EHR Adoption: The Tipping Point Has Been Reached

EHR Adoption: The Tipping Point Has Been Reached
Regardless of your feelings about the particular pros and cons associated with meaningful use—and you know that I have not been shy about expressing my opinions in that regard—it is impossible to deny the EHR Incentive Program’s positive impact on the implementation of healthcare IT. Meaningful Use has brought us to the tipping point, where EHRs are perceived as a necessity rather than an option for a successful medical practice. The enduring impact of ARRA is that it pushed the EHRs across the chasm, changing the profile of the EHR user from innovative, tech-savvy physician to mainstream physician.

We have reached the point where a critical mass has adopted EHRs, and paper charts are no longer acceptable. Practices that are not digital will find it hard to attract new physicians. Referrals will be affected as primary care physicians will prefer to deal with specialists in the community with whom they can share clinical data electronically, rather than bear the unnecessary costs incurred by the alternatives of faxing, printing, or mailing. These benefits can only be accomplished via an EHR, a fact reinforced by Stage 2’s increased emphasis on interoperability.

I still maintain that the decision to purchase an EHR should not be driven by potential government incentives but rather by the value delivered to a practice—improved patient care and service, productivity/efficiency gains, and cost savings. In fact, I would argue that participation in the meaningful use program is optional—but clearly, EHR adoption no longer is.

EHR Incentive Program Financed on the Backs of Physicians

I was shocked to read the following paragraph, buried on page 379 of the 455-page Proposed Rule for Stage 2 Meaningful Use, (page 13812 in the Federal Register). The paragraph also appears verbatim in the Final Rule for Stage 1:

Explanation of Benefits and Savings Calculations:

In our analysis, we assume that benefits to the [EHR Incentive] program would accrue in the form of savings to Medicare, through the Medicare EP payment adjustments [penalties]. Expected qualitative benefits, such as improved quality of care, better health outcomes, and the like, are unable to be quantified at this time.

While the second sentence is disappointing, I do respect CMS’s candor in acknowledging the ongoing paucity of hard data on the quantification of the assumed qualitative benefits of EHR adoption. The first sentence, however, left me short of breath because it points to the following inescapable, disheartening conclusion: The economics of the EHR Incentive Program is predicated upon physician failure!

EHR Incentive Program Financed on the Backs of Physicians

In fact, the government’s projections for physician participation from 2014 through 2019 are rather pessimistic. Meaningful use among Medicare EPs is estimated to grow, in the less optimistic (“low”) scenario, from 18% to a mere 36%, and in the most optimistic (“high”) scenario, only from 49% to 70%.¹ Even these high projections are low enough—incidentally—to give the Secretary of HHS the option to increase the penalties from the statutory 3% in 2017 to a potential 4% in 2018 and 5% in 2019.

What kind of program have we created that over a period of 9 years will likely take almost as much money from physicians as it gives them?

The government giveth and the government taketh away!

¹Source: Proposed Rule, Stage 2 Meaningful Use, page 13804, Table 19.

EHR Meaningful Use Not Being Embraced by Commercial Carriers

This time last year—amidst all the hoopla surrounding the finalization of the Stage 1 meaningful use requirements—it appeared that the commercial insurance companies were ready to jump on the meaningful use bandwagon and follow the government’s lead. What has happened to their interest? I have not read about the development of such programs since the initial announcement of the carriers’ intentions.

Aetna promised to reward the achievement of specific quality goals, and United HealthGroup, WellPoint, and Highmark (a Blue Cross Blue Shield program) said they were going to make meeting meaningful use criteria the basis for rewards in their programs. The general consensus was that we could expect many more carriers to align their payment systems with the EHR incentive program—but this has not happened.

