Holiday Musings over the Meaningful Use EHR Incentive Program

The following blog also ran on EMR Daily News here.

I see in breaking news that CMS has offered up an early present – a one year extension for meeting Stage 2 ‘meaningful use’ requirements.  Not to be a Scrooge, but this is like the fruitcake that everyone expects but no one cares about.  We are barely scratching the surface for meeting Stage 1 ‘meaningful use’ requirements.

Skeptical?  Well, have you checked out the latest CMS data and reports concerning the EHR Incentive Programs for Meaningful Use? Including October, CMS reports that more than 104,000 eligible professionals (EP) and nearly 2,600 hospitals have registered for the Medicare EHR Incentive Program. Of those registered, approximately 18% (5,805) of the EPs and just less than 11% (235) of the hospitals have qualified and received incentive payments for Stage 1. Not too bad, huh? That’s certainly better than the 4% for physicians and 1.5% for hospitals for ‘meaningful use’ of EHRs that came from Dr. David Blumenthal’s prestigious research team at the Mongan Institute for Health Policy.  It was, after all, the findings from his team’s peer-reviewed studies that formed the basis for EHR Incentive Programs requirements once Dr. Blumenthal took leadership of the ONC for HITECH. It seems appropriate to measure our success against those baselines.

However, the numbers in the CMS report are skewed. Eligible Professionals consist of physicians, nurse practitioners, certified nurse/mid-wives, dentists and physicians assistants. There are approximately 600,000 U.S. physicians and countless other NPs, mid-wives, dentists and PAs.  Yet only about 100,000 combined have registered for the program? If we use the conservative base of 600,000 EPs, it means we’ve only seen about 1% of the EPs qualify and receive payment – even worse than the study findings from the Mongan Institute!

Hospitals are doing somewhat better, but not much. Approximately 5,300 hospitals previously noted their intent to achieve ‘meaningful use’ per the recent Annual HIMSS Leadership Study. The CMS report notes only about 48% have registered for incentive payments. Since only 235 have qualified and received payments, the success rate for hospitals stands at 4.4%. That’s a big improvement over the 2009 study from Jha, DeRoches, Campbell, et al under Dr. Blumenthal’s guidance, but it is still a huge disappointment.

It is not for lack of effort, either. Most of the industry has been all-consumed in ‘meaningful use’ efforts for the past two years. Just look at the 2010 and 2011 Annual HIMSS Leadership Survey which show that the vast majority of our IT efforts have been focused on delivering fully functioning, enterprise-wide EHRs. So we’ve spent two years running flat out to achieve ‘meaningful use’, yet this is all we’ve done? Maybe you can argue the requirements are too stringent. Perhaps the CMS reporting is incomplete. Or, maybe, registration efforts are being hindered. Regardless, when I look at the numbers, I see disappointing results from Stage 1 for an industry that prides itself on outcomes. We simply must do better.

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