Is Meaningful Use Worth The Effort?

Compiled by Susan Kreimer, contributing editor

Attesting for Meaningful Use is a time-consuming and costly endeavor for physicians practices. Many practices are beginning to see the fruits of their labor, but others still think the program is misguided.

While the federal government’s EHR Meaningful Use (MU) program has multiple objectives, the following are two of the most important: 1) Motivate healthcare providers to adopt EHR technology; and 2) Create a structured foundation for electronic health data exchange. The realization of the second objective is still a ways off, and building towards it can seem like a fruitless, even counter-productive, effort for some healthcare providers — particularly physicians practices.

In short, many of the steps required for MU (e.g. blood pressure, obesity, smoking cessation documentation) seem more geared toward hospitals and PCPs than specialists. Moreover, the time and resources necessary to capture all of the data necessary for successful MU attestation can often seem to outweigh the promise of MU incentive dollars. We asked three representatives from three doctors’ offices to share their thoughts on the costs and benefits of the MU program to their practices, and how these factors have affected their participation in the program to date.

Q: What unique challenges do physicians practices face in trying to achieve MU?

Dr. Wayne: The increased requirements of our time and resources are certainly big challenges. Getting started with MU is a time constraint. To give you an example, I used to go home from the office at 3:30 p.m.; now I’m lucky if I get out by 5 p.m. I have to do an hour’s worth of homework, filling out charts and completing data. And I’m a small one-man practice. I share a secretary and medical assistant with several other doctors.

Medicare is paying us less for the same work. In 1992, I received about $450 for a hernia operation, and I am paid about $350 today.

That being said, there are some advantages to the MU program. For example, it helps you streamline and organize your practice by eliminating paper. MU is also a necessary evil if you want to continue to receive the compensation you’re accustomed to from Medicare. If I wasn’t participating in the MU program, I would eventually be assessed 1- to 2-percent penalties on my Medicare payments. Instead, each time I successfully attest for the next stage of MU, Medicare rewards me with an incentive payment of several thousand dollars and I avoid these payment penalties.

Ms. Hudson: MU is a huge financial strain on physicians practices, particularly those that are independently owned. In fact, a lot of specialists and family practitioners are selling their practices to health systems because they can’t afford to stay in private practice. Our hospital, for instance, has been active in hiring more family practitioners and specialists.

Dr. Girgis: As a private physician, I do not have an IT team like a hospital would. Basically, my IT department is a closet, and when it goes down, I’m standing on a chair unplugging things trying to fix it.

We are overwhelmed by MU and just trying to keep up. In order to learn the MU requirements and implement them, we had to dedicate one of our staff full time to this task. That took her away from other needed tasks and caused a lot of backlog in our practice. It was time-consuming and costly.

Q: How is MU different for specialists than for PCPs?

Dr. Wayne: For specialists, we don’t struggle as much to get material into the history and physical. Our history and physicals don’t have to be as expansive as those of nonsurgical specialists. MU criteria to date is definitely more geared toward family practice and internal medicine. There’s a lot of material that isn’t applicable to specialists.

Ms. Hudson: It’s technically not very different. The same measures are mandated. You can be excluded for certain criteria; for instance, if you’re a general surgeon who doesn’t e-prescribe more than 100 prescriptions within the 90-day time period.

Dr. Girgis: It is much more difficult for PCPs, because we are now being pushed to become certified as the patient’s medical home (my practice is certified, by the way). This makes us responsible for every aspect of the patient’s care and communication with the specialists. The specialist is responsible for only one aspect of the patient’s care and often for just a limited time. I do not know what their MU requirements are, but the steps for the medical home certification are an unduly burdensome process. It took us almost six months to submit all the data.

Q: How are you addressing MU challenges in your facility? What are your MU best practices?

Dr. Wayne: In my office I am using an EMR called Practice Fusion, which, amazingly, is free to the provider. There’s a small amount of advertising on the website, but this is not a problem for the user. I find this EMR to be very flexible and applicable to specialists. It incorporates all of the features required for MU. Plus, it includes a dashboard feature that tells you how I’m doing in regards to meeting MU.

Ms. Hudson: I monitor each of our 34 providers’ MU report cards, which are integrated into our SuccessEHS EMR Software. This MU report card lists all the required measures for our providers. By monitoring this weekly for the 90-day period, I can easily tell if they are not doing patient education or if someone was not e-prescribing as they should have been. I constantly monitor this report card and educate when necessary. I have EMR MU meetings twice a month —- once with primary care practitioners and once with our specialists.

