Skepticism Around Meaningful Use and Government Handouts

There’s a lot of skepticism in the air around the meaningful use requirements and the government handouts that we know as the EMR stimulus. Rightly so. People realize that the government doesn’t just give money out (unless you’re…well I won’t go there). Most government programs come at a cost. The cost of the EMR stimulus money is showing “meaningful use” of a “certified EHR.” Physicians and practice managers around the country are considering whether the cost is worth the benefit.

As an aside, it still upsets me that the conversation has moved to that. A year and a half ago, the conversation around EMR software was, “How and which EMR should I implement?” (A good question considering the 300 plus EMR vendors) Now that’s gone out the window in favor of, “How can I get the stimulus money and is it worth it?”

With every government program there are skeptics. Here’s an excerpt from an article Paul Roemer wrote for HCPLive.

This in turn leaves the healthcare provider in what is best described as a Morton’s Fork scenario. Shall I explain? A Morton’s Fork is a choice between two equally unattractive alternatives—a dilemma. The concept originated in 1487 under the rule of Henry the VII as a result of tax policy to ensure everyone paid taxes. The argument was because the rich had enough money to buy things they must have enough money to pay taxes, and the poor who had bought nothing had saved their money, and thus had money with which to pay taxes. The two prongs of the fork—back then forks only had two prongs. Q. E. D.

The healthcare provider must choose between—as one may not choose among—two alternatives. Attempt to meet Meaningful Use—a Procrustean Solution—and turn their business model inside out to meet the government’s Gossamer standards.

Attempting to meet the standards does not ensure they will in fact meet the standards. Should a practice only meet 99% of the standards, they lose. The Pareto principle does not apply. There is no 80:20 rule. They will not receive any incentive money as Meaningful Use is an all or nothing game.

The second alternative is to not meet Meaningful Use. This choice may be voluntary, or involuntary—trying to meet Meaningful Use and failing. Alternative Two—it is said—will result in reimbursement penalties from Medicaid and Medicare.

I do not think those penalties will be implemented, or at least they will not be implemented in the documented timeframe.

I also do not think there is a Morton’s Fork, because I think Meaningful Use will disappear because it is so arbitrary and capricious—and because the number of large providers who will meet it could all drive to lunch at Morton’s in a Yugo, at which time they could dine with a fork from Morton’s.

I disagree with Paul insofar as Meaningful Use won’t disappear. At least not for the next 5 years. It is what it is and it’s not going anywhere while there’s billions of dollars that hangs on it. However, the question of whether physicians will hop on board the meaningful use train is a better question. If they don’t, then I guess they will have effectively made it disappear.

What I believe is a reality is that physicians are going to implement EMR software. To me it’s just a question of whether the EMR stimulus incentives will be the driving force or whether physicians will learn to generally ignore the government handouts and go back to implementing an EMR because it’s the right thing to do for their business.

About the author

John Lynn

John Lynn

John Lynn is the Founder of, 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,, 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.


  • I’m fascinated by the schism that exists in the dialogue over MD’s ‘willingess’ to implement EHR/EMR and achieving meaningful use in so much that there is very little discussion as to whether the applications / technologies are designed to easily allow the MD to achieve meaningful use.

    Beyond the practice management capabilities, most EMRs are designed as glorified document management systems, but do little to easily allow the MD to achieve meaningful use as it’s defined.

    I don’t believe ‘implementation’ vs. ‘meaningful use’ is the complete debate; we need to see vendors enhance their solutions based on meaningful use outputs, with easy to use, and workflow-sensitive User interfaces. To achieve meaningful use with the majority of the EMRs in the Us today is going to be difficult without significant enhancements to the fundamental design tenets of those EMRs.

  • In software design, the problem first must be well-defined and the required outputs must be specified. Eric Gombrich clarifies some of those expected outputs: “solutions based on meaningful use outputs, with easy to use, and workflow-sensitive User interfaces.”

