Why Some Providers Are Opting Out of Meaningful Use

Since its inception, the Centers for Medicare and Medicaid's (CMS) EHR Incentive program has had detractors. In fact, many organizations have expressed concern about the timeline for the program’s Meaningful Use criteria each year. In response, CMS has made some changes to reporting periods and other aspects of the program.

However, these changes haven’t been enough for some providers. 2014 appears to be the year that many practices decided the program simply wasn’t worth their effort.

The numbers vary, but Medscape estimated that nearly 1 in 4 physicians would not attest to Meaningful Use in 2014. Future estimates show a further decline, with a survey from Medical Practice Insider and SERMO forecasting that over 50 percent of physicians do not plan to attest in 2015.

Attrition may be climbing, but this loss of participants isn’t new. “We saw a 17 percent drop off of Meaningful Use users that engaged in 2011 but didn’t in 2012,” said Jason Mitchell, director of the American Academy of Family Physicians’ Center for Health IT.

Despite investing tens of billions of dollars into incentivizing EHR adoption, CMS is faced with a major drop off of participants in only the second stage of a three phase plan. 

What are the factors behind this trend?

Misaligned Incentives
From a business perspective, healthcare has always been an industry dictated by incentives and reimbursements. Proponents of change have long called for a realignment of incentives to better reflect the priorities of physicians, but Meaningful Use wasn’t quite what they imagined.

Meaningful Use implemented a number of new standards, but research has yet to validate that adhering to these standards engenders better care or reduced operating costs. “The following sentence is false 100 percent of the time: ‘We completed Meaningful Use stages 1 and 2 and as a consequence the care we provided for our patients has improved,” said a physician respondent to Medical Practice Insider’s survey.

In addition, many providers have worried that the ambitious timelines for Meaningful Use would result in providers rushing to implement EHR systems without adequately training the practice staff. In some instances that’s exactly what has happened, and it’s resulted in new types of errors that could adversely affect patients.

Unrealistic Expectations
In addition to the incentive changes, Meaningful Use makes a huge leap in terms of quality measures and attestation expectations in Stage 2. Naturally, it’s when the majority of providers hit this stage in 2014 that the program began to see a large number of drop-offs.

The patient portal requirements, for instance, pose a conundrum for physicians who serve mainly patients who may have limited access to a computer due to age, illness, socioeconimic factors.

Additionally, the objective requiring data exchange between heterogeneous systems often seems out of the provider’s control. One provider may deploy a system that meets the interoperability standards, but the EHRs of her local peers may not match that capability. Obviously data exchange is a two-way communication, but physicians have little control over the other party’s priorities or systems.

CMS’s refusal to provide partial reimbursement for getting close to objective goals also means that months of hard work could be for nothing.

For some physicians this proposition no longer makes financial sense, and taking the penalty to Medicare reimbursement looks like the smarter business proposition.

CMS has implemented a hardship exception that allows certain providers to opt out of Meaningful Use attestation and avoiding penalties. However, this exemption simply reinforces the flawed nature of their rigid pass or fail system.

What Does this Mean for EHRs?
Despite the grim outlook for Meaningful Use, physicians shouldn’t abandon the concept of the electronic health records. Sticking with paper records only signifies a dedication to an antiquated system. Paper records offer no feasible methods for patients to access their health histories, for providers to effectively coordinate care, or for recovery in case of natural disaster.

In short, paper records are an anachronism, and technology will march on.

EHRs in their present condition are imperfect, but the increasing prevalence of cloud-based products will continue to simplify data transfer. And due to physician feedback, usability is becoming a larger priority for EHR vendors.

Additionally, there have been notable recent findings that link EHR use to better patient safety and outcomes. Success often lies in how the organization uses the EHR, rather than the software alone.

Even if the Meaningful Use program ultimately fails to reach the finish line, it will still have accomplished its main goal: to drive physicians to adopt electronic medical records in significant numbers offer a relatively short time period.

Healthcare has already moved forward. Debating the merits of using EHRs has lost its value. The conversation should now be focused on which products are working for physicians and how these successes can become the standard.