Search the KHIT Blog

Thursday, March 13, 2014

'An EHR should not be a federally-subsidized “hardship”.'

AthenaHealth's Dan Haley writes at THCB
Pursuant to the American Recovery and Reinvestment Act of 2009 (the “stimulus”—remember that?), the federal government certified Electronic Health Records (EHRs) for “Meaningful Use,” thereby stamping a government seal of approval on scores of software products.

Across the country doctors quite reasonably assumed that seal carried some meaning, and resolved to spend significant money, time, and effort to both purchase and implement MU-certified EHRs—many of them for the first time—and then to make “Meaningful Use” of them (as defined by the government).

For their pains, the doctors who succeeded in meeting MU metrics received a federal subsidy check. At last report nearly $21 billion in such subsidies have been paid.
Unfortunately, the ROI on that significant federal investment has been mixed to say the least. High numbers of providers on cutting edge health IT platforms who participate in the MU program successfully attest and receive a check. But the overall attestation rate nationally is woefully low (fewer than half)...
Now the federal government is defining as a “hardship” the use of many of the very systems that the federal government subsidized in the first place. Oy. No wonder the Government Accountability Office (GAO) recently issued a report eviscerating the MU program...

Interesting. Haley's boss Jonathan Bush once said of the HITECH initiative during a HIMSS video interview "you're just gonna schtimulate a bunch of losers."

Some effects of the "schtimulus."
He also recommended that the RECs get "a quick bullet... No one will even notice. Nobody's home."

Yeah, he actually said that.
Another of athenahealth's anti-REC practices: they entice their clients to buy into E-Z "Proxy Attestations" done on their behalf by athena, which cuts the RECs out of their Milestone 3 payments otherwise due the REC when an athena-using REC client attests.
I'm loving Dan Haley's use of the hyperbolic phrase "eviscerating the MU program." I'm reading the GAO report at the moment. Not finding any bloody entrails thus far, just some legitimate criticisms of the CQMs, which I regard as to a great degree simply time-wasting "Quadrant Three" stuff.

Mr. Haley graciously replied to one of my comment questions.

Well, OK, so MU attestation is a direct proxy for quality of clinical outcomes and patient satisfaction? Seriously, dude? How about answering the question?

Well, this article seemed equal parts blog post and press release (by a major THCB patron?). While you indeed cannot argue that EHR vendors failing to make the Stage 2 cut on time should get a pass via their customers, it's just a tad disingenuous that a vendor whose CEO crassly bashed the MU program while benefiting from it massively now proposes that the feds step on the air hoses of his competition.

Orange is the new black? Jonathan Bush is the new Judy Faulkner?

Another question I have with respect to the GAO report:

40% of the MU incentive payments have gone to the Medicaid side. What proportion of that is A/I/U "free money"? "A/I/U," recall, is "Adopt, Implement, or Upgrade." From the GAO report:
In addition to meeting program eligibility requirements, to receive incentive payments or avoid penalties, eligible providers must also satisfy reporting requirements by submitting information to CMS for the Medicare EHR program, to the states for the Medicaid EHR program, or to both. The reporting requirements generally incorporate the three statutory criteria for “meaningful use” established in HITECH—(1) demonstrate use of certified EHR technology in a meaningful manner; (2) demonstrate that certified EHR technology is connected in a manner that provides for the electronic exchange of health information; and (3) submit information on CQMs using certified EHR technology. To receive incentive payments from the Medicare EHR program, the information reported by providers must satisfy all three statutory criteria; that is, providers must “demonstrate meaningful use.” However, to receive incentive payments from the Medicaid EHR program in their first year of participation, providers need not satisfy the three statutory criteria. Instead, they must only report that they adopted, implemented, or upgraded to certified EHR technology [emphasis mine]. In subsequent years, though, they must demonstrate meaningful use to receive incentive payments.
Those incentive funds data may well be available, somewhere. It's alluded to tangentially in footnote 50:
Only a subset of providers that participated in the Medicaid EHR programs for 2011 and 2012 demonstrated meaningful use. For the Medicaid EHR program, providers are not required to demonstrate meaningful use for their first year of participation; they need only report that they adopted, implemented, or upgraded to EHRs. Of the providers that participated in the Medicaid EHR program in 2011, 27 percent of hospitals and less than 1 percent of professionals demonstrated meaningful use. Of the providers that participated in the Medicaid EHR program in 2012, 73 percent of hospitals and 29 percent of professionals demonstrated meaningful use.
I'd like to know to date (effectively through 2013) how many MU dollars went to A/I/U, prehaps stratified by EHR?


