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Medical groups ask Congress to refocus stage 3 Meaningful Use requirements
About 12% of participants successfully attested to stage 2 requirements and fewer will be successful in stage 3, according to a group of medical societies.
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Citing onerous reporting requirements, the American Medical Association, American Academy of Ophthalmology and other medical societies urged the House of Representatives and Senate to revise stage 3 of the Meaningful Use program for electronic health record adoption.
The CMS created the Meaningful Use program in 2010. Participating physicians and practices must report performance measures to qualify for up to $44,000 in incentive payments.
In a letter sent to the House and Senate on Nov. 2, the societies expressed concern about the Obama administration’s decision to move ahead with stage 3 of Meaningful Use “despite the widespread failure of stage 2.”
Only 12% of participating physicians successfully met stage 2 reporting requirements, and fewer will likely meet stage 3 requirements, the letter said.
Stages 2 and 3 of Meaningful Use impose unrealistic demands on participating practices and do not accurately measure quality of care, according to Michael X. Repka, MD, MBA, AAO medical director for governmental affairs.
“[The intent of Meaningful Use] was to get EHR into physicians’ hands. It has done that amazingly well. But doctors have paid a lot of money for it. Yes, there were some incentives, but we paid more. But stage 2, the measures, what do they really do? Do they really measure quality of care, or are they the administration’s thought of what should be quality of care? I think there’s a lot of debate about that determination,” Repka told Ocular Surgery News. “Stage 2 is difficult to do, although we’re getting better at it. Stage 3 just builds on it with more and more unrealistic measures, so that it seems hard to believe that more people will succeed.”
Legislative action will be needed to make the necessary changes to the Meaningful Use program, Repka said.
“It looks like legislative relief is what’s going to be necessary. It doesn’t look like this is going to be solved with just regulatory changes. That has not seemingly been very successful,” he said.
Meaningful Use has become more of a hindrance than a help in improving patient care, according to David B. Glasser, MD, AAO health policy chairman.
“Meaningful Use was a great idea to get people to use EHRs and install EHRs, but it has really run amok. It has gotten to the point where it’s counterproductive. The things that you have to do to satisfy the Meaningful Use criteria at this point tend to interfere with patient care rather than contribute to patient care,” Glasser said.
In October, the AAO, AMA and other medical societies asked CMS to create a hardship exception for providers affected by delayed rulemaking for Meaningful Use stages 1 and 2 and to delay finalization of the proposed stage 3 rule.
Also in October, CMS issued a final rule that clarified stage 3 requirements. The final rule specifies requirements that eligible professionals, eligible hospitals and critical access hospitals must meet in order to qualify for incentive payments and avoid a 3% penalty for noncompliance. It also changes the Medicare and Medicaid EHR incentive program reporting period to 90 days for all providers in 2015 and new participants in 2016.
Layers of requirements
In the letters to the House and Senate, the AAO and other societies said that, while more than 80% of physicians are using EHRs, CMS “has continued to layer requirement on top of requirement, usually without any real understanding of the way health care is delivered at the exam room level.”
The letter continued: “What has emerged from this morass of regulation is a system that relegates physicians to the role of data entry clerks, filling the patient record with unnecessary documentation requirements unrelated to the provision of quality care. In addition, the program has failed to focus on interoperability and has instead created new barriers to easily exchanging data and information across care settings.”
Stage 2 of the Meaningful Use program “has largely been a failure, with only 12% of physicians successfully participating and little improvement in data exchange across care settings,” the letter said. “CMS recently released modifications to stage 2 to make modest improvements, though some new requirements will cause still more physicians to fail.”
In addition, CMS imposed “more challenging” requirements for stage 3.
“Rather than build on the modest improvements made to stage 2, CMS reverted back to the same fundamental flaws in the previous version of the program by focusing heavily on measure thresholds and excessive documentation requirements rather than improving interoperability. Relying so heavily on the failed construct of stage 2 will only guarantee continued failure in stage 3,” the letter said.
