How Much More Evidence Does CMS Need?

I was glad to see that CMS was concerned enough about the 17% meaningful use dropout rate to do some research into this rather alarming statistic. Some of what they discovered lends credence to the arguments put forth in the large—and growing—number of recent letters from stakeholder organizations suggesting that the meaningful use train is simply moving too fast.

In a recent presentation, CMS accounted for half of the non-returning providers as follows: 5% retired, 17% switched to a practice without an EHR, and 28% claimed to have simply forgotten or missed the deadline to attest.

The remaining 50% of the non-returners cited a number of reasons—some identifying more than one—that are quite revealing and can only lead to future falloffs in participation. The reasons given are presented in the CMS chart below:

How Much More Evidence Does CMS Need?

What more evidence do we need that physicians simply find meaningful use too complex, too time-consuming, and too costly? And that is only their assessment of Stage 1. Many of the non-returners were unable to meet one or more Stage 1 objectives, yet many Stage 2 measures will be considerably more challenging—for reasons other than increased thresholds. The Stage 1 menu measures that had the highest exclusion or deferral rates—i.e., the measures that most physicians did not select because they considered them to be most difficult—become required core measures in Stage 2. Compounding that challenge is the addition of totally new measures related to interoperability and patient engagement, all of which will require completely new workflows, staff training, and massive patient-education efforts.

Given the experience to date, the associated explanations provided by physicians, and the volume and passion of the requests pleading for some relief—from the burden of the requirements and from the impending penalties—some flexibility is clearly called for. How about at least backing off from the all-or-nothing requirement? Doesn’t it make sense for the long-term success of the EHR Incentive Program to offer physicians some flexibility at this critical juncture?

3 thoughts on “How Much More Evidence Does CMS Need?

  1. Nice review. To attempt to answer your rhetorical question about backing off from all-or-nothing, yes it would make sense if improved patient care were the goal here. It is not. The goal is to control the medical care we provide, especially the costs. The additional benefit to CMS is that the more difficult EHR is to implement, the more money can be saved by Medicare through penalties. I would expect no progress in this area until nearly all of us abandon meaningful use. As stakeholders in an effective healthcare system, we provide the greatest benefit, yet are not included at the table where decisions are made. Remember what Reagan said about “I’m from the government and I’m here to help!”

  2. “Meaningful Use” has goals that do not improve healthcare and services to those that are paying for these services and care, the patient. The banana held in front of the practices, $$$$$$, has so many strings attached that the ultimate goal of patient care has gotten lost. Sure a medical practice is a business by all measures but to reward a practice to change course and goals distracts from the good old “care for the patient” objective. The CMS mode of reimbursment for patient care is gradually braking down as Physicians and Patients are finding new and more direct ways to pay for and receive healtcare services. Why are the “healthcare vacations” growing? Mostly because of the dissatisfaction of dealing with the complex CMS reimbursment system which is the basis for insurance reimbursment that limits the Physician’s time and judgement. A more direct global fee as in a Capitative Fee can spread the risk across the population much better than the present CMS system.

  3. As a consultant working with physicians to implement the EHR for the last decade, the history of adoption of this technology has been curious to me. In a land and time before Meaningful Use, I encountered a tremendous amount of pushback through each implementation. (I once witnessed a physician throw a computer monitor across the room at a go-live.) With the introduction of MU several years ago, I’ve witnessed a collective sigh of exasperated acceptance amongst the provider community, but it does not surprise me that many physicians have essentially “given up” on achieving the goals of this initiative. In many cases, particularly in the medium to smaller practice community, the physicians quickly purchased an EHR to gain access to the funding, but, the haste led to inappropriate vendor selection, lack of vendor support, and, in many cases, poor system and workflow design. For the physicians out there still struggling, I highly recommend the following: a.) contact your vendor for support b.) Seek out pragmatic ways that you can leverage the system to your advantage (e.g. what features can you exploit to improve documentation, expedite patient care, etc.) c.) consider an alternative technology – there is a good website to assist with this ( The “rip and replace” phenomenon is quite prevalent and may be the best solution towards achieving long term EHR success, beyond Meaningful Use.

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