Meaningful use finally working or not?

Those in Healthcare IT can stand as a witness to what I’m about to tell you, because you all lived it right along side of me.  When the Obama administration passed the HITECH Act as part of the American Recovery and Reinvestment Act (stimulus bill) of 2009 on February 18th of that year, it was supposed to give the industry providing IT for healthcare offices in America an economic boost.   From that bill, the term “Meaningful Use” was born, which is used to define how a medical practice meets the government set standards of automation, connectivity, and digitization.  Nearly a year and a half later, in July of 2010, the final requirements and definitions for the first stage of “Meaningful Use” were finally established.  What occurred during those nearly 18-months could actually be described as a ‘de-stimulus.’ Many medical practices, who may have been in the market for new medical software or hardware at the end of 2007, decided to take a wait and see approach on the stimulus before making any buying decisions.  Many medical-related companies, like Midmark, declared a hiring freeze during those months as they prepared for change.  My consulting business struggled; No EHR companies were willing to shell out dollars to implement new sales programs when no one was buying anyway.  So for 18-months it felt as if the entire industry neither grew nor shrank; we just maintained.

Fast forward another year and a half later to December 2011.  Would the next 18-months of Meaningful Use make more of an impact?  At a November 2011 meeting with two VPs from NextGen, they reported to me that they were “starting to see some movement.”  One VP went on to say that “Physicians have been waiting to see if other physicians would actually get checks.  Now that the checks are coming in, more physicians are making a move.”  From New York, the National Sales Director for OmniMD reported in a recent meeting that they have “well over a hundred physicians slated to receive their Meaningful Use checks.”

And it seems to be making a difference, especially in certain parts of the country.  A couple weeks ago CMS released a table showing total Meaningful Use payments through November 7th to physicians by state (see below).  Surprisingly or not, Texas and Louisiana have been the quickest to adopt EHRs and demonstrate Meaningful Use, getting over $75 million in additional reimbursement payments.  While physicians and hospitals in Oklahoma, Florida, Wisconsin, Illinois, Michigan, Ohio, Pennsylvania, and Kentucky filled out the next tier or states getting between $50-75 Million per state.  North Dakota was the only state reported to get $0 in Meaningful Use money.

I called several Healthcare IT resellers around the country to find out if their experience on the front lines of EHR implementation was any different than what I was hearing from the vendors.  Lee Orsag, the President of Altex Business Solutions in Houston and who is also on the board of directors for McKesson Physician Practice Solutions Division, expressed that they’ve “had a banner year in Texas.” This supports the CMS Incentives Programs Table; however, he went on to add that, “We attribute the good year to the 5010 mandate for electronic claims, which has required software upgrades for all of our physicians.  Meaningful Use has had very little impact on our business; however, we’re finding that many software companies have been subsidizing physician’s purchase of EHRs in Houston which has likely impacted the CMS numbers.”

Bob Miller, a McKesson Lytec reseller in Wisconsin said that he just closed his first EMR sale this month and that installation was scheduled for January 2012.  “Trying to get my doctors to switch over had been near impossible.” He went on to add, “Meaningful Use is the key.”

However, reports in every state are not all positive.  New Mexico is currently among the lowest states for receiving Meaningful Use money.  Joann Ahner, a Medisoft reseller in New Mexico expressed that many of her physicians are still fearful about implementing a new EHR system right now.  She went on to say, “Medicaid reimbursements have been cut significantly in New Mexico.  Doctors don’t feel they have the money to invest in an EMR system and are also worried the higher Meaningful Use Medicaid reimbursements won’t cover the overall EHR costs.”

And there is no doubt, based on the latest CMS report, that many areas of the country are not taking full advantage of the Meaningful Use opportunity.  Cyndee Weston, the Executive Director and founder of the American Medical Billing Association, had her take on why many parts of the U.S. are not fully participating:  “Some doctors are just tired of all the Medicare requirements.  Even providers who have an EMR aren’t trying to obtain the Meaningful Use money, partially because they got an EHR to improve efficiency and partially because they don’t do enough Medicare billing to make the hassle worth the extra money.   And with all of the penalties coming about, the doctor’s we are working with are saying they may just stop taking Medicare all together.“

So the Meaningful Use answer then begs the question: How wise is it to drive EHR adoption by a “supply push” instead of a “demand pull?”  William Johns, of the National Provider Network, expressed this very concern in a recent e-mail to me:  "It seems to me there are too many minimum-standard EHR systems surviving on incentives instead of quality.  This strategy did not work for General Motors and it won’t work for these IT providers either.  EHR adoption should be desired by all physicians and not just because they are paid to do it.  To get to that goal we should focus on what the providers and other users including front desk, assistants and billers want in their EHR."

Lee Orsag in Houston summarized the Meaningful Use quandary best when he said to me: “For many physicians, getting an EHR to get stimulus funds is sort of like a set of parents having a baby to get a tax write-off.  It’s not a legitimate reason.”

So is Meaningful Use working?  Perhaps it would be if there were a greater focus on provider EHR needs and usability?  Perhaps if Meaningful Use maintained a focus on the importance of professional training and support we could say definitively that it was working?  Those who have kids know that the only reason to have a baby has nothing to do with taxes or government, and everything about improving the quality of life for their families.  Likewise, the only reason a physician office should implement an EHR is because it improves the quality of patient care and the lives of the people who work there.  Any EHR that can do that is worth considering, regardless of Meaningful Use dollars.

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