What are they thinking?

By Bernie Monegain
11:42 AM

The October 4 letter four House leaders to Health and Human Services Secretary Kathleen Sebelius calling for a halt to the government's EHR Incentive Program seems to have come out of the blue.

Why now when the program is gaining momentum? Why now when every other industry has long ago made digital transactions of all kinds routine? Why now when healthcare is so long overdue for an overhaul, a move into the 21at Century.

The four congressmen, Ways and Means Committee Chairman Dave Camp (R-Mich.), Energy and Commerce Committee Chairman Fred Upton (R-Mich.), Ways and Means Health Subcommittee Chairman Wally Herger (R-Calif.), and Energy and Commerce Health Subcommittee Chairman Joe Pitts (R-Pa.), say it's because they are worried the government is squandering money by asking too little of providers. 

We have to wonder if they've talked with any providers? 

They also bring up recent reports that EHRs encourage "upcoding," potentially billing the government and insurance companies more for healthcare than they would have under the paper-based system. The question is are providers gaming the system, or are they "upcoding" to the correct code?

"We believe that the Stage 2 rules are, in some respects, weaker than the proposed Stage 1 regulations released in 2009," the House committee chairmen wrote. "The result will be a less efficient system that squanders taxpayer dollars and does little, if anything, to improve outcomes for Medicare."

"It is critical that your agency do everything possible to advance interoperability and meaningful use of HIT, not just in name only, the committee chairmen wrote in their letter. "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."

Two weeks later four Senators joined the chorus. Sens. Tom Coburn (R-Okla.), Richard Burr (R-N.C.), Pat Roberts (R-Kan.) and John Thume (R-S.D.) asked that CMS and ONC officials meet with Senate Finance and Senate Health, Education, Labor and Pensions Committees.

The meaningful use program was funded under the American Recovery and Reinvestment Act (ARRA) of 2009.  All eight lawmakers calling for scrutiny of meaningful use, voted "no" on ARRA.

While healthcare reform has been a political lightening rod, healthcare IT has enjoyed bipartisan support. We hope and expect that will continue. Perhaps the lawmakers inquiring into the details of meaningful use will take a page from the Bipartisan Policy Committee, where senators work across the aisle, so to speak. 

The numbers on the uptake of EHRs speak for themselves, says Aneesh Chopra, who the nation's CTO at the time ARRA was passed. The numbers, from Surescripts show uptake by office-based physicians went from .08 percent to 6.9 percent from December 2006 to December 2008. The numbers climbed to 20.7 percent by December 2010 and 40.2 percent by September 2011.

"Objectively speaking we have seen a dramatic uptick in the rate of EHR adoption since passage of the Recovery Act," Chopra notes.

The meaningful use program was designed for all providers  -  large integrated healthcare networks, cash strapped community hospitals, critical access hospitals as well as large and small physician practices. It can't leave anyone behind. It has to strike a balance. The bar has to be high enough, yet achievable by providers with varying resources.

Many CIOs, providers and others who work in healthcare would find it stunning to think of the meaningful use program as less than rigorous.

Yes, there is still work to be done on usability, interoperability, privacy, standards and on other fronts. Do the lawmakers realize that work on those issues continues in tandem with the EHR incentives, and that programs, also funded by ARRA, were established to address them?

As ONC chief Farzad Mostashari told the CMIO Leadership Forum in Chicago recently when speaking of meaningful use, "I know it may be easier said than done, but I also know that many are doing it. I have confidence that by working together we will be able to do what we couldn't have done on our own  -  reach a brighter future for medicine."

That's the end game isn't it? The point is to make sure patients receive the best care at the lowest cost. Meaningful use sets a course for transformation. It can be adjusted. But, while this ship is under way, is no time to throw down the anchor.