Earlier this week I attended the annual meeting of the primary professional organization for my specialty, the American Academy of Otolaryngology – Head and Neck Surgery. As you might expect the first thing I did was attend a mini-seminar on strategies to meet Meaningful Use (MU) requirements. These “mini-seminars” typically include 3-4 speakers presenting various viewpoints regarding the subject at hand. Presenting the supporting viewpoint on MU was Dr. K.J. Lee, who has been an icon in our specialty for decades. He had distilled MU requirements for Otolaryngology down to a few typed pages and reviewed each requirement, emphasizing how easy it should be.
The most interesting part of the presentation was the reaction of the audience. Presumably based on his professional reputation the audience initially bought into Dr. Lee’s enthusiasm for MU, hopeful that he was right. However, as he continued through the list of MU requirements his point of view became less credible, and the enthusiasm began to fade. When he suggested that it was no problem for ENT docs to ask and counsel patients about mammograms and colonoscopies, audience members began to stare at the floor and shake their heads. By the end of his presentation he had lost just about everyone. I have seen this happen before at MU meetings.
Later that morning in a different mini-seminar I gave my own brief presentation, a MU update. I was asked to give an update on how MU payments were going, presumably specific to our specialty. The August CMS report shows MU payments given to about 1100 providers so far (as of 7/31/11) totaling about $18 million. For the 6 weeks leading up to the meeting I tried, without success, to get MU payment data from CMS for ENT doctors. The best I could infer from the data available is that more than 1 but less than 28 individual ENT docs have been paid for year 1 MU. In any case the conclusion is clear: only about 0.1% of all eligible providers – and essentially no ENT docs – have met MU so far.
But isn’t it too early to draw conclusions? After all, the program just got started a few months ago. And the number of payments going out is increasing month to month. And providers still have a year to get the full payment.
My opinion is that the situation is worse than it looks, not better. I believe even this tiny number of payments represents an early peak of MU payments to providers who implemented EMR long before MU came along. Our practice is in this group, and we will begin our 90 day attestation period October 1. MU is achievable only for those providers that have already acquired several years worth of EMR skills. Once these early adopters are paid, no one else will be left. If I am right we should see MU payments plateau in Spring 2012 and start declining in the summer and fall.
MU remains a bad idea, especially for surgical specialties. It is not possible for a paper-based medical practice to complete the long process of selecting, installing and implementing EMR on the schedule imposed by MU. The provider skill set required to meet MU requirements takes at least 2-3 years to develop, and providers can’t even begin to acquire those skills until the EMR is chosen and installed. The MU schedule forces providers to rush the process, raising the risk of making catastrophic mistakes in the EMR selection and implementation process.
Do you think the Feds will extend the initial 2015 deadlines in order to allow practitioners enough time meet all the MU requirements, etc?
Quite possibly. They have already delayed phase 2.
Hi Mike, Thanks for sharing. I think your overall assessment is accurate and I hope that more healthcare professionals wake up soon to the realities at hand. To rush MU is to sabotage EMR/EHR implementations.
Dr. Koriwchak, I just happened to find your blog and was thrilled to see insight from our specialty. I have a comment regarding Dr. Lee’s viewpoint that asking patients about mammograms or colonsocopies. My understanding of the CQMs and related/redundant PQRS measure is that meeting the measures requires more than simply asking the patient if they’ve had it done. From what I see from our EHR vendor white paper on these measures there is an expectation that the physician is ordering the study and reviewing the report. After all a screening is looking for the disease before the patient is symptomatic. How is asking when their last mammo or colonsocopy was done meeting this definition? If you look at the related PQRS measure it requires a documented review of the test results themselves. I am just concerned because I think there are a lot of practices that