Reach­ing for the sky

Work group: Mean­ing­ful users should aim high, but don’t have to be per­fect

Modern Healthcare - - THE WEEK - Joseph Conn

The fed­eral in­cen­tive pay­ment pro­gram for the mean­ing­ful use of elec­tronic health-record sys­tems is set up to re­quire providers to meet in­creas­ingly high tar­gets through each of the pro­gram’s three stages. As providers await the CMS’ re­lease this sum­mer of the fi­nal rule for Stage 2 cri­te­ria, what can they an­tic­i­pate down the line? How high will the bar rise to de­fine suc­cess?

Ac­cord­ing to a panel charged with ad­vis­ing the fed­eral Health IT Pol­icy Com­mit­tee on mean­ing­ful-use cri­te­ria, that mean­ing­ful-use bar won’t hit the ceil­ing.

“One of our prin­ci­ples is not top­ping out,” said Dr. Paul Tang, vice chair­man of the fed­eral Health IT Pol­icy Com­mit­tee and co-chair of the mean­ing­ful-use work group that met last week.

There should be an up­per limit short of per­fec­tion, or less than 100%, of what­ever met­ric is be­ing mea­sured—for ex­am­ple, record­ing a pa­tient’s vi­tal signs elec­tron­i­cally, ac­cord­ing to the panel.

“We sort of stopped around 80%,” Tang said. “There’s al­ways go­ing to be le­git­i­mate rea­sons why we can’t get to 100%.”

Through June, 3,388 hos­pi­tals and 108,308 of­fice-based physi­cians and other so-called el­i­gi­ble pro­fes­sion­als have shared nearly $6.2 bil­lion in Medi­care and Med­i­caid EHR in­cen­tive pay­ments through pro­grams cre­ated by the Amer­i­can Re­cov­ery and Rein­vest­ment Act of 2009, ac­cord­ing to CMS data.

The Medi­care pro­gram re­cip­i­ents were paid af­ter at­test­ing they had met Stage 1 cri­te­ria for mean­ing­ful use of an EHR sys­tem. At dead­line, the Stage 2 fi­nal rule was un­der re­view by the Of­fice of Man­age­ment and Bud­get.

Tang and other work group mem­bers were re­view­ing feed­back from the full pol­icy com­mit­tee on its ini­tial draft of rec­om­men­da­tions on mean­ing­ful-use cri­te­ria for Stage 3, which isn’t expected to take ef­fect un­til at least 2016.

Work group mem­bers let stand their rec­om­men­da­tion that “100% is al­ways the goal from a pol­icy per­spec­tive,” but “80% is the bar we want to set.”

For a provider to fall short of 100% by a per­cent­age point or two and lose a pay­ment or to be en­cum­bered by the need to seek waivers would be detri­men­tal to the pro­gram, which aims to im­prove the qual­ity of care and lower health­care costs through health IT adoption and use, Tang and his work group col­leagues con­cluded.

Their dis­cus­sion of the up­per lim­its of ef­fec­tive mea­sure­ment came as mem­bers re­viewed rec­om­men­da­tions on sev­eral spe­cific cri­te­ria that re­quire per­cent­age cal­cu­la­tions, in­clud­ing a re­quire­ment that providers use their EHRS to record changes in a pa­tient’s vi­tal signs, in­clud­ing blood pres­sure, height, weight and body mass in­dex.

The Stage 1 mean­ing­ful-use re­quire­ment is that vi­tal signs be recorded in an EHR for 50% of pa­tients ages 2 and older.

The Stage 2 pro­posed rule, pub­lished by the CMS in March, pushed the vi­tal signs tar­get up to 80%. But that’s where it should stay for Stage 3, the work group rec­om­mended.

If a provider is ca­pa­ble of achiev­ing 80% of a com­pli­ance tar­get, they are ca­pa­ble of do­ing more—and prob­a­bly will, Tang said. “Peo­ple don’t stop and say let’s don’t go be­yond 80,” he said. The work group re­viewed 51 pro­posed cri­te­ria types. One of those cri­te­ria, un­der the broad cat­e­gory of lever­ag­ing health IT to bet­ter en­gage pa­tients and their fam­i­lies in the care and well­ness process, ad­dresses the ad­vent of ac­count­able care or­ga­ni­za­tions and pa­tient-cen­tered med­i­cal homes. It seeks to lever­age home and mo­bile-health tech­nolo­gies to gen­er­ate pa­tient data that is com­mu­ni­cated to and stored in providers’ EHRS.

For ex­am­ple, it would re­quire that hos­pi­tals, physi­cians and other EPS give at least 10% of their pa­tients the abil­ity to send to a provider’s EHR one or more type of pa­tient-gen­er­ated in­for­ma­tion. That would in­clude a pa­tient’s fam­ily health his­tory, func­tional sta­tus, blood glu­cose level, blood pres­sure or weight.

Much of pa­tient in­put in the med­i­cal record of the fu­ture is expected to come from per­sonal health mon­i­tor­ing ap­pli­ca­tions on smart­phones and tablets, ac­cord­ing to mo­bile health ex­perts. (See story on p. 30.)

Tang: “Peo­ple don’t stop and say let’s don’t go be­yond 80.”

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