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Physicians Seek 'Meaningful Use' of Health Records in New Payment System

By Kerry Young, CQ Roll Call

January 15, 2016 -- Health groups see a looming revamp of Medicare rules on electronic health records as an opportunity to make the tools more relevant to patient care, while also reducing the administrative burden on doctors.

Doctors are pushing for a major reset of Medicare's approach to electronic health records, pressing the agency to develop new rules that would aid them in the practice of medicine.

By 2019, Medicare will tie payments for many doctors to new metrics that depend heavily on electronic health records to evaluate the past quality of care. The Centers for Medicare and Medicaid Services (CMS) is in the early stages of creating this merit-based incentive payment system, which was mandated by last year's sweeping overhaul of physician reimbursement (PL 114-10).

Medicare's direct payments to doctors are one of the largest single federal health expenses, with more than $69 billion reimbursed for so-called physician fee schedule services in 2014.

Looking at the results to date from a federal initiative to spur the use of electronic health records, many doctors say they are concerned about how CMS will develop the new payment system, known as MIPS. In addition to complaints about time lost on patient care due to data entry work, doctors frequently question the value of the information that they've been tasked by CMS to gather through electronic health records. In their view, stumbles with past efforts to decide what constitutes the so-called "meaningful use" of electronic records should serve as a caution to CMS as it develops the new MIPS system.

"If you are going to judge my quality by a system that is flawed and doesn't work very well, that just seems wrong," John Meigs, Jr., a doctor from Centreville, Alabama, who is president-elect of the American Academy of Family Physicians, told CQ HealthBeat in a recent interview. "Right now, providers are being held to a standard that our electronic health records can't meet and I am going to be the one who gets penalized." 

The American Medical Association (AMA) and other health groups have urged CMS to avoid repeating what they consider mistakes made with the meaningful-use rules as they develop the new MIPS framework for documenting quality of care with electronic health records. The AMA urged CMS to allow more flexibility in the new rules, making it easier to adopt emerging technology. It also asked that rules be more tailored to the concerns of specialty practices.

Acting CMS Administrator Andy Slavitt agreed with the need to move away from the current approach, and regain doctors' confidence and interest.

"We have to get the hearts and minds of physicians back," Slavitt said Monday at the J.P. Morgan health care conference in San Francisco.

Impact of Existing Health IT Program

There have been successes as well as setbacks so far in the roughly $30 billion federal push for greater use of electronic health records, which the 2009 stimulus law (PL 111-5) jump-started. More than 400,000 doctors and other providers of health care received federal money intended to help them adopt electronic health records. 

But about 209,000 medical providers will see their Medicare reimbursements shaved this year for failing to meet CMS' 2014 targets for demonstrating the meaningful use of electronic records.

The hit for more than half of these doctors and other health workers will be less than $5,000. The relatively light penalty made it easy for some doctors to abandon the program. With an interest in keeping doctors engaged, CMS last year modified some Stage 2 meaningful use demands for 2015 but only finalized these changes in mid-October. Congress last month raced to pass a law (PL 11-115) that expanded CMS' ability to offer exemptions from penalties to doctors who missed the 2015 target. Medical and health IT groups had been pressing for this relief due to CMS' tardy release on the revisions. 

"If the stage 2 rule is any indication, they need to beef up their efforts and work harder with stakeholders to implement" the 2014 overhaul of Medicare payments to doctors, Joel White, executive director of Health IT Now Coalition, told CQ HealthBeat.

CMS received many complaints about the kinds of questions doctors have been tasked with asking. Representatives of specialty practices bristled at being asked to check whether patients with eye and skin complaints received pneumonia shots. 

Sam Horton, an Indiana physician, urged the agency to focus on "maintaining humanity in the patient encounter.

"I want to practice medicine! Not try to sign 90-year-old demented patients up for email and help them remember their password, so that I can pass along a medication list electronically," Horton wrote in a comment last year to CMS.

The use of electronic health records in the United States is in the "training wheels" stage, said Robert Watcher, a professor at the University of California, San Francisco, School of Medicine (UCSF). An advocate for the use of electronic records, Watcher, the chief of the division of hospital medicine at UCSF, studied the bumps in the road with the implementation in researching his recent book The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine's Computer Age. Early rules for electronic health records focused on what's simple to measure, not necessarily what's best for patients, he said. 

"It's easier to capture for a patient with heart failure that I performed an echocardiogram than did I have a good conversation with the patients about their disease. We are measuring the things that are accessible," he said. "The measures need to get better."

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