Providers skeptical of meaningful use reimbursement process

October 28, 2009 | Diana Manos, Senior Editor

WASHINGTON – Healthcare providers should be gearing up for reimbursements for meaningful use of healthcare data under the American Recovery and Reinvestment Act (ARRA), but many argue that healthcare IT adoption may not be worth the effort.

At a two-day hearing held Oct. 27-28 by the HIT Policy Committee, small practice physicians, community health providers, specialists, behavioral health providers, doctors who care for minority patients and others testified that meaningful use may be a good idea in theory, but there are many problems with what is proposed so far. The providers said they don't see many doctors adopting HIT, while others say collection of data could be used to punish them in the future.

Many of the complaints centered on financial and time barriers to HIT adoption. Providers have asked the Office of the National Coordinator for Health Information Technology and the Centers for Medicare and Medicaid Services to consider expanding and clarifying the requirements for "meaningful use." CMS, with counsel from ONC, is currently writing a proposed rule on meaningful use, to come out by the end of the year, according to David Blumenthal, head of ONC.

Under a draft of potential measures released in September by the HIT Policy Committee, eligible providers would have to use CPOE (computerized physician order entry) for all orders, implement drug-drug, drug allergy and drug-formulary checks and maintain an up-to-date problem list of current and active diagnoses based on ICD-9 or SNOMED.

By 2011, providers would be required to report to CMS the percentage of diabetics with their A1c numbers under control, the percentage of hypertensive patients who are controlling their blood pressure, and the percentage of smokers offered smoking cessation programs.

Specialists argued that these measures are not specific enough for them.

Albert L. Strunk, MD, representing the American College of Obstetricians and Gynecologists, said ACOG is concerned that the measures, while clinical in nature, are not related to adoption of electronic medical records. "The meaningful use measures for ARRA should determine whether a physician has met the objectives shown in the meaningful use matrix, not whether the EMR is being used to report clinical quality measures that rarely apply to that physician's patients," he said.

Other providers, particularly those serving rural and minority communities and small practices, argued the cost of implementing healthcare IT is too much for physicians to pay.

Physicians who have everything in place to collect data by 2011 can receive up to $44,000 over five years under ARRA. Experts have placed the cost of establishing healthcare IT between $30,000 and $70,000. This does not take into account the amount of time it costs physicians to adopt the new system and the disruption to workflow.

Experts at the hearing testified that providers are willing to wait to purchase a HIT system until they know it will be interoperable. They said physicians from small practices often interact with more than five community hospitals and several labs, each with a different system. Doctors need to know that whatever electronic health record they buy will work with the systems the labs and hospitals have.

Marty Fattig, CEO of Nemaha County Hospital in Nebraska, said hospitals need a clearer picture of how interoperability will work. Healthcare IT vendors who serve small hospitals differ from those who serve large hospital systems, he said.

All healthcare providers are striving to improve patient care, Fattig said. At his hospital, adding new requirements will only slow down the quality improvement strategy the hospital already has in place, he said.

Willarda Edwards, from the National Medical Association, said the NMA, which mainly serves minority populations, is concerned that the collection of baseline data for ARRA reimbursement could eventually be used against its members. Social determinants such as lack of food, housing, transportation and health literacy make it harder to improve outcomes among the minority population, she said.

Members of the HIT Policy Committee were concerned that providers may choose to opt out of participating in the funding opportunity provided through ARRA incentives, but also acknowledged there is not a lot that can be done to change the progression of how ARRA will be implemented in 2011.

Paul Tang, vice-chair of the HIT Policy Committee said the committee will review the many comments received and it will use them to form a strategic plan for 2013 and beyond. He said the committee will focus on preventing minority health disparities as healthcare IT adoption advances.

Tony Trenkle, director of the CMS Office of e-Health Standards and Services and a member of the HIT Policy Committee said the public should use the comment period to voice concerns when the proposed meaningful use rule comes out later this year.

Reader Comments (3)Login to Post a Comment

PrWise says: It's interesting that the

November 03, 2009 | 11:05AM GMT

It's interesting that the concern here is about the impact on the physicians rather than the impact on the patient. For a lot of patients, especially medicare patients, the only doctor they ever see is a specialist so why wouldn't we ask the specialists to at least monitor basic health?

If you've ever spent any time in any medical office, you know that paper is a horrible way to manage a patient's health information. Lost notes, improperly disclosed information, inability of the provider to find a patient's information quickly if needed, etc.

No technology is perfect but their are standards for interoperability and in many cases they already work fine (ePrescribing, lab interfaces, etc) Time for doctors to make the investment and realize that it's about the patient, not them.

jdearinger says: Physician Reimbursement

October 29, 2009 | 2:48PM GMT

I'm surprised we haven't heard more from the physicians that will not qualify for reimbursments. If they don't have 30% Medicaid or a significant amount of Medicare allowable provider charges it will not amount to a sliver of the amount of capital outlay it will take to be up and running in the world of EHRs and HIEs. They will be left out and we will not see them adopting the new technology.

aharangozo says: limitations of HIT reimbursement

November 03, 2009 | 9:25AM GMT

In our region, the private physicians agree that the implementation of HIT would be beneficial for delivery of quality healthcare for our patients. We have formed a not for profit organization, Central Jersey Health Information Exchange Project (CJHIEP) and have been trying to apply for funding from various sources. We are aware that the implementation physicians need for patient care in the outpatient setting is different than that needed by hospitals and IT professionals. Having an isolated EHR is of no use for us or the patients or society in general. We are trying to build simply and efficiently from the bottom up. Vendors need to be making their systems interoperable and the charges for the maintenance and implementations are out of proportion to the true outlay of the development. Unfortunately, everyone has their own agenda and few are looking to the true meaningful use, exchange of laboratory, radiology, important documents, vital signs. If these issues are taken into consideration, the expense of the systems should go down and become affordable. (development of an interface, 1.5-2hr work, should not cost $5000) Once developed, the interface should work with the same products. Thus, a common language for vendors to use is imperative, as is a common patient identifier.

We, the small practice physicians in the majority, have been trying to be heard, but the system is being developed by healthcare policy experts, hospitals, larger groups, medical societies and vendors.