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Killing Meaningful Use and Proposals to Change It

Posted on September 16, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Isn’t it nice that National Health IT Week brings people together to complain about meaningful use? Ok, that’s only partially in jest. Marc Probst, CIO of Intermountain and a member of the original meaningful use/EHR Certification committee (I lost track of the formal name), is making a strong statement as quoted by Don Fluckinger above.

Marc Probst is right that the majority of healthcare would be really happy to put a knife in meaningful use and move on from it. That’s kind of what I proposed when I suggested blowing up meaningful use. Not to mention my comments that meaningful use is on shaky ground. Comments from people like Marc Probst are proof of this fact.

In a related move, CHIME, AMDIS and 15 other healthcare organizations sent a letter to the HHS Secretary calling for immediate action to amend the 2015 meaningful use reporting period. These organizations believed that the final rule on meaningful use flexibility would change the reporting period, but it did not. It seems like they’re coming out guns blazing.

In even bigger news (albeit probably related), Congresswoman Renee Ellmers (R-NC) and Congressman Jim Matheson (D-UT) just introduced the Flexibility in Health IT Reporting (Flex-IT) act. This act would “allow providers to report their Health IT upgrades in 2015 through a 90-day reporting period as opposed to a full year.” I have yet to see any prediction on whether this act has enough support in Congress to get passed, but we could once again see congress act when CMS chose a different course of action like they did with ICD-10.

This story is definitely evolving and the pressure to change the reporting period to 90 days is on. My own personal prediction is that CMS will have to make the change. I’d love to hear your thoughts.

Happy National Health IT Week!

To ICD-10 Delay or Not To ICD-10 Delay

Posted on March 27, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

UPDATE: It looks like this bill has passed the house with a voice vote. I believe it still needs to be passed by Congress and not be vetoed by the President.

UPDATE 2: Late on 3/31/14, the Senate passed the bill which delays ICD-10 by a vote of 64 – 35. Barring a veto from the President, the bill will go forth and the ICD-10 implementation date will be moved to October 1, 2015. All of the discussion for the bill was around the SGR fix with no conversation around the ICD-10 delay. It’s unlikely that the President would even consider a veto of this bill.

We’d already stoked the ICD-10 delay fires in Kyle Samani’s post on “Why ICD-10?” before the news came out yesterday that a one year ICD-10 delay was put in an SGR bill. Word on the street was that the bill would be put up for a vote today. However, I hear now that the vote on the bill is going to be delayed at least until tomorrow.

The reports are saying that this bill was developed by John Boehner and Harry Reid which likely means they have enough votes to make it a reality. I read that Nancy Pelosi said on CSPAN that the bill wasn’t perfect, but needed to be passed. My only question is whether the delay in voting is because they’re still trying to cull votes for the bill or something else.

As I suggested in my post linked above, my guess is that congress is hearing from both those for delaying ICD-10 and those who oppose delaying ICD-10. I bet they consider the response a wash and so it won’t sway them either way. Plus, I bet that most in Congress are only talking about the SGR portion of the bill without much discussion on the ICD-10 delay.

This decision is going to cut many people. Let me share a few of the comments I’ve read.

First, from the LinkedIn AHIMA group, here’s a coder perspective on the delay:

I think of the coder who is a single mom struggling from pay check to pay check who had to spent $500 (or more) to take a course and another $60 on the proficiency exam, spent time away from caring for her family to prepare for the implementation only to have the rug pulled right from under her. The $560 is likely her discretionary income for the month. Who is thinking or her?

Don’t tell us there will absolutely be NO delays, allow us to spend our hard earned money to prepare, and then say “just kidding– we are going to tease you with another year — make you spend more money — promise no delays — then change our mind again!” “Oh, and the check is in the mail.” Yes ladies and gentleman, this is our government working “for the people.” And I ask, why does Congress even care about ICD-10? Do they even have a clue what they are voting for or against? They are trying to quietly slip it into a bill so that no one notices. I could be wrong, but it sounds like the work of a single lobbyist and Senator/Congressman. I would like to know the name of the person who put that language into the bill. Democracy at its finest!

Now a perspective that is likely shared by the thousands of ill-prepared practices and hospitals (although, my guess is that it was their larger organizations that lobbied for it, not the individual practices and hospitals that aren’t prepared):

As bad an idea as it is, a majority of practices, and a significant number of hospitals, health systems and other providers are, or feel, very un-prepared for the transition, and so have lobbied for delay. D.C. insiders say it’s a done deal.

On the other side is the prepared health IT vendors that think that a delay is letting the ill prepared off the hook. One EHR vendor sent me an email with this message:

This really is a pain to a vendor like us that is all ready to launch and take good care of our clients with ICD-10. Everything we programmed came out great and we are ready to go.

This feeling doesn’t just apply to health IT vendors that have procrastinated, but to all the procrastinators:

Why prolong the inevitable, again? The procrastinators should be penalized, not the rest of us who’ve been preparing for it.

What we all want most is certainty. HHS came out with certainty during HIMSS when they said that there would be no more delays with ICD-10. Unfortunately, HHS doesn’t control congress.

I’ve been reading a lot of reports that a delay in ICD-10 would cost billions of dollars. I’m not sure I trust those numbers, but it’s no surprise that those numbers don’t take into account the impact and cost of ICD-10 being implemented. Personally, I see costs in ICD-10 going forward and costs in ICD-10 being delayed. I’m not sure we can quantify either number accurately.