Dr. Girgis: Regarding the MU challenges, I have to do much of this myself. I will not take time away from patient care to do this, because that is why I’m a doctor —- for my patients. So I end up doing it at home after office hours. I stay up late doing these things, learning MU, and deciding how to implement change. It has cost me personal time.

To ensure we stay current with MU recommendations, our staff goes through the records to make sure everything is in the chart that needs to be after our encounter notes have been done. We also have staff looking through the preventive measures to see if the patient is due for any services and try to address these ASAP with the patient.

Q: Where is your practice currently as it relates to MU attestation?

Dr. Wayne: I have completed attestation of MU Part 1. The second year, Part 2, is a 12-month attestation to meet criteria, and I’m on track to meet it using Practice Fusion. The software from Practice Fusion provides online support that helps with MU attestation.

Ms. Hudson: We’ve successfully attested for all of our providers who were able to attest in 2011 and 2012 reporting periods. We’ve done two years of MU successfully and soon will be submitting our third year. None of my providers failed any measures in two years. We did 90 days in 2011 and a full year in 2012.

We’re currently in the process of moving into Stage 2 MU in January 2014. The way I personally prepare for MU is to start on top of the requirements and implement them as soon as possible. If you wait until the end of the reporting period to implement new changes, you will overwhelm your staff and providers. I also run a trial period from January to March to see where everybody sits and to see who I need to educate to prepare for the reporting period.

Dr. Girgis: We were qualified and have already been paid for the two attestation periods for Stage 1 MU. We have some changes to implement before the Stage 2 reporting period, mostly in the way we are charting, but we will be ready.

Q: What does Stage 3 MU need to focus on to cater to the physicians practices/specialists?

Ms. Hudson: Stage 3 needs to be geared more toward how to bring it all together and incorporated into patient-centered medical home (PCMH), instead of straight criteria meeting certain measures by a percentage. The program could be improved if it could focus more on patient care and provider development.

Dr. Girgis: I think Stage 3 should focus on the interoperability of EHR systems. However, this is not something docs have any control over. The technology is just not there yet.

Q: What impact do you think MU will ultimately have on physicians practices and the healthcare system at large?

Dr. Wayne: The downside is that it still slows you down somewhat, even after you get good at it. I’ve been doing it for a couple of years in the office. However, I definitely feel MU improves patient interaction. The program reminds doctors to fulfill certain patient recommendations, particularly those that are required in preventive health, such as a colonoscopy every number of years, a Pap smear, or a mammogram. The reminders are programmed into the EMR, and they’re more effective than us telling ourselves, “I hope I remember to do that when the patient comes back.”

Ms. Hudson: MU promotes patient care by improving documentation. With an EMR, you can easily identify errors and improve the quality of care. You also have easier access to your medical records regardless of your location. MU ensures all providers are doing the same thing, which is great. The downfall to it is the strict time constraint. Providers don’t have enough time to adjust. Meeting much of the criteria requires resources, time, and funding that most practices just don’t have. Plus, managing all of this change is stressful on a practice.

Dr. Girgis: MU has already had some adverse effects on my practice. Doctors now spend more time charting. We feel that we are sometimes treated like data-entry clerks. And this does take away face time with the patient. My opinion is that an EHR should make us more efficient and enable us to have more time with the patient. However, MU requirements have the exact opposite effect. We should be more concerned about the patient’s well-being than hitting points that the government wants us to include in the chart — especially since many of these data points are not important for the actual care of the patient. They are only important for data gathering. Many docs fear a lot of the data collected for MU will be used against us in some way to decrease our reimbursements. EHRs are great and can be a very effective tool for improving the practice of medicine. MU, however, is not promoting their use in the right way. It is putting too many time-consuming burdens on us at the sacrifice of time with the patient, quality patient care, and decreased quality of the whole healthcare system.

Also, the people who are making the requirements for MU and developing EHRs are not physicians. Docs are rarely consulted about these things. If we truly want to make an EHR that is efficient and interoperable, it needs input from the ones on the frontlines actually using the technology: the doctors. Many docs feel that MU is merely a way for insurance companies and the government to be able to harness data on our practices, thus not “meaningful” to us and the way we practice medicine. We need to get the focus back on making the medical record a means of transmitting information that is useful for patient care, not merely for satisfying data requirements others have set for us.