Tom Sullivan, Editor, Government Health IT
Tom Sullivan is the Editor of Government Health IT. Tom covers healthcare IT in all government settings, at the federal, state and local levels. He writes about industry trends and is responsible for overall coverage decisions. Follow Tom on Twitter @GovHITeditor.
Commentary: 5 points congressmen missed in call to end MU
WASHINGTON | October 5, 2012
Timing being everything and all, the four Republican congressmen who on Oct. 4 sent a letter asking HHS Secretary Kathleen Sebelius to stop distributing meaningful use incentives probably should have attended the Oct. 3 Bipartisan Policy Center event instead.
The day was packed with doctors, politicians, healthcare industry heavyweights, state and local health officials, who were all essentially agreeing that health information exchange and interoperability are gaining purchase in the industry.
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Farzad Mostashari, MD, the national coordinator for health IT, was at the BPC event, where the group unveiled two reports on electronic data sharing and ever-enthusiastic as he is, said of the results BPC presented, “the report, the way it starts off, the first finding is dead-on, in terms of the centrality of every conversation we’re having, that a business case is emerging,” for exchanging health information, Mostashari added. And he’s not the only one.
Shortly afterward Mostashari, who along with acting CMS director Marilyn Tavenner is cc’d on the letter, said that during Stage 2 of meaningful use, “you’re going to see a major difference in your vendors not having to negotiate with each other,” over things like what coding system to use, how to package patient information, what secure protocols to use for exchanging data over the Internet.
At issue for the congressmen who sent the letter are what they identify as $35 billion in Medicare and taxpayer funds potentially distributed to providers for purchasing EHRs that are not interoperable with other vendors EHRs.
“The Stage 2 rules fail to achieve comprehensive interoperability in a timely manner, leaving our health system trapped in information silos, much like it was before the incentive payments,” the authors wrote.
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The letter is signed by Dave Camp, chairman of the Ways and Means Committee, Wally Herger, chairman of the Ways and Means Subcommittee on Health, Fred Upton, chairman of the Energy and Commerce Committee, and Joe Pitts, chairman of the Energy and Commerce Subcommittee on Health; Republicans, all.
“More than four and a half years and two final Meaningful Use rules later, it is safe to say that we are no closer to interoperability in spite of the nearly $10 billion spent,” the authors continued.
Now, in all due respect, they are missing a number of points, not least of which:
pjcasey75 say: Are they saying,"If you STOP building it, they will come?"
I allude to, but rephrase, the famous line from Field of Dreams. If we stop incentivizing the evolution of EHR technology, how will that somehow promote or accelerate it's development? I try to maintain my cool, but this one got me going.
Please don't tell me the market will take care of it. We've been waiting on the market to do this on it's own since the late 80's and the last 3 years of market stimulation have witnessed more progress than the previous 20 combined. Incentives aren't perfect, but they don't have to be. They just have to be better than what came before.
The call to end (rather abruptly, I take it) incentive payments to providers for demonstrating meaningful use of CEHRT may save some money for a government which, by the way, can't seem to interoperate much between two parties who meet in the same building (i.e., the Capitol), but it won't fix the problem of heretofore inadequate interoperability between EHR products. That will only occur with the diligent and collaborative development and enforcement of standards (a perfect place for government to set the fair rules for all players) by industry experts, legislators and government regulators working together.
This call is also disappointing because EHR migration is one of the few ideas which has previously escaped the rancor of political feuding so far. Proposed by a Republican administration, it has continued under a Democrat. Let's hope it won't matter who wins the next election as far as this program goes. How about a little stability?
As for stopping now, might as well sew up the patient's empty chest midway through an open heart surgery (that is, before you put in the new heart) because he's lookin' a bit pale half-way through the operation. There are some projects which cannot be stopped mid-course without wasting most of what you've already spent, doing real damage, and incurring more costs in the long run than you supposedly save by a shortsighted act. The EHR incentive program is one such project because it involves a transition between two methods of doing something which are so different that the half-way point is precisely where the inefficiencies of both are at their peak - stopping then is the worse thing you can do. No, we're really all in or all out on this one.
Cut the payments now and you'll leave about one quarter of providers just reaching proficiency on emerging EHR technology, another quarter just getting started on a long and difficult learning curve, another quarter about to make the plunge and the last quarter still waiting to see what's going to happen, but pretty clear what's coming is coming. The technology market will experience an even bigger and much more chaotic shakeout than is inevitable even if we stay the course. That shakeout will leave truly huge numbers of providers who've adopted EHRs from now failed vendors with no support and no migration path. If you think the electorate blames Congress for SPENDING this money, you can't imagine how mad they'll be if family doctors go bankrupt in droves because, having bought an expensive EHR based on a promised incentive, they're now unable to pay off their debts because Congress reneged on the promise.
The fact that the distinguished members of congress are obviously unaware of the timeline for the successive stages of Meaningful Use indicates that they don't really know even the basics on the subject.
It was Hubert Humphrey I believe who once said something to the effect: "Freedom of speech guarantees your right to say whatever you want, but it does not guarantee that anyone has to take you seriously." Amen to that.