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Has CMS Failed to Demonstrate Value of Meaningful Use?

Last week's meaningful use town hall in Seattle was the latest in a series of nationwide events aimed at promoting discussions about meaningful use requirements.

By Kyle Murphy, PhD

For all the complaints about the EHR Incentive Programs and meaningful use requirements, one raised at a recent town hall meeting on the subject of meaningful use is especially important to determining the future of the program — what is the return on the sizeable data investment made by eligible providers?

Convened by the American Medical Association (AMA), last week's meaningful use town hall in Seattle was the latest in a series of nationwide events aimed at promoting discussions about certified EHR technology use and potential solutions to challenges raised by the EHR Incentive Programs.

Of the several physicians who shared their stories during the open mic event in Washington State, two brought attention to the inability of eligible providers to make use of the data collected and reported to the Centers for Medicare & Medicaid Services (CMS) as part of meaningful use.

The first was internist William Hirota, MD, who issued his own challenge to CMS:

One of the great frustrations about meaningful use for me is that it has not demonstrated any specific transformative change in the quality that I see. We’re incentivized to three specific metrics financially for meaningful use. We have to document problem lists, that we’re reviewing problem lists, the medication lists, and the after visit summary. There’s a group of 20 of us and routinely we meet on a quarterly basis to see how we’re doing. And universally, although our threshold is 80 percent, we’re capturing 100 percent of this data on every single visit with our patients and it’s because we’re just going straight to those metrics, quickly looking and clicking on it.

My challenge to CMS and the people who look at this data is to now, they probably have a massive amount of data throughout the country, where they could collate and demonstrate to the providers that this information has made an impact in quality. Every time you bring it up to the administration, if everyone’s giving 100 percent every quarter for a year, two years, why are you continuing to collect this data, and how has it changed our practice?

Later in the town hall, family practitioner Reena Koshy, MD, voiced sentiments in a similar vein while considering how meaningful use data could serve a valuable role in population health management:

One of the potentials would be being able to do more population health medicine because I think what we do is — we’re seeing all of these individuals in our clinic and we’re trying to imagine how does their health compare to others in our population — are we doing better, are we doing worse? How does their health compare to the national trends?

What we don’t see is our information going in to create this big picture that we can then also see back in real time. What would be really helpful, just an example, vaccines. I have plenty of patients who move from other place and say, ‘oh you don’t have my vaccine in some national database?’ and I’m like, ‘that would be so cool.’ And it would be great if we had a national database of vaccines, and then when I put the vaccine data in for my individual visit, it populates this national data base. And then it would be even better if we could see, what by zip code is your vaccine rate in my community compared to maybe my state, or the nation? And then even be able to at that point of care tell people, well here’s what your vaccine exception rate look like in your school.

Given medicine's adherence to evidence-based practices, the absence of new guidelines — at least as far as EHR use — coming out of meaningful use is problematic. Eligible providers already struggle with realizing a return on investment for meaningful use. Others soldiered through Stage 1 and Stage 2 Meaningful Use despite setbacks and regulatory changes.

The notion that CMS wants to put providers back in charge through meaningful use is unlikely to gain traction without addressing the wants and needs of the provider community. Even if the EHR Incentive Programs cease, the federal agency has data for hundreds of thousands of meaningful use attestations — data that could prove meaningful use when made actionable.

With help from Sara Heath

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