APA Joins Call for Reform of ‘Meaningful Use’ Program

APA has joined the AMA and some 60 medical specialty groups, as well as medical societies from the District of Columbia and every state in the country, in protesting the Obama administration’s decision to proceed with the third stage of the Meaningful Use (MU) program.

The MU program was established by the Health Information Technology for Economic and Clinical Health (HITECH) Act to promote the adoption and meaningful use of health information technology.

In separate but identical letters to Paul Ryan (R-Wis.), speaker of the House, and Rep. Nancy Pelosi (D-Calif.), minority leader of the House, APA and the other medical groups wrote that the regulations enacted by the Centers for Medicare and Medicaid Services (CMS) to enforce compliance with the law have hindered, rather than helped, physicians to adopt electronic health records.

“[A]s the regulatory scheme to measure ‘meaningful use’ of this technology has evolved, CMS has continued to layer requirement on top of requirement, usually without any real understanding of the way health care is delivered at the exam room level,” the medical groups stated. “What has emerged from this morass of regulation is a system that relegates physicians to the role of data entry clerks, filling the patient record with unnecessary documentation requirements unrelated to the provision of quality care. In addition, the program has failed to focus on interoperability and has instead created new barriers to easily exchanging data and information across care settings.”

To demonstrate meaningful use and qualify for incentive payments from CMS for treating Medicare patients under Stage 1 of the MU program, physicians were required by the end of 2013 to meet 20 objectives. These included 15 core objectives that all participants were required to demonstrate, as well as a list of 10 “menu” objectives from which physicians could choose five that apply to their practice. The objectives included requirements intended to improve quality, engage patients and family, improve care coordination, and maintain privacy and security. One of the required elements was to use EHRs to collect and report on clinical quality performance measures.

Beginning last year, physicians participating in the EHR Incentive Programs who met Stage 1 were required to meet Stage 2 criteria to receive incentive payments. These included new objectives to improve patient care through better clinical-decision support, care coordination, and patient engagement.

In October, CMS released guidelines for Stage 3, including eight new objectives for eligible professionals and hospitals, new adoption thresholds, advanced use of health information exchange functionality, and an overall focus on continuous quality improvement. In Stage 3, more than 60 percent of the proposed measures require interoperability, up from 33 percent in Stage 2. The Stage 3 requirements are optional in 2017, but all providers are required to comply with Stage 3 requirements beginning in 2018.

But APA and the letter co-signers stated that Stage 2 has largely failed to achieve its goals and that the program’s structure needs to be reassessed. “[W]e are writing to express our strong concerns with the decision by the administration to move ahead with implementation of Stage 3 of the Meaningful Use program despite the widespread failure of Stage 2,” the letters stated. “While the overall goal established by Congress in the HITECH Act, namely to promote widespread adoption of electronic health records by physicians and hospitals, has largely been achieved, the Stage 3 requirements are inconsistent with the goal of promoting better coordinated and high-quality patient care. Congressional action to refocus this program is urgently needed before physicians, frustrated by the near impossibility of compliance with meaningless and ill-informed bureaucratic requirements, abandon the program completely.”

They added, “Stage 2 of this program has largely been a failure, with only 12 percent of physicians successfully participating and little improvement in data exchange across care settings. CMS recently released modifications to Stage 2 to make modest improvements, though some new requirements will cause still more physicians to fail.

“Simultaneously CMS laid out more challenging requirements for Stage 3. Rather than build on the modest improvements made to Stage 2, CMS reverted back to the same fundamental flaws in the previous version of the program by focusing heavily on measure thresholds and excessive documentation requirements rather than improving interoperability. Relying so heavily on the failed construct of Stage 2 will only guarantee continued failure in Stage 3.”

APA and the medical groups urged CMS to make the program less rigid. “We believe that the success of the program hinges on a laser-like focus on promoting interoperability and allowing innovation to flourish as vendors respond to the demands of physicians and hospitals rather than the current system where vendors must meet the ill-informed check-the-box requirements of the current program.

“The administration has not responded to this need and instead has chosen to perpetuate the current failed program through the release of Stage 3 Meaningful Use. It is unrealistic to expect that doing the same thing over and over again will result in a different outcome. We believe, therefore, that it is time for Congress to act to refocus the Meaningful Use program on the goal of achieving a truly interoperable system of electronic health records that will support, rather than hinder, the delivery of high-quality care.” ■