MGMA president’s open letter to HHS Secretary Kathleen Sebelius from Susan Turney, MD, MS, FACMPE, FACP president and CEO, that is an important summation of the current meaningful use Stage 2 situation facing physicians and caregivers:
August 21, 2013
The Honorable Kathleen Sebelius Secretary Department of Health and Human Services 200 Independence Ave., S.W.
Room 445-G Washington, DC 20201
RE: Stage 2 meaningful use EHR Incentive Program
Dear Secretary Sebelius:
The Medical Group Management Association (MGMA) writes today to share our concerns regarding the current meaningful use environment and diminished opportunity for physician practices to meet the requirements for Stage 2 of the program. If the appropriate steps are not taken, we believe physicians that have made significant investments in EHR technology and successfully completed Stage 1 requirements will be unfairly subject to negative Medicare payment adjustments. Accordingly, HHS should immediately institute an indefinite moratorium on penalties for physicians that successfully completed Stage 1 meaningful use requirements.
Say it isn’t so: Farzad Mostashari, National Coordinator for Health Information Technology, is going the way of David Blumenthal and is exiting the position he has held for more than two years.
He announced today that will leave this fall, according to a letter by U.S. Secretary of Health & Human Services Secretary Kathleen Sebelius.
Mostashari has served as National Coordinator since April 2011. Mostashari served as deputy national coordinator prior to his current post.
“During this time of great accomplishment, Farzad has been an important advisor to me and many of us across the Department. His expertise, enthusiasm and commitment to innovation and health IT will surely be missed. In the short term, he will continue to serve in this role while a search is underway for a replacement,” Sebelius said in the letter.
Mostashari spent four years with ONC.
“During his tenure, ONC has been at the forefront of designing and implementing a number of initiatives to promote the adoption of health IT among health care providers,” Sebelius wrote in the memo. “Farzad has seen through the successful design and implementation of ONC’s HITECH programs, which provide health IT training and guidance to communities and providers; linked the meaningful use of electronic health records to population health goals; and laid a strong foundation for increasing the interoperability of health records — all while ensuring the ultimate focus remains on patients and their families.”
Fortuneteller Farzad Mostashari said recently that a lull in adoption of EHRs is expected, by him, and that 2014 will be a huge – banner – year for the adoption of the technology to participate in the meaningful use program, since 2014 is the last year to participate and still be eligible for federal incentives.
The penalty phase begins in 2015.
The incentive program is having a clear impact on adoption of the technology, as we all know. Without the “free” federal money and the threat of cuts in reimbursements, motivation to implement the oft described as burdensome technology was lagging.
However, the tools that allow us to do extraordinary things contribute to nearly all of the problems physicians and their practices face in healthcare. IT is to blame for healthcare’s problems; not lack of payment reform, overarching government intrusion, lack of research, the fact that doctors are only able to spend about eight minutes with each patient per visit, etc.
On its face, the CommonWell Health Alliancee really seems to hit the mark. A collection of the top EHR vendors coming together, sharing a stage and shaking hands; smiling; snapping photos of smiling happy CEOs. All together for one cause, or so the story goes: healthcare data interoperability. According to the “organization’s” website, interoperability is the cornerstone of healthcare’s future.
“Interoperability helps improve quality, reduce costs, enable regulatory compliance and ensure better access to healthcare for millions of people,” and so on and so forth.
Finally, CommonWell’s call to action: moving the healthcare industry beyond just recognizing the importance of interoperability, but moving the industry forward. CommonWell is supposed to be the health IT superhero that moved this giant boulder up the hill and positions it so eloquently on the top.
For those of us who didn’t know this already, CommonWell sums it up: “It’s time for healthcare IT organizations to come together and commit to achieving interoperability for the common good,” and so on and so forth.
So glad it took the giants of the industry to tell us as much.
Okay, so admittedly, this is a step in the right direction. It’s like putting big money behind a good cause. For everyone who has ever worked in the nonprofit trenches who spend their days begging the haves for the have nots, this a dream come true.
Those in the spot light can move us forward to a point where we must be. Allowing private enterprise to bear this mantle means we might finally make the move forward instead of being held back by the shackles of the federal reform and imposition.
After all, wasn’t interoperability a staple of meaningful use; an “industry consortium to adopt common standards and protocols to provide sustainable, cost-effective, trusted access to patient data,” if you will?
Because of meaningful use, we were supposed to be singing in circles by now, discussing all of the advancements we’ve made; our coming together and our ascending to the precipice. Alas, little has been attained through federally funded meaningful use except implementation and wars of words.
We waited, didn’t we? Long enough? Perhaps, perhaps not; depends on who you ask. Farzad Mostashari says we should wait a bit longer for the results to role in. The boys at Allscripts, athenahealth, Cerner, Greenway, McKesson and Relay Health (imagine the feelings of all the other vendor’s CEOs who were left out of this pre-arranged agreement; I guess there’s mincing words anymore) decided private enterprise is the way for things to actually get done.
And while it’s an interesting experiment, I think I agree with some of the other more intelligent folks in the field. Until we see some sort of actual forward movement with this initiative and until there’s some proof of life, this is really nothing more than a stake in the ground. A happy public relations move designed to flex a little corporate muscle on the industry’s largest stage.
The meaningful use of data collected in an electronic health record continues to be the stump speech of Farzad Mostashari, National Coordinator for Health Information Technology.