Obviously, this is a fast moving story, so I’ll update this post with any updates as I get them. Feel free to leave comments with updates as well.

The Meaningful Use Sky is Falling

Posted on January 28, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The always opinionated Anthony Guerra has an article up on Information Week that describes why he thinks the Meaningful Use sky is falling. Add that to a recent comment I got on a previous post that links to a Healthcare Data Management article talking about the potential repeal of the HITECH act and it seems worthwhile to assess the state of meaningful use.

I’ll start with the potential repeal of meaningful use first. We’ve known for a long time that the house was going to be going after healthcare reform once the republicans took over control of the house. In fact, we posted about the potential impacts to HITECH from the new Congress before.

I personally get the feeling that not much has changed on this front. I’m going to reach out to some of the government liasons for EHR vendors that I know that follow this even closer than I do. However, I still believe that:
1. The HITECH funding or at least the Medicare and Medicaid stimulus funding is safe from Congress. I’ve read this a couple of places and so I believe it to be true.
2. Any legislation that is passed by the house still has to pass through the democratic controlled Congress and avoid the Presidential veto. These two seem unlikely.

Of course, when it’s government work you could always be surprised by some loophole in the process that impacts funding or legislation. I won’t be surprised if one of these loop holes appears and affects the HITECH act. However, I still argue that if something does happen to HITECH, it will likely be a casualty of some other political agenda (ie. cutting whatever costs they can find) and not actually because they were specifically targeting HITECH.

Long story short: I still feel like the EHR incentive portion of HITECH is likely safe. Maybe some of the other funding will be cut short. We’ll see.

Now to the points that Anthony Guerra makes in his article. He describes the challenges that many hospitals are facing in regards to meaningful use. Plus he highlights the potential difference in the number of people who “think they qualify for the money” and those who “plan to apply.”

I might argue that if EHR adoption is the goal, then this might not be such a bad result. The idea of “forcing” meaningful use on people has always bothered me a little bit. Encouraging people to show meaningful use is only as good as the meaningful use criteria. If the meaningful use criteria is not very good, then do we really want everyone showing meaningful use?

For example, imagine that a doctor or hospital decides to use an EHR based on the EHR software’s ability to improve the efficiency of their office and the quality of the services they provide to the patient, but deems meaningful use as contrary to those goals. This seems like a great outcome to me. In fact, it seems like a better outcome than a doctor trying to force themselves into the meaningful use hole.

Obviously there are parts of meaningful use that can be very beneficial. For example, having an EMR that can communicate using a standard format (CCD for example) is important and valuable. If it is beneficial, then I see most doctors implementing these features regardless of whether they showed meaningful use or not.

One thing definitely seems clear from all the surveys and other stats I have: interest in EMR has never been higher. Whether that translates to “meaningful use” of a “certified EHR” or physicians meaningfully using an EHR of their choice, is fine with me.

You know my mantra: Select and implement an EMR based on the benefits that you and your clinic want to receive from the EMR. Don’t select and implement it based on a government handout. Those hand outs will be gone after a few years, but your EMR will be with you long after.

HITECH’s Fundamental Assumptions and Plans

Posted on February 27, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I was browsing through a document on the House Ways and Means website and I was really interested in what I found listed for what I believe is the basic assumptions and plans Congress and the House used to pass the HITECH act through congress.

Health Information Technology for Economic and Clinical Health Act
or
HITECH Act

Health information technology helps save lives and lower costs. This bill accomplishes four major goals that advance the use of health information technology (Health IT), such as electronic health records by:

  • Requiring the government to take a leadership role to develop standards by 2010 that allow for the
  • nationwide electronic exchange and use of health information to improve quality and coordination of care.
  • Investing $20 billion in health information technology infrastructure and Medicare and Medicaid
  • incentives to encourage doctors and hospitals to use HIT to electronically exchange patients’ health
  • information.
  • Saving the government $10 billion, and generating additional savings throughout the health sector,
  • through improvements in quality of care and care coordination, and reductions in medical errors and duplicative care.
  • Strengthening Federal privacy and security law to protect identifiable health information from misuse as the health care sector increases use of Health IT.

As a result of this legislation, the Congressional Budget Office estimates that approximately 90 percent of doctors and 70 percent of hospitals will be using comprehensive electronic health records within the next decade.

The opening line underscores what I believe is their basic assumption “Health information technology helps save lives and lower costs.” The main problem with this assumption is that it’s not complete. A more complete assumption would be “Well implemented and designed health information technology helps save lives and lower costs.” Unfortunately, you can take a look through this long list of cases to see that poorly implemented EHR can do just the opposite. My strongest hope is that doctors will understand this and choose an EHR wisely instead of focusing on the potential stimulus money.

We could discuss many of the other points in more detail, but the one that stood out to me was the purported $10 billion in government savings from the HITECH Act. At least all of the other bullet points had a section in the document which at least at a high level described how it would be done. Somehow the description of how the HITECH Act would achieve $10 billion of government savings was missing from the document.

Can we seriously believe that the $10 billion in government savings from the HITECH act is anything but conjecture? I can’t remember the last time I looked at my savings and it ended on a nice round number like this. Maybe this calculation was done in the math class I never took in college.

I’m not saying that HIT can’t save the government money. I’m a huge proponent of leveraging technology to save money and improve quality. I just wish the HITECH act would tell me how they think this is going to happen.