The pace at which eligible providers are leaving the EHR Incentive Program is higher than most high school dropout rates, according to the latest data from CMS. Seventeen percent of providers who collected a 90-day incentive payment in 2011 either decided not to pursue the program for the following full year or were unable to sustain their efforts for that long. Despite the continued increase of new providers joining the program, the rate of failure is astonishing and somewhat troubling. If meaningful use can’t hold on to participants by offering big incentives, what will happen when that money goes away – and what does that say about the deeper issues underlying EHR adoption in the United States?
Some EHR implementations simply detonate on impact, falling prey to poor planning or the dreaded EHR backlash from unhappy physicians and clinical staff. Other providers find that their first EHR system doesn’t meet their needs, and hunt for a replacement that better suits their practice’s style, which might delay their participation in meaningful use by a few months. But after investing in a certified EHR, adapting their workflow to successfully meet the EHR Incentive Program’s requirements for three months, and collecting their money from CMS, why would a provider decide that continuing on that path just isn’t worth it?
One reason might be the number of providers caught in the no man’s land of being desperately unhappy with their EHR, but unable to afford a replacement. In a recent Black Book survey, 8% of providers indicated that they’re dissatisfied with the software they chose, but it’s simply too expensive to do anything about it. With 79% of disgruntled providers admitting they didn’t do enough research during their initial purchasing process, and more than 80% of specialists frustrated with products that don’t meet their needs, maybe it’s just too much to wrestle with frustrating, inadequate software every day and try to collect all the additional data required by the meaningful use program at the same time.
In addition, another recent survey indicates that 14% of respondents who successfully attested to Stage 1 don’t plan to continue their participation when Stage 2 comes into effect. Stage 2 raises reporting thresholds and adds patient engagement and health information exchange requirements at the same time that ICD-10 is scheduled to slam providers with questionable revenue effects and major documentation adjustments.
Is it all simply too much? Maybe. But providers who accept Medicare patients will be facing payment adjustments in 2015 if they don’t stay on the path of meaningful use. The initial 2% penalty might not seem like much, and some EHR opponents are telling physicians just to take the hit instead of throwing money down the drain to adopt an EHR and train staff to participate in time-consuming data collection that doesn’t improve their daily patient care. But it’s a risky choice, especially as baby boomers age into Medicare eligibility at an increasingly rapid rate.
It’s no secret that physicians just want to practice medicine. They want to spend time with their patients and have the freedom to decide how to run their own businesses and take their own notes. Not everyone sees the EHR Incentive Program as an effective way to make medicine smarter and reduce costs. Not everyone agrees with the ONC’s methods of fostering interoperability of health IT systems, or the way CMS is threatening non-compliant providers.
But left to its own devices, it’s unlikely that healthcare would make the necessary sacrifices to bring it into the digital age and realize the benefits of health IT. It’s clear from the haphazard and reluctant ICD-10 transition that people will put off anything that isn’t mandated as long as humanly possible, no matter how inadequate their current state of affairs.
Meaningful use may be painful, and it may be difficult. It may not be perfect. However, providers who drop out of a program that’s paying them to participate are setting themselves up for an uncertain future, and need to think carefully about frying pans and fires before choosing to leave meaningful use behind for good.