He’s been pushing the message for months: those achieving or working toward meaningful use attestation need to get beyond just the financial incentives of the program, he says.
Physicians and their healthcare systems need to dig deeper and realize the importance of the data that they have at their hands. They need to realize just how to leverage the data to improve their patient’s health outcomes and lead those in their care down an educational path about the importance of their involvement in their care and how electronic systems can help improve their interaction with their care providers.
For meaningful use to work, those in the community need to make sure they’re using the data collected meaningfully. Meaningful use is a tool and it should be used as one; but unlike a simple jack knife, it’s a multi-purpose, multi-blade, do-it-all Swiss Army knife.
If used correctly, as a means for change rather than a singular solution for incentives, Mostashari believes that meaningful use can actually lead to population health management (the real reason behind meaningful use), more patient engagement (this is yet to be determined) and the creation of health information exchanges (yes, but we need interoperable systems before we see wide spread use of data outside their silos).
His ambitions are correct, and collectively, there is a fundamental agreement that meaningfully using EHRs will help accomplish all of these goals (though patient engagement may remain the stickiest of wickets). The problem here, though, seems to be that even though most physicians want to dive into the deep pool of big data, but they just don’t seem to be able to catch their breath.
In all walks of life we face the day-to-day grind of ongoing and seemingly never ending tasks that drive us further away from our goals. However, it’s different in healthcare. I just can’t seem to think of any other professional group (other than members of the military and police forces) under so much constant pressure to produce positive, long-term results for the people they serve.
In addition to making life and death decisions, our physicians and healthcare leaders are constantly facing the deluge of regulation and reform (meaningful use, ICD-10, HIPAA and even to a certain extend malpractice and 5010).
Healthcare professionals are overrun by details that have taken them into the weeds. Their days are long and their time is short. We can argue if electronic health records actually save them time and money. Depending with whom you speak, each person has an opinion as to its effect. Add everything I previously mentioned and it’s simply overwhelming.
I firmly believe that in a best case scenario, we’d be able to meet all of Mostashari’s proposed goals. Big data would (and can) lead to a changed system and provide real and personal stories of improved health outcomes. I believe that if we could clear away the clutter, we could begin building upon the foundation and create the best, most comprehensive, patient-serving healthcare system that produces results and actually changes lives.
But, for now, we live in a database world where no matter how meaningful we use them there’s still much left to be desired.
Farzad Mostashari, national health IT coordinator, says more progress has been made in health IT in the last 20 months than during the last 20 years. It’s a statement he made during the first day of National Health IT Week in September.
Increased adoption of electronic health records and the push toward meaningful use have been the catalysts for this movement, most of which has been driven by the financial incentives associated with meaningful use.
The ultimate goal of meaningful use, and the subsequent adoption of the healthcare technology, is data collection. A subset is patient engagement.
To a lot of different people, patient engagement means a lot of different things. For some, it’s about patients having access to their information, and for others it has nothing to do with “giving” patients information, but more about making them the center of care, Mostashari said recently.
Health and its information are owned by its community, he said, and the community must have access to its information. Policies and practices need to be set in place to unleash and unlock the activities of the community.
One effort to encourage this is “Blue Button.”
“Blue Button is national symbol for the concept of ‘give me my data,’” he said during his address at National Health IT Week in September 2012.
But the effort is transcending patients. It’s being brought to the vendor community, and their commitment is being requested. Mostashari has challenged vendors to make it easy for consumers, by as early 2013, to view, download and transmit to another party their health information through Blue Button. Engaging the vendor community is exactly the kind of effort the market needs since they have a seat at the table.
So far, several vendors have committed to meeting the deadline for the challenge, which is by the HIMSS Annual Conference in early March 2013. The current list of vendors to accept the challenge (those deserving some recognition) include:
Greenway Medical Technologies
Engaging the vendor community in this effort, for an early push toward view, download and transmit, is the right thing to do and it’s encouraging to to see Mostashari putting ONC’s muscle behind this effort.
Vendors are the folks playing a huge part in the overall effort for a transformed healthcare system and they plan to gain the most because of it. As such, it’s good to see them encouraged to take greater ownership of this process and play a larger role in encouraging the patient engagement process.
The numbers don’t lie. The meaningful use incentive program is working, at least as far as awarding stimulus funds is concerned. The incentive program awarded “761 hospitals and 56,585 professionals a total of approximately $2.3 billion for 2011; $1.3 billion to hospitals and $1 billion to eligible professionals,” according to Healthcare IT News.
The median payment to hospitals was $1.7 million. According to the same publication, in a recent interview with National Coordinator for Health Information Technology, Farzad Mostashari, his top concern is how hospitals and practices embrace the spirit of the rule and use their technology to successfully engage patients.
From dollars to sense. Without patient engagement, meaningful use is meaningless. Without applying the patient information to the population served and working to improve outcomes and offering education and guidance – perhaps creating support groups for smokers wanting to quit or practice-sponsored nutrition plans for obese and diabetic populations – to patients, meaningful use is nothing more than a government-run plan to collect information about its citizen’s health.
Incentives aside, healthcare providers should wish to do no harm and use the information available to fully commit to embracing change through the technology and data available and do what they do best: care for and help provide health education to their patients, their customers.
In other words, to borrow a line from Mostashari, “If you treat meaningful use as work, you won’t get much out of it.”