Commentary: MU numbers encouraging, but cautionary signs linger

By Ed Larsen
08:49 AM

Last month, we noted the growing number of eligible providers (EPs) and hospitals (EHs) that have signed up and qualified for Medicare and Medicaid incentive payments for meaningful use of EHR systems. This week, CMS updated those numbers at the latest meeting of the Health IT Policy Committee. These numbers show  the acceleration in EPs an EHs that CMS was expecting.

  • Almost 30 percent of eligible providers and 60 percent of hospitals have now registered for the incentive programs. 
  • Total incentive payouts under Medicare and Medicaid are now over $900 million each through November,
  • Thus, total payouts for 2011 will easily exceed $2 billion – of which close to a third of total incentive payouts for 2011 occurred in November alone. 

ONC and CMS now believe they are at a “tipping point,” where Meaningful Use stage 1 participation is no longer an “if” but a “when.”

[Related: Meaningful use -- how patient should patients be?]

Still there are cautionary signs. 

As we noted earlier, year 1 requirements under Medicare and under Medicaid are substantially less burdensome than subsequent years. While eligible providers have registered for one or other of the programs, only 4 percent have actually qualified for incentives. Also, interoperability-related criteria were among the least popular menu objectives. In addition, 2012, not 2011, is likely to be the pivotal year. 

The pace must pick-up and be sustained if meaningful use is to reach its full potential, particularly for interoperability to coordinate care among providers. We expect the proposed rules for Meaningful Use Stage 2 by the end of January, if not sooner. Now that HHS has announced that providers will not have to meet Stage 2 criteria until January 2014, providers have an extra year under Stage 1 criteria without new interoperability requirements.

Two other year-end healthcare-related notes out of Washington were the failure of the Congressional “super-committee” to reach a budget deal and the Supreme Court’s grant of review to the states suit challenging the constitutionality of Affordable Care Act, aka health reform. 

The former outcome is now supposed to automatically cut projected growth of Medicare payments to providers by 2 percent, $123 billion, in addition to previous planned cuts of $500 billion over the 10 years starting in 2013. Neither of these provides a blueprint for improving care quality, access or cost effectiveness.  It falls on provider organizations to develop innovative models to transform healthcare. 

[Q&A: Between the lines of NEJM's EHR report, 'trust trumps tech'.]

Ironically, both the administration and the plaintiff states have asked the Court to decide that any decision is to be“non-severable.” While the Court is not bound by the request, a finding that individual mandate or other section of the law is unconstitutional could lead to declaring the whole law unconstitutional.

While some may want this outcome and a new start, it could wipe out the regulations covering Accountable Care Organizations, the Center for Medicare and Medicaid Innovations initiatives and other transformative programs – the programs aimed at helping providers reduce their costs to balance the programmed cuts.

Ed Larsen is an independent strategy consultant with over 30 years experience in the health IT and medical technology industries. Mr. Larsen has authored the HIMSS Standards Insight, providing insight and commentary on the technical, business, and now regulatory issues around interoperability for more than 10 years.

This article originally appeared on the HIMSS Blog.