In the 5-plus months since the Centers for Medicare and Medicaid Services released interim criteria that defined what providers need to do in order to qualify for HITECH incentive payments, providers of all shapes and sizes have expressed concern that the criteria are unreasonably strict and ambitious.
Now, as CMS’ so-called “Meaningful Use” criteria are on a glide-path towards final form, the outcry has been joined by providers with reputations as national leaders in health information technology.
Take Intermountain Healthcare, for example. The Salt Lake City-based hospital network has repeatedly been cited by President Obama as a shining example of the benefits of HIT, yet last week its Chief Medical Officer, Brent Wallace told the New York Times that as of now “Intermountain could not meet 36 of the 48 Meaningful Use requirements.”
The CMS criteria are “too rigid, requiring too much change in too short a time,” Wallace explained.
Then there’s Kaiser Permanente, the nation’s largest nonprofit health plan. Kaiser has invested more than $4 billion implementing its EHR, yet its VP for government relations, Anthony Barrueta told the Times his organization did not come up to snuff when it comes to Meaningful Use.
The same message echoed from Partners HealthCare, the Boston-based parent organization of Brigham and Women’s Hospital and Massachusetts General Hospital. In a letter to CMS officials, Thomas Lee, the president of that organization’s physician network said CMS’ approach featured “unrealistic expectations” and “unachievable timelines.”
“We are very concerned about the requirement that hospitals and eligible professionals must meet each and every one of the objectives to demonstrate meaningful use and thereby qualify for incentive payments,” Lee wrote.
The message from Steven Safyer, who is president of Montefiore Medical Center, was similar. “Even as an early adopter of (EHR) technology,” he told the Times, “we find ourselves struggling to meet the federal standards.”
To qualify for HITECH payouts, Safyer said, Montefiore would need to upgrade its systems at its main facility as well as 75 locations in the Bronx, New York.
In addition to HIT leaders on the provider side , 27 senators and 245 House members have raised similar concerns to administration officials. These officials have indicated that they understand the concerns, but they have not suggested they would back-off.
“We want to strike a balance,” Jonathan Blum, CMS’ deputy administrator told the Times. “We will provide flexibility for doctors and hospitals, but push them to elevate their performance. Final rules will be out in early summer.”
A Way Forward
EHRBloggers has consistently argued that the administration’s vision for HIT—as articulated in the ONC criteria for electronic health record certification—is transformational, a perfect elixir for a grievously insulated HIT industry that badly needs a swift kick in the rear. We maintain this stance.
The EHR market is a cottage industry right now. It contains 300-odd vendors that offer products of varying quality and uneven service. That might be acceptable if the products were Valentine’s day flower arrangements, but health care providers must be assured that the EHRs they use are safe and capable of helping them achieve high levels of quality and efficiency. The ONC criteria and certification requirements do this. They will consolidate the EHR sector by setting the bar high and requiring vendors to jump over it in a timely fashion: that’s a good thing.
But CMS can no longer ignore providers’ nearly universal push-back on Meaningful Use criteria. If the government’s all-or-nothing Meaningful Use targets are too onerous for providers with national reputations for excellence in the space, the problem lies with the criteria, not the providers. If too many providers become frustrated and give-up on the lure of HITECH incentive payments, the net will be a further delay in national adoption of EHRs, which amounts to an abject failure of the HITECH program.
Pragmatic solutions are needed. The simplest solution is what the Brigham’s Lee has recommended (and we recommended months ago, as well): CMS should award partial credit in the form of fractional HITECH payouts for each Meaningful Use criterion that providers can meet. Perhaps a scheme can be devised that curtails incentive payouts over time if providers do not progress in their efforts to meet additional Meaningful Use criteria. There may well be other solutions, and we encourage further discourse on the matter. But the bottom line is that this whole thing isn’t going to work unless providers believe they have a chance to win the game.
Glenn Laffel, MD, PhD
Sr. VP Clinical Affairs
Practice Fusion EMR