Focus on interoperability
The letter said that the success of the Meaningful Use program “hinges on a laser-like focus on promoting interoperability and allowing innovation to flourish as vendors respond to the demands of physicians and hospitals rather than the current system where vendors must meet the ill-informed check-the-box requirements of the current system.”
Rather than responding to calls for changes to the Meaningful Use program, the Obama administration has “chosen to perpetuate the current failed program through the release of stage 3 Meaningful Use,” the letter said. “It is unrealistic to expect that doing the same thing over and over again will result in a different outcome. We believe, therefore, that it is time for Congress to act to refocus the Meaningful Use program on the goal of achieving a truly interoperable system of electronic health records that will support, rather than hinder, the delivery of high quality care.”
Repka said that, even with interoperability among practices, his practice receives duplicate and outdated patient records.
“[All of a sudden] you’re getting these diagnoses from 6 years ago, many of which are duplicate, so you’ve got to go through the record and sort out which of those you have to take seriously. In my medical record, I’m supposed to decide which ones we retain and which ones we don’t in the permanent record. I have to do the same thing for medications and drug allergies, so each of those is a pain to complete. I guess it’s on the way to getting better interoperability,” Repka said.
Reporting requirements undermine EHR interoperability, Glasser said.
“As they’ve increased the stages of Meaningful Use, instead of forcing the vendors to make these things talk to each other and make us more efficient, they’re basically just increasing the number of buttons that the doctor has to push,” he said. “The regulations should be geared toward making EHRs more useful. It really seems as if they’re geared toward making the numbers more easily reportable to Medicare. I don’t think there’s a connection between them and better outcomes for patients.”
Data sharing and registries
There are many advantages to EHRs, such as electronic prescribing, easier communication with other providers and the ability to avoid errors, Glasser said. However, Meaningful Use requires practices to document performance measures more than once, which detracts from patient care, he said.
“There are a lot of times when you’re just pushing buttons to confirm in a Meaningful Use-compliant way that you did something that you already did in your EHR. It’s very redundant,” Glasser said. “You want to be able to check for allergies. You want to do the various different public health things and check for blood pressure and all. But most of those things are things that practices already do. Now we are taking a detour to not only do it to take care of the patient, but we’re re-documenting it for Meaningful Use, so it’s actually taking time away. That’s time that could be spent talking to the patient and examining the patient, and that’s just not right. It just doesn’t make sense.”
Glasser also said that medical registries such as the AAO’s IRIS Registry can automate many documentation requirements through data extraction and reporting functions.
“The Academy has the IRIS Registry. That has the potential to automate most of this. A lot of these documentation requirements could be satisfied through automatic data extraction and reporting to our registry,” Glasser said. “That way, Medicare can get their numbers, and the doctors can go back to using the EHR in a way that will actually support patient care. On top of all that, you get useful data feedback from the registry so that you can see where your complications are, where you’re doing well, where you’re efficient, where you’re not efficient, where your outcomes are good, and actually use those data to improve care.” – by Matt Hasson
- References:
- Letter to U.S. House. http://assets.fiercemarkets.net/public/004-Healthcare/internal/housemuletter11-3.pdf. Nov. 2, 2015.
- Letter to U.S. Senate. http://assets.fiercemarkets.net/public/004-Healthcare/internal/senatemuletter11-3.pdf. Nov. 2, 2015.
- Medicare and Medicaid programs; electronic health record incentive program – stage 3 and modifications to Meaningful Use in 2015 through 2017. https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-25595.pdf.
- Physician Payment Reporting System. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/. Accessed Oct. 26, 2015.
- For more information:
- David B. Glasser, MD, can be reached at Patapsco Eye MDs, 6350 Stevens Forest Road, Suite 101, Columbia, MD 21046; email: dbg@comcast.net.
- Michael X. Repka, MD, MBA, can be reached at American Academy of Ophthalmology, 20 F St. NW, Suite 400, Washington, DC 20001; email: mrepka@jhmi.edu.
Disclosures: Glasser and Repka report no relevant financial disclosures.