    EHR vendors now have the MU Final Rule details they need to modify their software according to what providers need and CMS expectations. Modifying CCHIT-certifed stable software will introduce new bugs that de-certify the program; vendors will be extremely hesitant to make major modifications because the new, higher costs in terms of capital and time. In spite of provider need and CMS expectations.

  • Hi, another relevant blog post; and constructive replies as well. That’s one of the reasons I keep coming back to this board. Keep up the good work Jon.

    Our team and myself find most of the MU requirements to be around ‘structured data’ to fully take advantage of the data and leverage it to practice preventive care.

    Like John has said many time in many posts, EHR should be embraced for the right reasons and Stimulus $ is not one of them. Its just an accelarator and a catalyst.

    As far as the serious vendors in the EHR business go, they will find the time and resources to be compliant with the MU requirements. Usability is an evolving exercise and it will get better over time due to the competition in the market place. For instance, taking advantage of all the touch pad features of iPad, it takes a time to port the application over; but it will get there.

    There are substantial changes taking place in the Lab World and MRI sector. Labs have to have the capability to for bi-directional data flow based on LOINC standards; in our experience, the national vendors have achieved the capabilities and have certified vendors such as us. But the regional labs are just exploring the LOINC standards and still figuring out the intricacies. Similarly with the MRI Centers, their turn comes only in 2013 but have to be prepared for bi-directional data flow as well. All these requirements have been, at least I believe, documented in the right spirit. Can the industry get there? Absolutely yes; but required commitments from all the stakholders, especially the Providers.

    Just a few thoughts

  • “Beyond the practice management capabilities, most EMRs are designed as glorified document management systems, but do little to easily allow the MD to achieve meaningful use as it’s defined.”

    I disagree with this. Most of them are much more than document management. The granular parts is what makes them so much more difficult to use. Maybe I should clarify…the poorly implemented granular parts is what makes them so hard to use.

    As far as meaningful use goes, we’ll see. I expect every EMR vendor will provide a path that their EMR can show meaningful use. Some a little easier than others, but on the whole they’ll almost all be able to do it.

    A better question is whether doctors want an EMR that shows meaningful use. Or whether doctors want to just meaningfully use the EMR and not meet some government definition.

  • Great points. My point in my post on EHR and Meaningful Use is that providers ought to look at their organization and determine what they need EHR to do for them, not what they need to do to EHR to get a check—those are two very different business and HIT strategies.

    One of my clients had already implemented CPOE and EHR. We assessed what they had to do just to meet Stage One MU requirements. Incentive dollars minus cost, to have the chance to meet Meaningful Use, left them upside down by five million dollars, and it would use eighty percent of their IT resources for the next three years.

    If the organization is so quick to divest itself from the IT projects that would have been completed were there no Meaningful Use, what does that say for the planning that went into defining those projects? How much further down the ROI chasm should an organization be willing to fall to grab a check? To whom do these organizations ultimately have to answer—CMS?

  • Good post, John

    I agree with you that EMRs should be implemented because it is the right thing to do,not because of the incentives. The government incentive is a dangling carrot.

    Money promised for implementation comes by way of increased Medicare and Medicaid reimbursements by 1-2% from each claim. Talks of slashing Medicare reimbursements by 21% came soon after. So after investing money and time in a system, you are going to get….what was that?

    This was considered by the government when they issued the proposal that rather than getting money, reimbursements would be taken away as a penalty for failure to comply as of 2014.

    Clever. Not only will they not have to dish out much money, now they will be getting money ( in the sense that services will not cost as much)

    Now consider the physicians that do not have a large percentage of patients that participate in theses Medicare and Medicaid programs. They too, will not be seeing any government subsidy for implementation.

    Yes, get the system because of increased efficiency or because you can achieve more with it, like any piece of medical equipment. If it is for the subsidy, don’t hold your breath!

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