Truthfully, when I opted out of Medicare (and seeing those patients) in July 2011, I kind of sealed my fate in not being able to go for the Meaningful Use EHR incentives. I did however, as an experiment, try to attest to see how far I could get using data from the first six months of the year. Let me just say that the chart reviews, mouse clicks and calculations got so involved that I was glad when I found out, after only reviewing the charts of 55 qualifying Medicare patients, that my numbers and percentages weren’t sufficient for qualifying for meaningful use.
Nevertheless, I forged ahead to the end of my “experiment”. CMS’ EHR incentive portal is a funny and bass-ackwards system, in a way, because it lets you get to the painful end of the long data entry process without telling you, “Hey wait, stop now since you’ve already failed on this one measure (by percentage).” Half of the time I was guessing at what I thought they wanted, being that the specific questions involved in attsting are so poorly worded that they leave a lot of roof for creative interpretation. How the people in charge at CMS figure that they will get accurate research data in such a context is beyond me, but then this is a typical government-run system — dysfunctional is par for the course. You can honestly attest that your numbers are true “to the best of your knowledge” in the end because you didn’t really know what some questions were asking for. Apparently, your best guess is okay.
Nope. Rather than warning you of your demise early, they let you get to the bitter end and then they tell you in a summary page all the points along the way that you actually failed at in meeting the MU requirements. I have to admit that they had me going there for a while. I really was thinking, “Well, they let me get this far, so maybe I can just submit and report the measures and the government will honor all my hard work and time spent. Maybe the goal for a partcular measure X is 50%, but they just want any numbers this time around, being that this is only Stage 1 of MU.”
I have heard stories of MU attesters/doctors who said they were so exhausted by the time they finally finished the process that I suspected, going in, this wasn’t going to be a cake walk. However, in fairness, our EMR system had not yet put into action its “MU Dashboard” function during the first part of 2011, when I actually saw the patients. The dashboard function/page now allows convenient tracking of all measures and calculates the numbers for you… after, of course, you go through the time-sucking process of checking off all the measures that are required to qualify. And I only had around 70 Medicare patients. Imagine those doctors with hundreds or…. gulp… thousands. Just to give you a sample of the pain, last week I tried entering allergies for 20 random (non-Medicare) patients the next day after I saw them. The dashboard function doesn’t do this for you, after all, and my patients’ allergies are recorded as free text (unstructured data) using my template system. By the time all clicks were done, it took me 10 minutes of solid mouse clicking time at a brisk pace. Pages have to load up, after all. I could have done so much else with that 10 minutes of my life that I’ll never get back. Talk about frustrating.
I did a crude calculation and took $44,000/(5 yr x 365 days/yr) and came up with $24/day for a heck of a lot of work. In doctor-speak, it ain’t worth it. Now I’m not poo-pooing the do-gooders out there who want to give their time to this process and try to make the world a better place through being meaningful users of health IT. Just please don’t hate the business-oriented group of doctors out there who have done the math and dabbled in it enough to choose otherwise.
Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine and opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009. He can be reached at email@example.com. He blogs at HappyEMRDoctor.com and EHROutlook.com.