Private Payers and Meaningful Use

Is it time for Private Payers to join in on Meaningful Use? A number of people are starting to ask this question after CSC released a recent white paper called “Meaningful Use for Health Plans: Five Things to Consider.” I’ve always said that private payers adopting meaningful use would be a HUGE deal and would likely sway many doctors who are on the fence. The question is, will private payers adopt meaningful use?

An article in the American Medical News says they will:

Private insurers are latching onto the government’s meaningful use definition to bolster their own efforts to promote EMR use and possibly impose their own financial penalties for nonuse among contracted physicians, according to the author of a new study looking at the challenges physicians face with meeting meaningful use.

Neil Versel in his story on Fierce Health IT quotes the more reasoned opinion:

“At minimum, plans should use this as an opportunity to reformulate and realign existing pay-for-performance incentives with health IT implementation and meaningful use deadlines,” CSC says. “Minimizing differences between plan-sponsored incentive programs and Centers for Medicare & Medicaid-sponsored programs will also serve to simplify compliance and achievement, for provider organizations.”

Neil also ends with this little zinger, “Those statements are long overdue. Private payers, it’s time to ante up for the quality game.”

My personal feeling is that insurance plans won’t be adopting the meaningful use objectives. That’s not to say that they aren’t or won’t “ante up for the quality game” since healthcare quality could be great for insurers. However, I think it’s a stretch to call the meaningful use objectives a healthcare quality initiative. Maybe that’s the intent, but I think it misses those goals.

The bigger reason why I believe private payers won’t adopt meaningful use is there’s far too much kick back from doctors. Insurers do an interesting dance with doctors and I think that insurance plans won’t want to deal with all the angry doctors if they force meaningful use upon them. Plus, the case that meaningful use actually will provide benefits to private payers is a murky grey with little solid foundation.

Private payers do want doctors using EMR. They do want standards for communication. They do want EMR initiatives to work and quality of care to increase. However, I’ll be surprised if they choose to latch on to meaningful use to achieve these goals. If they do, then meaningful use as means of getting the EHR stimulus will be an afterthought.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

5 Comments

  • “Private insurers … promote EMR use and possibly impose their own financial penalties for nonuse among contracted physicians”

    If plans establish a requirement … they will need to contribute on a per patient basis for the practice to deploy and maintain it.

    If the plans want to talk financial penalties yet not contribute to full fielding and maintenance … they can find a new doc for their plan’s beneficiary.

  • “Plus, the case that meaningful use actually will provide benefits to private payers is a murky grey with little solid foundation.”

    … and MU benefits to the public payer are crystal clear and rock solid foundation? (rhetorical)

    @John… Your last paragraph is exactly on target. If the private plans and practitioners work together without regard to HHS defined MU incentives and penalties there may very well be means to achieve quality goals … without regard to the ARRA incentives. Such an initiative would place practice effectiveness and clinical quality on the right track which has been muddied by all the ARRA babble.

  • IMO, “Meaningful Use” is pure bureaucratic BS; there is no real substance there. John’s last paragraph is the red meat here — more specifically, the “standards for communication” phrase.

    If the standards are there, economic self-interest will bring about a healthy migration to EMR. Without standards, no amount of pretty-sounding initiatives or financial assistance will make any difference.

  • “Now how to get there.” …

    I’ve mentioned before that the EMR industry needs to fund an IEEE-like organization to work out standards for structuring patient data, then getting the various vendors to agree. Patient data then becomes truly useful, and doctors will tend to sign on to EMR knowing they’re not “locked in” to a particular vendor.

    A similar battle is playing out on the internet. A new HTML5 standard is being worked out with support from browser makers, Google, Apple, Microsoft, and others. But the staid W3C [non-]working group was not functioning, so a competing (WHATWG) organization was initiated to actually work out and test various new HTML features. So we now have a work-in-progress, with emphasis on “progress”. Of course, W3C was offended, but is now actively promoting an alternative standard; so at least they’ve come alive.

    Why the difference in urgency? Obviously HTML5 is important enough to fund properly and “get it right”. Perhaps EMR is not.

    Ref: “Growing pains afflict HTML5 standardization” — http://news.cnet.com/8301-30685_3-20008935-264.html

Click here to post a comment
   

Categories