AMA Wants Major Changes in Meaningful Use

Ken Terry

May 16, 2014

The American Medical Association (AMA) challenged the way the "meaningful use" electronic health record (EHR) incentive program is being conducted in a May 8 letter to the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC).

Unless significant changes are made to the program, the AMA contended, more physicians will drop out of the meaningful use program; patients will face disruptions and inefficiency in their care; many physicians will incur financial penalties that hinder future technology purchases; and "outcomes-based delivery models, which require data driven approaches, will be jeopardized."

The AMA's point about physicians leaving the meaningful use program resonated in the industry because of a recent CMS report. Just a week ago, the agency revealed that, through March of this year, only 4 hospitals and 50 eligible professionals (EPs) had attested to the second stage of meaningful use. Not many EPs could have attested by then, because their 90-day reporting period started January 1. But the hospitals had had 5 months to show meaningful use.

The AMA letter noted that an analysis of CMS' data from 2013 showed a 20% dropout rate in the meaningful use program when providers only had to contend with the stage 1 criteria. Now, as many providers face the stiffer requirements of stage 2, the AMA said, "We expect this [dropout rate] to grow substantially unless the all-or-nothing approach is removed."

This all-or-nothing provision requires EPs and hospitals to meet all meaningful use criteria to qualify for incentives and avoid later penalties. In all stages of meaningful use, the AMA wants physicians to have to meet just 75% of the criteria to obtain incentive payments. Moreover, its letter asks CMS and ONC to allow physicians who meet at least 50% of the meaningful use requirements to avoid financial penalties.

These penalties can be fairly steep, starting at 1% of Medicare reimbursement in 2015 for those who failed to attest successfully in 2013 and rising to 5% in subsequent years for nonattesters.

The AMA also demanded other changes in the meaningful use program. Although the letter listed most of these in response to the recent stage 3 proposal of ONC's Health IT Advisory Committee, the AMA is clearly seeking broader changes in stage 2 criteria, as well. An association spokesperson confirmed this in an email to Medscape Medical News.

The AMA requested that CMS and ONC

  • Remove the distinction between "core" and "menu" objectives, allowing physicians to choose the measures that are most applicable to their practices

  • Streamline and focus the number of requirements

  • Remove any mandates outside the control of physicians

  • Align the meaningful use quality reporting criteria better with the Physicians Quality Reporting System (PQRS) to avoid duplication of effort

  • Make sure that meaningful use mandates are evidence-based

  • Tie the requirements to testing, standards, and implementation guides

  • Consider costs, especially in criteria that require expensive interfaces.

The AMA also asked ONC to consider changes in EHR certification criteria. Arguing that the "volume and prescriptiveness" of certification requirements "are hindering many vendors from being able to deliver high performing systems," the letter requested that the certification process be redesigned to focus on greater interoperability of systems and smart workflow features that could make EHRs more usable than they are today.

Will Anyone Listen?

Michelle Holmes, a Seattle-based principal at ECG Management Consulting, told Medscape Medical News that it's likely that CMS and ONC will pay attention to the AMA's letter "because of the looming dropout rate this year," which will probably be bigger than last year's.

Holmes said it wouldn't be hard to implement the changes the AMA has requested in the all-or-nothing and penalty regulations. But some of the other items on the AMA wish list are more challenging, she said. For instance, while there are problems with the differing timelines of the meaningful use and PQRS programs, any change in the clinical quality measures would cause big problems for vendors at this point.

The 2 areas where providers and hospitals are having the most difficulty with stage 2 meaningful use, she said, are the objectives related to patient engagement and the objectives that require providers to exchange care summaries at "transitions of care," such as hospital discharges and referrals.

The latter criteria are challenging, she noted, because many providers are still trying to figure out their health information exchange strategy or are having to learn how to use direct messaging through Health Information Service Providers.

The technical challenges are less in the patient engagement arena, which includes the use of EHR portals to share records and communicate securely with patients. But many providers are still finding it difficult to meet the requirement that at least 5% of their patients view, download, or transmit their electronic records.

As the AMA letter indicates, some providers are having trouble getting enough patients to participate. That isn't so much because patients are reluctant to go online with their physicians, Holmes observes. In fact, surveys show just the opposite. But physicians have not been educated about the importance of signing up patients, she says. Many believe it's just another meaningful-use hoop they have to jump through.

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