Doctors Propose 5 Changes To Meaningful Use Guidelines

1 7 Portals Powering Patient Engagement

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The American College of Physicians is the latest physician organization to push back against the Department of Health and Human Services' Meaningful Use timeline, one that has received widespread criticism from industry leaders across the board. In a letter sent Thursday to the department, Centers for Medicare & Medicaid Services, and the National Coordinator for Health Information Technology, the ACP recommended the extension of the MU timeline and more flexibility for the MU scoring measures.

Meaningful Use, which requires the complete transition to electronic health records by 2014, is intended to improve patient outcomes and increase patient engagement. The American Hospital Association, the American Academy of Family Physicians and the Healthcare Information and Management Systems Society (HIMSS), an influential research non-profit, have all expressed concerns that the aggressive timeline will prevent successful implementation of the MU Stage 2 goal of transitioning all hospitals and practices to EHRs by 2014.

The deadline for eligible hospitals to meet MU Stage 1 requirements is Oct. 1, 2013. For eligible professionals, the deadline is Jan. 1, 2014. Hospitals and physicians have one year from the starting dates to meet the MU Stage 2 requirements.

The ACP addressed five main concerns:

Meaningful Use Timeline

"Additional time is needed to educate practices in how the Meaningful Use functions can be implemented in ways that improve workflows, improve patient care, and ensure patient safety," the letter, written by Peter Basch, the chair of the ACP's Medical Informatics Committee, states. "We further support the extension of Stage 2 by at least one year, and perhaps even longer."

Basch cites certification and vendor challenges as reasons to extend the timeline. To date, no EHR system is certified for the full set of MU requirements, Basch writes. The lack of a certified EHR could lead to practices building a full system from multiple EHR modules, which is expensive and time consuming, especially for smaller practices with limited resources.

There is also the issue of implementation. Even if vendors are able to achieve certification, they aren't necessarily prepared to implement the new system for all customers in a timely fashion.

Clinical Quality Measures

Basch argues there isn't enough time for e-measures to be tested or to determine if EHRs are accurate representations of the performance of eligible physicians.

"While it is true that CQMs [Clinical Quality Measures] can be seen primarily as a test of reporting and not of performance, we see this view as not one that is consistent with the overarching goal for clinicians for Stage 2 -- which is using, or developing and using advanced clinical processes," Basch writes.

ICD-10 and PQRS

By 2014, every practice will be using ICD-10 and will need a new or updated EHR system ready to go on Jan. 1, 2014, in order to meet the data collection requirements for the Physician Quality Reporting System (PQRS) and combined PQRS/EHR incentive reporting using e-measures.

"2014 will be a difficult and frustrating year for physicians and other healthcare professionals no matter what might happen with Stage 2 Meaningful Use," Basch writes.

Scoring Meaningful Use Measures

Basch supports a more flexible system for scoring MU measures.

"The all-or-none, pass-fail requirement placed on providers attempting to participate in Meaningful Use is counter-productive," he writes. "Forcing providers to focus solely on achieving particular scores on a broad range of measures prevents them from implementing the innovations that will lead to the achievement of the actual intended goals of improving care and value."

Basch recommends moving to a partial scoring or tiered system in MU 2, with a higher score required for the EHR Incentive Program and a lower threshold required to avoid penalty.

"Not every measure is absolutely appropriate and of equal value to every practice situation," he writes. The measurements don't recognize the degree of practice variability that exists in today's market. "We support switching to a scoring system that recognizes the differences in practices and the differences between incentives and penalties."

Meaningful Use Stage 3 Planning

Moving forward into MU Stage 3, Basch recommends improving the implementation of the requirements as to lessen the burden on physicians and hospitals. Part of this can be accomplished by less "checking boxes" and more flexibility in the standards that recognize better patient outcomes.

Some of this flexibility could come from participation in appropriate activities, such as participation in national registries, published data or other specified Maintenance of Certification programs.

"While we support the goals represented by the Meaningful Use objectives, we are concerned about the appropriateness, focus and feasibility of some of the proposed measures, as well as the potential unintended consequences and additional costs to the practices of these well-intended efforts."