At HIMSS 2014, the health information technology’s (HIT) largest annual confab, the bestest-best news we heard from a policy perspective, and maybe even an industry perspective, was the Centers for Medicare & Medicaid Services’ (CMS) dual announcement that there will be no further delays for either Meaningful Use Stage 2 (MU-2) or ICD-10.
Perhaps we should have immediately directed our gaze skyward in search of the second shoe preparing to drop.
As it turns out, CMS de facto back-doored an MU-2 delay by issuing broad “hardship” exemptions from scheduled MU-2 penalties. To wit: any provider whose health IT vendor is unprepared to meet MU-2 deadlines, established lo these many months ago, is eligible for a “hardship” exemption.
Few would disagree with the notion that it’s unproductive to criticize policy without offering constructive ideas to fix the underlying problems.
Here, the underlying problem is easy to define: it is in point of irrefutable fact fundamentally unfair to penalize care providers for their vendors’ failings—especially when the very government proposing to penalize them put its seal of approval on the vendors’ foreheads to begin with.
CMS’s move to exempt providers from those penalties is correctly motivated, but it seeks to ease the provider pain without addressing its cause.
Instead of issuing a blanket exemption for use of unprepared vendors, CMS should:
- Waive penalties only for those providers who take steps to replace their inferior technologies with systems that can meet the demands of the 21st century’s information economy;
- Publish lists of health IT vendors whose systems are the basis for a hardship exemption, along with an accounting of how many of those 21 billion dollars have been paid to subsidize those vendors’ products; and
- Immediately initiate a reevaluation of the MU certification of any vendor whose products form the basis for a hardship exemption.
This proposal might seem bold, but if we’re truly looking to advance health care through the application and use of EHR, then what I’ve outlined above simply represents necessary and sound public policy. Current practice rewards vendors whose products are falling short by perpetuating subsidies for those products.
The federal government should stop paying doctors to implement health IT that cannot meet the standards of the program under which the payments are issued. That’s just a no-brainer.
An EHR should not be a federally-subsidized “hardship.”
Some brief background is perhaps in order:
Pursuant to the American Recovery and Reinvestment Act of 2009 (the “stimulus”—remember that?), the federal government certified Electronic Health Records (EHRs) for “Meaningful Use,” thereby stamping a government seal of approval on scores of software products.
Across the country doctors quite reasonably assumed that seal carried some meaning, and resolved to spend significant money, time, and effort to both purchase and implement MU-certified EHRs—many of them for the first time—and then to make “Meaningful Use” of them (as defined by the government).
For their pains, the doctors who succeeded in meeting MU metrics received a federal subsidy check. At last report nearly $21 billion in such subsidies have been paid.
Unfortunately, the ROI on that significant federal investment has been mixed to say the least. High numbers of providers on cutting edge health IT platforms who participate in the MU program successfully attest and receive a check. But the overall attestation rate nationally is woefully low (fewer than half).
Much worse: as each subsequent stage of the MU program draws near far too many care providers are notified by their health IT vendors that their “MU certified” systems cannot and will not be ready to transition to the next stage on schedule. Those providers quite reasonably raise a mighty hue and cry, amplified by provider advocates like the American Medical Association, the American College of Physicians, and others, calling for repeated delays in the MU program.
These cries grew louder with the approach of Stage 2, which carries with it not only the threat of withheld incentive payments, but also penalties in the form of Medicare reimbursement cuts.
The latest behind-the-veil MU delay only underscores the degree to which the Meaningful Use program is slowly undermining itself. Track this: The federal government shelled out almost $21 billion (so far!) to help docs pay for a bunch of IT systems that cannot meet the government’s own standards.
Now the federal government is defining as a “hardship” the use of many of the very systems that the federal government subsidized in the first place. Oy. No wonder the Government Accountability Office (GAO) recently issued a report eviscerating the MU program.
The proposal above would both correct for the unintended consequences of current policy and advance one of the few truly bipartisan goals of health reform: modernization of our care delivery system and the information technologies that enable it.
Dan Haley is the vice president of government and regulatory affairs at athenahealth and is a regular contributor to the athenahealth blog.