In case you missed it, Jeb Bush put out his healthcare plan and called for termination of the meaningful use program. Here’s that section of his plan:
Promote private sector leadership of health information technology adoption: Lead private sector collaboration, rather than government mandates, to establish national standards for electronic health record features and data interoperability; eliminate government mandates and penalties for health care providers who do not use government-approved electronic health records; protect health information from hackers and cyber attacks; and enable patient ownership of their medical history and records. Individuals should have access to their longitudinal medical records, which will help providers offer more personalized and timely treatments for individuals.
This sounds a lot like my plan to blow up meaningful use and focus on interoperability. I think it’s the right strategy and the more I think about the future of meaningful use, the more I’ve realized that it needs to end (at least in its current form).
I’ve been talking with a lot of people lately and I’ve been asking them this fundamental question: If the government chose not to spend the ~$15 billion of meaningful use money that remains would it change the trajectory of EHR adoption and EHR use at all?
There are a number of ways to look at the answer to this question. First, all of the remaining meaningful use money has basically been spoken for. I can’t think of anything anyone can do to change which companies are going to get the EHR incentive money. Everyone that’s going to get future EHR incentive money has already purchased their EHR and that $15 billion is already more or less committed to the various EHR vendors. Meaningful use has essentially locked practices into their current EHR and that’s not going to change (give or take a few hundred million).
Second, what major benefits will continued participation in meaningful use bring healthcare? This is an important question. If the government’s going to continue spending $15 billion on this program, don’t you think we should be able to trace that spending to specific benefits we’re going to receive? One way to look at this is to consider the benefits we’ve received from the first ~$20 billion (Medicare) (and another $10 billion for Medicaid) spent on meaningful use. We’ve seen adoption of EHRs. That I can’t argue. However, it’s hard for me to argue much benefit beyond it. Looking at the future meaningful use stages, I’m not optimistic of the benefits future meaningful use compliance will bring either. I’d love to hear if you have a different perspective.
I do know hundreds (probably thousands) of doctors who would argue that continuing the meaningful use program will not only not provide us any benefits, but will actually cause harm to health care. They would argue that meaningful use is a tax on their time and it provides no actual value to them or their patients. This is evident when you consider the number of doctors who have chosen not to participate in meaningful use even though they know doing so is going to cause them to incur penalties. Think about that. Many doctors think the cost to participate in meaningful use is more expensive than the guaranteed penalties for non-participation.
Returning back to the government perspective, is it wise for the government to spend another $15 billion on a meaningful use program which will actually do more harm than good?
The one challenge with the idea of discontinuing meaningful use is that it will make some organizations that were planning on the money angry. I get it. If you’re a hospital that just spent a few hundred million dollars on an EHR with the expectation that you’d be getting paid the meaningful use money, meaningful use being terminated would be quite a blow. Same goes for small practices that have invested in an EHR with the hope of EHR incentive money. I’m sympathetic to this challenge.
The solution is simple though. You find another more meaningful (pun intended) way to spend the $15 billion so these organizations can still recoup some of the investment they made in their EHR software. The meaningful way to do this is to pay them for being interoperable. Disregard all the other prescriptive elements of meaningful use and create a much simpler program that’s focused around healthcare organizations sharing data. Incentivize healthcare organizations to do something we all know is the right thing to do but which has no natural incentive. Focus the incentive on the outcome.
Am I optimistic this will happen? No. Unfortunately, I think it would take some legislative action for CMS and ONC to be able to do this. They can’t just do it on their own (I believe). Given the state of affairs in Washington, I can’t imagine congress caring enough about $15 billion here or there. It’s sad to say, because so much more could be done to improve healthcare as we know it if that $15 billion were part of the right incentive program. As it is, if the meaningful use program were cut today or the money is spent, I don’t see either action changing the trajectory of EHR and healthcare IT in a significant way.