Great THCB comment by Dr. Rob:
...The real flaws rest not in the EMR products, or even the implementation of MU, but in the central task of health care in the US: to identify problems (diagnoses, ICD codes) and apply a procedure to them (CPT, E/M). EMR systems are not designed with doctors or patients as their main target audience for their data; it is for the government agencies and insurance companies this [sic] data is being collected. For physicians, the EMR products are often, therefore, not very usable for true clinical purposes.

This is a window into so much of what is wrong on a bigger scale, in that it shows how the patient has moved far from the center of care, and now is more of a commodity from which to get data and justify billing. Patient outcomes have little to do with this, a reality that most patients in the system realize pretty quickly.


Farzad sent me a direct tweet message asking that I give a shout-out ONC's Mat Kendall for his tireless REC efforts, especially regarding workforce and the rurals. Done.

Mr. Kendall is one tireless, extremely smart person who could be making serious Bank in the private sector. Dude is a walking encyclopaedia of Health IT knowledge.


Oh, now I understand the context of Farzard's request.
Champion of IT extension centers leaving HHS
By Joseph Conn

This month, someone you probably don't know, but who had a major impact on healthcare IT, will be leaving your employ. And as he leaves office, the major project he built is in danger of disappearing as well.

Mat Kendall steps down March 21 from the Office of the National Coordinator for Health Information Technology at HHS. There he has quietly headed the department that created a nationwide network of regional health IT extension centers known as RECs. The RECs are creatures of the American Recovery and Reinvestment Act.

Kendall has been ONC's director of the Office of Provider Adoption Support for 4½ years. Since their inception, the 62 RECs have been Kendall's babies.

The RECs have proven to be quite popular with Modern Healthcare readers, according to our latest health IT survey in which 71% of respondents indicated they wanted to see federal support for the REC program extended.

A key goal set for the RECs by the ONC was that they help 100,000 providers enroll in the ARRA's electronic health-record incentive payment program. Adding to the challenge, RECs would focus on smaller, primary-care physician practices and on smaller, rural clinics and critical-access hospitals, many of which were health IT neophytes before the RECs arrived.

To date, the RECs have worked with more than 150,000 providers. About 134,000 of them now have EHRs. Nearly 94,000 of them have achieved meaningful use...
Yeah. Continuing,
Dr. Farzad Mostashari, the former ONC chief and Kendall's one-time boss, in commenting on the Modern Healthcare survey results, said it would be “a great investment” for the feds to continue funding the RECs, adding, “We would be crazy to let this slip out of our hands.”

So far, though, federal funds on the RECs are running out and no one in either the executive or the legislative branch has made an effort to support them.
What have I been saying? Arguing for? Recall what I wrote in my post #HIMSS14 Day Four?
Were Congress to newly appropriate half of the initial REC grant expenditure to fund the 62 RECs through Stage 2, it would work out to about $65 per month per EP, based on the latest MU enrollment numbers. Commercial HIT consultants are will cost you $100 per hour at best (which is why the Privateers hated the REC initiative right out of the chute, particularly the vendor-neutral RECs like mine). It irks the crap out of me that HHS will let this hard-won new resource just fade away -- all the Happy Face talk about "no-cost extensions" and "sustainability" notwithstanding.

Federal Ag Extension Centers are now 100 years old since they were legislated into being. Given that the HIT effort will likely be 10 years in bearing visible Triple Aim outcomes and financial fruit, you would think that the feds would take a longer view. Maybe not a century, but, jeez, how about six years?

But, No.o.o.oo.OOOOh...

Having retired from the REC, I have no dawg in this fight, but, still, when I see ONC trying to spin how effective they've been for MU, it just begs a compelling question.

More to come...

No comments:

Post a Comment