Docs con­tem­plate mean­ing

In­dus­try pushes mean­ing­ful use through in­cen­tives

Modern Healthcare - - The Week In Healthcare - Jen­nifer Lubell

lmost ev­ery­one in the health­care in­dus­try, it seems, wants physi­cians to get on the mean­ing­ful-use band­wagon. The ques­tion is whether most physi­cians are ready to jump on­board.

Pay­ers as well as provider and li­cen­sure or­ga­ni­za­tions re­cently made a gi­ant push to en­cour­age physi­cians to adopt elec­tronic health records, an­nounc­ing sev­eral health in­for­ma­tion technology ini­tia­tives at a fo­rum held re­cently in Washington.

“This is a team sport,” said David Blu­men­thal, na­tional co­or­di­na­tor for health IT, dur­ing the fo­rum, which was spon­sored by Health Af­fairs and Bran­deis Uni­ver­sity’s Health In­dus­try Fo­rum. To ad­vance the CMS’ new mean­ing­ful-use reg­u­la­tions, “it’s clear that the sus­tain­abil­ity of this ef­fort … has to come from the pri­vate sec­tor,” Blu­men­thal said.

Unit­edHealth Group, for ex­am­ple, is de­ploy­ing on a na­tional scale its per­for­mance­based con­tract­ing pro­gram, which pro­vides out­comes-based fi­nan­cial in­cen­tives to physi­cians who use EHRs in ways that meet mean­ing­ful-use cri­te­ria. And ThedaCare, a sys­tem of three hos­pi­tals based in Ap­ple­ton, Wis., plans to train all of its physi­cians on the mean­ing­ful use of health IT through ex­ten­sive

Atrain­ing of its em­ployed physi­cians and in­de­pen­dent com­mu­nity physi­cians. Physi­cians will also be feel­ing the pres­sure to be IT savvy in or­der to main­tain their pro­fes­sional cer­ti­fi­ca­tion. The Amer­i­can Board of Med­i­cal Spe­cial­ties said that it would in­cor­po­rate tools to pro­mote mean­ing­ful use of health IT into its main­te­nance-of-cer­ti­fi­ca­tion pro­gram.

More than 750,000 U.S. physi­cians are cer­ti­fied by an ABMS mem­ber board, “so it’s read­ily ap­par­ent” that build­ing mean­ing­ful use of health IT into cer­ti­fi­ca­tion main­te­nance will ben­e­fit pa­tients, ABMS Pres­i­dent and CEO Kevin Weiss, said in a writ­ten state­ment. Ad­di­tion­ally, the merg­ing of these two tools “will help to fa­cil­i­tate physi­cians’ knowl­edge, skill and use of health IT, and in turn can im­prove physi­cian per­for­mance and pa­tient out­comes,” he said.

In par­tic­u­lar, the ABMS wants to de­velop new knowl­edge self-as­sess­ment mod­ules that among other things would eval­u­ate a physi­cian’s knowl­edge of health IT for in­cor­po­rat­ing ev­i­dence-based medicine into their prac­tice, de­ci­sion sup­port and data ac­qui­si­tion, and anal­y­sis and re­port­ing re­lated to cor­rect use of the technology. The li­cen- sure board is also in­ter­ested in data in­ter­change util­i­ties that would en­able physi­cians to sub­mit Physi­cian Re­port­ing Qual­ity Ini­tia­tive and health IT mean­ing­ful-use mea­sures to the boards in the same for­mat used by the CMS in an ef­fort to avoid re­dun­dant data sub­mis­sions.

Rep­re­sen­ta­tives of li­cen­sure or­ga­ni­za­tions stress that the new health IT tools would not be re­quired of doc­tors to stay cer­ti­fied. But some doc­tors are wary of this pair­ing of main­te­nance of cer­ti­fi­ca­tion and mean­ing­ful use.

“I don’t be­lieve achiev­ing mean­ing­ful use equates to main­te­nance of cer­ti­fi­ca­tion,” said Michael Migliori, an oph­thal­mol­o­gist in Prov­i­dence, R.I. Main­te­nance of cer­ti­fi­ca­tion is a mea­sure­ment of clin­i­cal knowl­edge, whereas mean­ing­ful use is a cler­i­cal des­ig­na­tion, he said.

“I un­der­stand the clin­i­cal im­por­tance of elec­tronic med­i­cal records both in terms of pa­tient safety and qual­ity, but we are not at the point where EMR and health in­for­ma­tion ex­change are ready for uni­ver­sal im­ple­men­ta­tion,” Migliori said. “They should not be linked at this time.”

The in­tent of these ini­tia­tives is laud­able, but “the devil is in the de­tails” on how this will all play out in the long run, said Lori Heim, pres­i­dent of the Amer­i­can Academy of Fam­ily Physi­cians. It’s un­known at this point whether the ABMS’ new health IT pro­vi­sions to main­tain cer­ti­fi­ca­tion “will re­main sim­ply a tool or a re­quire­ment,” she said.

“We cer­tainly sup­port health IT adop­tion, but it has to work within physi­cian prac­tices” and not be im­posed upon fam­ily physi­cians, she said.

Migliori: “They should not be linked at this time.”

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