I regularly get passionate emails from readers of EMR and EHR (and of course my other site EMR and HIPAA. I don’t always agree with the emails, but I almost always find them interesting. The following is one such email. It wasn’t intended to be published, so excuse the format. However, I find much of the comments about ONC’s approach to specialists spot on. The hard part is that I think ONC realizes this as well. The question is whether ONC in meaningful use stage 2 is going to do anything to address the specialist problem. I think this is a topic we need to voice to ONC.
The EMR’s basically started with certification requirements from CCHIT…ONC took that starting point…and moved to MU from it…without regard to specialty. Properly done, they should have started with MU by specialty…then figured out what the product certification requirements should be from there—for that specialty: Orthopedic guys see lots of patients (50-70 per day, and lose two days/week to surgery), mostly NEW patients with specific problems (broken bones or joint replacements)…no big longitudinal charts…and need to dictate complex notes; Dermatologists have lots of lab/biopsy tests, need to draw pictures and annotate them, not dictate; Pediatricians need growth charts and long medical histories and trends; Oncologists need detailed treatment histories, dosages, outcomes; Ophthalmologists need lots of technical data, measurements and interfaces to optic devices. Yet ONC made a set of rules that really only apply to Primary Care…which is where much of the CHRONIC conditions (and a large portion of the medical cost issues) are quarterbacked…and have the best chance of prevention.
Besides…all the data from specialists should flow back to the PriCare docs anyway…why try to keep it coordinated in both places? I think we have a long way to go to get all healthcare “communitized”…and powers that be need to recognize how different things are for various specialties…and define MU from each specialty’s point of view…and find out that the current certification standards are WAY overkill for most of them…unnecessary complexity and, thereby, cost….to do the irrelevant things to qualify for incentives. After five years, they will stop doing those things anyway, when incentives run out. Having a data pathway between in-patient and out-patient (ambulatory) is a great goal…that should come first..the ability to share data…even if via documents. That could be done today. Trying to devise interoperability standards for 400 EHR’s, a dozen or so major Hospital-based vendors…and registries, labs and other participants….that is a LONG way from being reality
Will be interesting to see how the “success stories” pan out this year starting in May for EP’s. Thank goodness ONC has made it almost impossibly easy for specialists in Stage I….they can opt out of almost everything required and get incentives the first 2 years($30k)…is that a good use of taxpayer money?
Once AGAIN, ONC does not define meaningful use, CMS does. ONC doesn’t have EHR incentives. CMS does.
And the incentives “don’t run out in 5 years” for Medicaid, just for Medicare. Medicaid is through 2021.
I’d be more likely to give credence to these kinds of posts if they had a clue what they were talking about. CMS has $27 billion for the EHR Incentive Programs. Of non-discretionary (read: safe) money, paired with on-going, uncapped administrative matching funds for States. ONC has $2billion in discretionary funds, which once spent, are gone.
It bears remembering that the idea was to use the incentives to also fortify primary care. The specialists already get higher reimbursements and see fewer Medicaid (though not Medicare) patients so this is one of a meager bunch of carrots dangling in front of primary care providers.
Yes, the specialists matter but HIE is meant to tie them in, not just EHR adoption.
Jess,
Certainly CMS has the final say and publishes the final meaningful use rule, but from my vantage point ONC is driving much of the definition of meaningful use. There’s much collaboration between CMS and ONC from what I can tell when it comes to the incentive money and the publishing of the rule. Plus, ONC has taken a much more vocal role in the process than CMS (from my vantage point) and so this could be why the reader said ONC and not CMS in the above comments.
The comments above were referencing the Medicare portion of the incentive money (which is the larger portion anyway) which does end in 5 years.
Certainly there’s some language that says that the EHR incentive money was to fortify primary care. Meaningful Use reflects that focus as well. However, then they allow specialists to be considered eligible providers. So, there’s this contradiction in the legislation that says that specialists can get the EMR stimulus money, but then they make requirements that make it onerous for specialists.
I hear you about public perception and ONC’s role. It’s the primary mechanism for public input. But I’m hearing a lot about alignment with other CMS programs and simplification that make me wonder to what extent CMS will exert itself…
The CMS rule didn’t break out the total incentive funding estimates or the estimated number of providers between Medicare and Medicaid. Or did I miss something that indicated that the Medicare portion is greater overall? The Medicare incentive, after all, is less than for Medicaid.
Jess,
That’s interesting to consider. I’ll have to keep an eye out to watch that play out. Might be a good question to ask them at HIMSS.
I think I saw some estimates a while back. I can’t remember where. I want to say it was the CBO, or maybe it was something coming out of ONC that estimated the Medicare vs. Medicaid portion of the estimates. I just remember that Medicare was much larger than Medicaid.
Jess made a comment about specialists getting higher reimbursement rates for care than PCPs. This is not true any longer for Medicare, which did away with consultation codes last year. Thus, just like PCP’s, now specialists can only bill new patient visits and established patients visits. My 99204’s and 99214’s are paid the same as PCP rates.
Dr. West,
But specialists do get higher reimbursement for other insurance other than Medicare no? At least the specialists I know make a lot more.
Yes, John, that’s true outside of government insurance plans. At least for the time being.