2 on interconnectedness/HIEs.
I have not read the entire white paper provided by Lucien. I would like to comment about the bullet point- “Smaller practices don’t value emphasis on MU 2 interconnectedness/HIE’s”- I would put the burden on the .gov not doing a better job at showing the benefits of HIE and why the work is worth it.