Tech

The Case For Payers to Oppose Meaningful Use

flying cadeuciiThe Meaningful Use program is at a critical inflection point.  On one hand, the payers could jump on the MU bandwagon, follow Medicare’s example and demand provider MU attestation.

On the other hand, they could throw private practice a bone and help them weather the storm until MU goes away or loses its teeth. Let me explain.

Payers could take the easy money and penalize according to the upcoming ACA “adjustment” schedule.  Lots of people think this is inevitable. This would certainly provide an easy way to increase payer revenue and is as simple as letting the practices [continue] to do all the work.

However, this would be incredibly short-sighted.

Meaningful use, as things stand in 2014,  has not been shown to improve patient care. Indeed, it is common for Stage 1 attesting MDs to abandon the program during Stage 2, with many doctors citing lack of efficacy of the program. Stage 3 MU is projected to have even worse results.

What this tells me is that the stress and time-cost of MDs and their staff is not worth the benefits of Meaningful Use.  Don’t get me wrong – there are some great things in the MU guidelines, and we are implementing them in the software we create, but they are overshadowed by the onerous, less-effective 5% and it’s all or nothing. There is no MU wiggle-room.  These days you have to have real grit and determination to stay in private practice, no matter your specialty.

Without financial support or legislative reform, Meaningful Use will eventually drive independent doctors out of business.

That’s bad news for payers.

Let’s say you run a Big Name Private Insurance Company. In 10 years, if most doctors are on salary at a large healthcare organization, will you wish you had helped those doctors stay independent so you could pay ⅓ the cost for the same bone marrow biopsy or routine follow-up visit?

The Blue Cross Blue Shield BQPP program is an example of one way payers can help. Blue Cross Blue Shield of NC is taking a proactive approach to help independent doctors stay independent. By developing their own metrics of what makes a productive and cost-efficient practice, they are rewarding those physicians who show that they are providing cost-effective care. In doing so, they are reducing the sting of Meaningful Use.

Another way to help private practices is to convince the administrators of the Meaningful Use guidelines to loosen the requirements to attest to MU so that practitioners can get back to taking care of patients and not worry about whether their practice is producing enough clicks to safely attest to MU.

It is certainly noble to look at the good points of MU with regard to evaluating physician performance and gathering population health metrics, but surely we can accomplish this through less invasive means and in a way that will not alienate doctors who just want to care for patients.

Nicholas Orlaski is a programmer and the founder of  Ankhos software. He lives in North Carolina. 

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12 replies »

  1. ‘The trouble is making the distinction between “I’m doing this because the evidence is there” and “I’m doing this, and here BTW, is the evidence.” ‘

    And then there’s the EMR/MU variant of “We’re going to make you do this because we hope the evidence will be there at some point in the distant future.”

  2. That, too, is a very good point with a lot of implications.

    When something is self evident it requires no writ.

    When something isn’t, that’s when evidence comes in to play.

    The trouble is making the distinction between “I’m doing this because the evidence is there” and “I’m doing this, and here BTW, is the evidence.”

    Much more blurred than one might think.

  3. I agree with you.

    But methodological limitations in studies which inform policy are much greater than limitations in comparative pharmacology.

    That’s because it’s more difficult to measure outcomes and control for confounders.

  4. “You can’t ethically provide care any longer without an EHR …”
    Seriously? What moral duty is being violated by not participating in the particular iteration of what people are calling EHR? Having an EHR does not translate to care coordination.

  5. What makes policy so impatient? Who decides what a good idea is? Aren’t you granting indefinite longevity to bad ideas? If evidence is not driving policy, what is?
    Certainly, the wheel does not need to be reinvented at each step. But if you are going to reinvent the wheel, you need to at least show that it rolls and that it beats the wheels in place already.

  6. ” Where is the evidence that phones improve outcomes or exam tables or hey lights in the office. ”

    This statement, though it might appear flippant, is a very important one and has considerable implications.

    It means that policy cannot wait for evidence to be instituted. If it’s a good idea at the time it will be employed.

    The idea that policy is a tabula rasa upon which ideas arise from evidence and evidence alone should be cast aside.

    The idea is floated first. Then evidence is gathered. If the evidence is not convincing, we can say more evidence is needed.

    To be honest, I really don’t see how it can be any other way.

  7. We have attested to stage 1 and 1a. We are finding it extremely difficult to comply with stage 2. I word for surgeons, and these measure have very little to do with our practice. You can meet all the measures, but unless you can get your patients to participate, you will not pass stage 2. Of our patients, only about 10% will provider their email address and of that 10% none have accessed the patient portal. Due to the fact our records have to be scanned and are not input as structured data, the patient can’t see the operative report anyways. Why should a surgeon who sees a patient for about 8 weeks be required to send preventative care reminders to patients they no longer follow. Other issues, EHR’s are not able to speak to each other without an HIE (health information exchange) and these interfaces are expensive. I have been quoted anywhere from 8 K to 10K per interface. Lets not talk about the clinical quality measures you have to collect and that fact that these are the same measures our practice is already reporting through a PQRS registry (also another fee to be paid by the provider).

  8. Oh please JH, surely you know there’s a difference between having an EHR and using it to improve your practice in various aspects, vs meeting MU guidelines and proving that you’ve done so?

  9. Oh please Nickolas you sound like a MU Luddites that doesn’t know the first thing about health care or healthIT or just enjoy attention. Where is the evidence that phones improve outcomes or exam tables or hey lights in the office. Should the govt provide a tax payer subsidy – no but should they ask for docs to do what we know works in order to get paid to care for their patients? Yes

    The reality is that healthIT is a 50 year old industry (HIMSS celebrated their 50 year anniversary last year) and was a multi-billion industry prior to MU

    The shift to salary has little to do with MU – you can get a free EHR for heavens sake.

    The only docs who need to attest to MU stage 2 this year are those that have meet MU stage 1 for 2 years.. Most of those are in huge systems like Kaiser and they will attest in the last 90 days of the year (just like they did for stage 1)

    Govt si the largest purchaser of health care in the US (and they pay to train us specialists at a cost of 10 billion a year) so they get to make the rules – they have a vested intered in tools that improve outcomes.

    You can’t ethically provide care any longer without an EHR – it is the first ste to being a medical home, to being an ACO or being able to genuinly coordinate care and if you don’t know the evidence about outcomes it isn’t worth the time (Mayo, Partners, Kaiser etc all have the best outocmes in the US and they ALLL have EHR’s and docs on salary).

  10. All well and good EXCEPT by taking on meaningful use the payers are taking on a reform effort that has been very good to them. I’m not sure that they’re willing to go down that road. But you’re right, in the long run, they may be hurting themselves.

  11. “In 10 years, if most doctors are on salary at a large healthcare organization, will you wish you had helped those doctors stay independent so you could pay ⅓ the cost for the same bone marrow biopsy or routine follow-up visit?”
    __

    I’m seeing that already. I’m now in the Muir system after retiring from the REC last year, selling the house in Vegas, and relocating to the Bay Area where my wife works. I have a new Muir Primary in Walnut Creek. My first “meet & greet” office visit (“moderate complexity new pt”) came to $416. Given that we’re on a high-deductible / HSA plan through my wife’s employer, my cut was $303.77. Dude is real quick to refer me out to specialists, too.

    Beautiful upscale new Treat Blvd facility, though.

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