A cautionary tale on incentive audits

By Frank Irving
07:44 PM

The HIMSS/AMDIS Physician's IT Symposium, a daylong event held Sunday, included vivid testimony of the importance of meaningful use in a practical sense. 

Leland Babitch, MD, a pediatrician and co-presenter, shared a CMIO's perspective on complying with the MU mandate: Responding to audit requests about how his employer, Detroit Medical Center, calculated various MU measures took four full-time equivalents about four to five weeks to complete.

DMC attested for MU Stage 1 in May 2011 and earned approximately $33 million in incentive payments. During the subsequent audit, the possibility of a partial payback of incentive funds arose. Points of contention with auditors included variable quality measure denominators due to patients moving in and out of the hospital population, and the absence of formulary alerts from the vendor's EHR. Babitch said that DMC's parent organization, Vanguard Health System, which he described as "hyper-compliant," became concerned about $14 million in potential paybacks.

"(Vanguard) said they didn't like the way things were going," Babitch explained, "…and that led to my termination as CMIO at DMC. So the biggest unintended consequence of meaningful use, in my instance, was that I lost my job."

Even though the audit eventually concluded that DMC was not at fault and did not have to issue any repayments, "my name was at the bottom of those attestations," said Babitch, "and I was the one sending this information back and forth." Consequently, his warning to CMIOs in the session's audience was "(a) don't sign anything," he joked…and then added on a serious note, "(b) be very careful with your auditor."

During an earlier session at the symposium, Clement McDonald, MD, chair of the HIMSS/AMDIS Physician Community, shared views from a pioneer in the development in health data standards and EMRs. McDonald, who directed the creation of an EMR in 1972 at Indiana University School of Medicine, portrayed the system, in its initial stages, as "not beautiful, but docs loved it." 

The primary driver of the positive feedback was the system's rapid response time. Looking ahead to current and future systems, McDonald commented, "fast is not a priority, it is the priority.

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