Meaningful Use Measures: The “All 3” Vital Signs Dilemma – Meaningful Use Monday

How does a physician meet this measure if only one or two, but not all three, of the vital signs are a routine part of their practice? This is an issue on which I have sought clarification since before my first Meaningful Use Monday post.  The question has now been asked frequently enough to warrant a formal answer on the CMS FAQ site—and the answer is problematic.

Meaningful Use Core Measure: Record Vital Signs
For more than 50% of all unique patients age 2 and over seen by the EP, height, weight, and blood pressure are recorded as structured data.
Exclusion: Any EP who either sees no patients 2 years or older or who believes that all 3 vital signs of height, weight, and blood pressure of their patients have no relevance to their scope of practice.

You’d think this measure would be pretty straightforward—and it is, for primary-care physicians (and some specialists), for whom taking vital signs is a given. Other specialists, such as dermatologists, ophthalmologists, and psychiatrists, will likely attest that (all 3) vital signs are not a routine part of their practice, and they will meet the measure by attesting to an exclusion.

But how will other specialists meet and report on this measure? Some orthopaedists, for example, routinely* record height and weight, but few take blood pressure, (recording it only when documented—typically by the patient’s primary-care physician—for surgical clearance). ENT specialists may routinely* take blood pressure, but don’t record height and weight.

According to FAQ Answer ID# 10593, “If an EP believes that one or two of these vital signs are relevant to their scope of practice, they must record all three in order to meet the measure.” Therefore, specialists like the above have two choices if they want to demonstrate meaningful use:

  • Attest that all 3 vital signs have no relevance to their practice, or
  • Add the missing function(s) to their practice’s workflow, despite the lack of relevance.

I am interested in how physicians facing this dilemma plan to address the vital signs measure.  Please share your comments below.

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*Note:  “Routine” is a key word here. I received an e-mail from a senior CMS staff member saying that “there is nothing in the regulation that specifies that claiming this exclusion precludes an EP from recording these vital signs on an occasional basis.” Therefore, the dilemma exists only for those physicians who routinely record one or two of the vital signs.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

About the author

Lynn Scheps

Lynn Scheps

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.

13 Comments

  • So now providers and staff have to add height and weight checks to all visits regardless of when the last ones were checked. While it will make a nice fat dataset for CMS to use in their research, it will also add delays in time of checking patients in (when considered en masse) to already busy doctors who are running behind. I do get the point in trying to collect this data, but can’t CMS just fund studies like the NIH if they want to answer scientific or medical supply usage questions of their own? The size of subjects needed to statistically power a study should not be as many as they are proposing by using the incentive programs.

  • This is a sh#t or get off the pot moment folks….

    I have conflicting views on this subject entirely:
    1) Stick your hand out for money from the G and you have to play by their rules…
    2) This stinks, and why the G making me do this?!

    Hmm, #2 innately refers to #1.

    Let us not forget that for most physicians – You were not forced to go electronic**.

    The current flurry of EHR adoption is based on one thing and one thing only: FREE MONEY.

    This free money isn’t from efficiencies derived from your new EHR–wouldn’t that be nice (and long lasting)!

    This free money is purely a pay off by the G.

    So, unfortunately, it comes down to: those that are handing out the free money are free to make the rules, no matter how stupid/ridiculous/ignorant/idiotic/asinine the rules may be.

    As much as it may pain you to do this: accept the rules and live by them…you’ll have a lot less heart burn and at least you’ll get that reimbursement check.

    **I understand in some areas physicians were forced by their local medical groups to go electronic. That is completely different than being forced by the government.

  • Dr. West,
    At least those vitals are done by a nurse or MA at intake as opposed to the doctor. If the doctors are running behind, then the extra time to get this information shouldn’t be an issue right;-)

  • Actually, for psychiatry, it’s not even as simply as John (#3) suggests. Most do not have nurses or MAs in their offices, many single practitioner offices do not even have a receptionist. So it’s a matter of doing everything oneself. Since most patients’ height doesn’t change that often and since many patients in psychiatric practice need to be seen fairly frequently, taking a height at each visit makes absolutely no sense. Depending upon the type of practice, weights and vitals may be taken infrequently as well. Of course, the issue of irrelevant vital sign measures to meet meaningful use is only the tip of the iceberg as many other items on the “meaningful use” list are similarly irrelevant. The answer is to get an EMR only if it makes sense otherwise and not worry about meaningful use at all. (The “windfall” that will be received is no where near what it will cost to deal with all of the irrelevant requirements.)

  • Leo,
    My comment was partially tongue and cheek. You’re dead on about the challenges for specialties like psychiatry. I’ve been saying for a long time that you choose to implement an EMR for other reasons, not for the stimulus money. Use the government handout as a possible bonus if all goes well, but those that go after the government handout will likely end up disappointed.

  • John, hate to say it but it doesn’t matter who collects the extra, meaningless data when I am paying their paycheck and reducing my personal income to do so. And there is no way I am hiring an MA or, GOD FORBID, an expensive nurse as a solo doc in 2011. Time is money, regardless of who checks the vitals (which is currently my part-time receptionist in the morning, and Ken in the afternoon). 🙂

  • John, also agree with your last statement. People should get an EHR for other reasons besides the proposed incentives. I love mine, with (before 7/1) or without (after 7/1) Medicare. 🙂

  • Dr. West,
    It makes good business sense if you only have to pay that MA $5000 to meet the MU criteria if you’re going to get $44,000 back. Whereas, that same amount of time might be $20,000 for a doctor to input the data. That makes a big difference. Of course, there are a lot of other scenarios you could lay out where going after meaningful use doesn’t matter at all. However, especially for meaningful use stage 1 where the bar is so low, it’s definitely at least worth considering if it’s worth attesting. In many cases it might not be much work for a nice $18k per provider. This is especially true for those already using an EHR.

    As I said above, to implement an EHR chasing these incentives is where I draw the line.

  • From a Lean perspective neither of the options makes sense. One of the deadly sins of waste for Lean practitioners is over processing. Collecting and reporting, even electronically, meaningless data is over processing and adds nothing to the value stream for many specialties. Reasoning that a nurse will collect the data and not the doctor is nothing more than moving the wasteful effort to a different step in the process. What part of any of that waste is meaningful?

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