The American Medical Association (AMA) recently released a blueprint with recommendations for improving the Electronic Health Record (EHR) Meaningful Use (MU) program, which the organization believes is ill-equipped to meet the needs of physicians and patients.
On October 14, 2014, AMA executive vice president James Madara, MD, sent a letter to Centers for Medicare & Medicaid Services (CMS) administrator Marilyn B. Tavenner and National Coordinator for Health Information Karen B. DeSalvo, MD, MPH, detailing the blueprint, which explains problems with and offers solutions to all three stages of the meaningful use program.
Explaining the purpose for these recommendations, Dr. Madara wrote, “The hope and promise of EHRs emphasized greater efficiency in health care, improved care coordination, and clear and legible medical information that could be easily shared among providers, regulators, and public health agencies. Many of the MU requirements were designed to increase patient choice and quality of care. Unfortunately, many of these requirements, especially those in the latter phases of the MU program, are having the opposite effect. Oftentimes the requirements decrease the efficiency of patient visits.”
That is why the AMA decided to outline its vision for the MU program. The main changes the AMA outlined are as follows:
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1. Adopt a more flexible approach for meeting MU. For stages 1 and 2, this means eliminating the program’s all-or-nothing approach by adopting a 50% threshold for incurring a penalty and a 75% threshold for earning an incentive. For stage 3, which will be officially rolled out in 2017, this means removing percentage thresholds for measures and the difference between core and menu requirements.
Dr. Madara wrote, “The single greatest barrier physicians face to date in meeting MU is the all-or-nothing approach of the program that results in a zero sum game. … the program requires 100 percent compliance at all times to earn an incentive and avoid a penalty, despite the fact that certain measures are less relevant in different care settings or that technology may create barriers in meeting certain requirements.”
Thus, the AMA believes that this policy change could encourage more physicians to meet the MU requirements and prevent them from facing penalties for missing a single measure.
2. Expand hardship exemptions for all MU stages. The AMA recommends providing exemptions for physicians who successfully participate in the Physician Quality Reporting System Program (PQRS), for hospitalists and for physicians about to retire. The AMA also would like to keep exemptions for anesthesiologists, radiologists, and pathologists.
Dr. Madara explains that, “having to report quality measures for both MU and PQRS, which have different reporting periods, places a duplicative burden on physicians.”
3. Improve quality reporting. Specifically, the AMA calls for better aligning the MU program with the PQRS program, ensuring public input for new electronic clinical quality measures (eCQMs), registry participation and interoperability as well as developing a way to eliminate outdated measures.
Regarding interoperability, the AMA noted that problems continue to exist among physician practices and hospital systems as well as between EHR systems and clinical data registries. Dr. Madara wrote,“We believe CMS needs to play a greater role in facilitating the use of clinical data registries by encouraging the development of standards for sharing/transmitting data between EHRs and registries.”
4. Address physician EHR usability challenges. The AMA aligns with the Health IT Certification/Adoption Workgroup recommendations to focus the certification program on: 1) interoperability; 2) quality measure reporting; and 3) privacy/security.
Usability continues to be an issue, with a 2013 study from RAND Health reporting dissatisfaction among many physicians who said that their EHR degraded patient interactions, made exchanging information between different systems more difficult and was time-consuming to learn and to use.
Cost is another major concern. According to a recent Health Affairs article and reported in GSN,“the average physician would lose $43,743 over five years; just 27% of practices would have achieved a positive return on investment; and only an additional 14% of practices would have come out ahead had they received the $44,000 federal meaningful-use incentive.”
More recently, the AMA amended its policy statement after it found that so far only 2% of physicians have shown stage 2 MU. In a press release, the AMA called for CMS to “suspend all penalties to physicians and health care facilities for failure to meet meaningful use criteria.”
There is a long way to go before EHRs may actually live up to the promise of enhancing patient care and efficiency in the health care arena, but hopefully the AMA’s recommendations will mark a step in the right direction.
Date: January 22, 2015