What caused the private sector to abandon the rush to meaningful use? I believe that the following are the factors preventing private payers from embracing meaningful use and incorporating it into their reimbursement schemes:

  • CMS essentially acknowledges that the clinical quality measure data being collected through meaningful use will be of no real value. We have heard over and over, in response to criticisms levied, that for Stage 1 this is strictly a reporting exercise. Unlike PQRS, there are no thresholds to meet, physicians are being asked to report on measures not relevant to their practice, and no one’s medical practice is being judged on the numbers submitted.
  • Private carriers cannot afford failure. They would like nothing more than to be able to use proven quality measures to drive quality and efficiency so that they can keep their premiums competitive and gain market share. But the evidence is not there yet.
  • There has been a great deal of conversation about whether physicians are being pushed too hard and too fast. Providers are challenged by an overwhelming number of looming IT requirements. Registration for the EHR incentives is moving forward, but attestation numbers and incentive payments are lagging behind expectations.
  • Insurance carriers also have a lot on their plates—health care reform, insurance exchanges, maintaining the required loss ratio, ICD-10, etc. Meaningful use is taking a back seat to other priorities.

HIEs and Information Sharing: Physicians Feel the Pressure

The exchange of clinical data is one of the three pillars of the EHR incentives program, and the legislation was intended to serve as a stimulus (pun intended!) for the creation of health information exchanges (HIEs) by including significant funding earmarked for their establishment. The stage 1 meaningful use requirements provide further support by requiring physicians to take a first step towards information sharing. EHR adoption was expected to be the impetus for the development and flourishing of HIEs.

HIE and Information Sharing - Physicians Feel the Pressure

It appears that it may be just the opposite—interest in HIEs may be driving adoption of EHRs, rather than the other way around. Growth in the HIE arena is coming from private HIEs—those sponsored by health care systems to connect their own providers and facilitate the effective sharing of clinical information about their mutual patients. The growth in private HIEs is far outstripping the growth in community HIEs, according to KLAS, and physicians are facing new and stepped-up pressures to participate.

It is no longer just the carrot of the meaningful use incentives at play. The following are just two examples that have recently been brought to my attention where sticks are being used to “encourage” physician participation in information sharing. The University Physicians Network (UPN) at NYU is making participation in its information-sharing network a requirement for membership in the UPN, without which physicians do not have access to the group’s favorably negotiated reimbursement rates. A similar physician group in Massachusetts is making membership in its network a prerequisite for patient referrals.

I’m interested in hearing from readers about the development of HIEs and other information-sharing networks in your markets, and the carrots and/or sticks associated with participation.

EMR Straight Talk’s 2nd Birthday—Over 100,000 Views and Counting

Thank you for making EMR Straight Talk the success that it is today. I was very enthusiastic when I started writing this blog, and am even more so now, having watched it grow and having had the opportunity to personally engage with a number of readers. Your support and ongoing interest are truly appreciated.

EMR Straight Talk was launched exactly two years ago today—February 17, 2009—at precisely the moment that President Obama launched the EHR incentive program. I vividly recall sitting in my office watching the news coverage of the fanfare surrounding the president’s signing of the Stimulus Plan (the American Recovery and Reinvestment Act). As he put his pen to paper, I pushed the “Send” button for the first post.

A lot has transpired since then, and EMR Straight Talk’s readership has boomed. Recently it surpassed 100,000 views, with a single-day traffic milestone of 1,197 readers on February 4, capping a record-breaking week that had 2,072 readers.

I enjoy sharing my thoughts and hearing comments from readers, whether or not they agree with me. It is particularly rewarding to find EMR Straight Talk posts referred to—and the conversation continued—in other industry blogs such as HIStalk, EMR and HIPAA, Health Data Management, and FierceHealth IT, to name a few. What that says to me is that the blog addresses issues of concern to a wide audience, offers a fresh perspective on these issues, and provides educational content that my readers seek.

Last year, I was identified as one of the “disruptive forces in healthcare,” a badge that I wear proudly. I like to think that EMR Straight Talk was responsible—at least indirectly—for stimulating conversation with the government that changed the playing field for physicians, and particularly for specialists.

I look forward to continuing the dialogue with you and welcome your suggestions of topics that you would like me to discuss in future posts.

Test Your Meaningful Use IQ

Meaningful Use IQ TestNow that the EHR incentive program has officially begun, physicians and practice managers are taking a closer look at the meaningful use requirements and the rules for participation. At my company, we have been fielding an increasing number of questions about meaningful use, and it is clear that the complexity of the regulations has created a fair amount of confusion.

See how well you understand meaningful use. Challenge yourself: Check your knowledge by taking this quiz, and learn some important information in the process. Comments are welcome.