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Technology Healthcare

Rotten Carrots and Broken Sticks: The Death of Meaningful Use

By Adam Rantz

Let's be honest: it had a pretty good run, but somewhere outside of Washington soon there will be a tombstone that reads:

EHR Incentive Program
"Meaningful Use" 
Over $28 Billion Dispersed

This post can serve as the guide to cope with the death of the program that set Healthcare IT ablaze with opportunity, because we all know nothing lasts forever. So, take a step back and look at the program with an outsider's perspective for a moment, the program was a relative success in terms of longevity and participation. Even if it did not achieve the universal adoption of electronic health record (EHR) applications at every medical practice or completely implement interoperability to the desired depths, hundreds of thousands of providers and a majority of hospitals are now using EHRs to document their patient encounters. 



Let's have an exercise in the grieving process:

Stage 1: Denial - Sure, some eligible providers and hospitals are still jumping through the hoops, and they are putting their best effort to stay the course. Soon a grave realization will strike: it is costing more to achieve compliance than it will to accept the payment reductions. The way the incentives are paid out, chances are a provider is looking at just under $4,000 this year, and that probably won't cover the cost of one lab interface. 

Stage 2: Anger - Let's find someone to blame! The Federal Government is the easiest target for anger. After all, they were the ones who set and changed the rules in the middle of the game, leading to muddy waters that confused an entire industry. 

Stage 3: Bargaining - Maybe if CMS didn't change the rules, or implement universally unachievable goals that involved direct addresses, when next to no one uses them... We cannot change the past, but maybe the industry can make a deal with CMS to avoid these looming penalties since it seems a majority of the population will not meet the goals of the program. 

Stage 4: Depression - Jobs will be lost, bonuses will be missed, Medicare payments will be reduced. Sorry, the truth hurts.

Stage 5: Acceptance - This is where the healing process really begins, and I have some tips on how to start practicing better electronic medicine in a post Meaningful Use world. 

You will be better than ever:

First, celebrate the fact that it is finally time to start using the EHR application the way you want. No more meaningful use means no more having to repetitively ask every patient at the OB-GYN if she smokes. No more having to take blood pressure on a follow up visit to change a leg cast at the Orthopaedic office. An adapted workflow that cuts out the frivolous objectives means saved time and money. 

Second, upgrade on your schedule for the right reasons. If your practice has invested countless hours and dollars into a particular customized EHR version, keep it for as long as it is technologically viable. If 2014 taught us anything about upgrades, it's that they should not be rushed and they shouldn't be mandatory.

Third, find a way to make up for the loss due to Medicare payment reductions. Utilizing the current technology available to identify financial gaps in patient care could be just what a practice needs. Start utilizing the patient portal to send reminders or schedule appointments. 

Finally, embrace the autonomy that you have bought yourself for (at maximum) a 5% reduction in Medicare payments. It's your practice do what you want. All the ideological rabble of industry thought leaders won't make one bit of difference when it comes down to the patient and the doctor in an exam room. I'm not telling you take all of your technology out into a field and have an Office Space moment, because I really do believe that electronic health records are the future. I am telling you to let self determination play its course. If you have a doctor who has practiced on paper for 30 years, let he or she stay the course until retirement. The doctors coming out of college will be trained on EHRs from day one, and they will take to your system like a fish to water.

Let the death of Meaningful Use be celebrated like an Irish Wake. Revel in the achievements of a program that made progress and launched companies and created jobs for people all over the country. Move on with knowledge and gained experience that will continue the advancement of patient care.


by Adam Rantz

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