Few Doctors Ready To Qualify for Meaningful Use

A new study published in Health Affairs has confirmed what I, at least, have suspected for some time about physicians and their EMRs.  The study, which surveyed 3,996 physicians, found that while 91 percent were eligible for Medicare or Medicaid Meaningful Use programs, only 11 percent of those intending to apply had their act together.

Researchers, who analyzed data from the 2011 mail survey supplement to the annual National Ambulatory Medicare Care Survey, found that 51 percent of respondents were planning to apply for MU Stage 1 incentive programs. However, it seems that only 11 percent of doctors planning to apply have a capable enough EMR set-up to support up to two-thirds of Medicare Stage 1 core objectives.

Now, this was not completely unexpected. In the final Stage 1 MU rule, CMS had estimated that 10 to 36 percent of Medicare eligible pros, and 15 to 47 percent of Medicaid eligibles, would end up meeting the agency’s criteria.

And it should be noted, the HealthAffaits authors remind us, that about 124,000 eligibles had registered in 2011, and that CMS had paid out $275 million to 15,000 participants. Also, Medicaid programs paid out about $220 million to about 10,500 physicians.

Still, you can’t bury poor performance like this in a pile of data. Clearly, a program is lacking something important just over 1 in 10 physicians manage to set themselves up for Meaningful Use cash — especially if  they were trying hard to do so.

The problem with news items like these is that they don’t get into what’s holding physicians back. It’s actually a bit disappointing that the HealthAffairs study didn’t offer any red meat on the “Why Can’t Doctors Qualify?” issue, as we all know that talking about problems doesn’t make them go away.  (I do admit that in the world of public policy at least, simply underscoring a problem gives rulemakers ammunition to dig deeper into an issue.)

Still, I’d love to know what you’re seeing out there in terms of unprepared physicians. Are we talking practices that got fast-talked into buying inappropriate or junky technology?  Lack of understanding what they bought?  Slow-moving practices that are on the right track?

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.


  • I’d say that matches up with my own personal experiences. I’ve done close to 100 EHR installs with my company that could poentially take advantage of the incentive and probably about 15% actually have successfully implemented, got fully up to speed, and successfully performed their attestation and gotten their money.

    The rest is a combination of doctors still trying to get up to full speed (doing all their encounters a day in the EHR instead of a subset – lot of older docs fall in this group), doctors who start and decide “this is too much work on me personally” and do little but the rest of the staff use the EHR a lot, ones who feel the time impact per encounter makes it not worth the payoff of the incentive, and docs who just wont commit the time to do the implementation and train on the systems (eternal installs).

    The good news is the ones who havent thrown up their hands on the whole idea will eventually get there, but we find ourselves constantly having to encourage and cajole the doctors to move faster if they really want to achieve their goals.

    I also suspect that a percentage of the ones who have not gotten things ready by the time Stage 2 is the goal will drop out at that point due to the target objectives increasing.

    It’s also been very eye opening to see just how much of the clinical work that the doctor puts their name on is not phyiscally done by them, but was documented to reflect such in the paper world. Lots of oppotunities for workflow analysis.

  • I would have to agree with Mark. Although many providers and clinics are willing to adopt to a new system not, many of them are even mentioning MU.

    I thought that MU incentives would be a driving force for most ‘Medicare’ offices to make the switch, but that does not seem to be the case. I think the skeptics have seen that monies are, in fact, being paid, but is it worth the extra effort to comply is the question.

    It will be interesting to see how it all shakes out in the end.

  • My experience has been the same as well. Physicians want the system but when it comes time to actually learning how to use it they are unwillingness to decrease their patient load temporarily so they have the time to become efficient with their EMR.

    Physicians are creatures of habit, so often they are just too comfortable in their own practice that it’s simply too difficult for them to accept a new way of doing things.

  • When I manage to leave my EHR bubble I find that most doctors I know or have had experiences with are holding onto their legacy systems that are poor EHR’s at best and mostly just a PMS.

    I imagine most who haven’t converted are looking to see what their local peers and colleagues will do, and in communities where no one pulls the trigger the doctors are left in a cold war against the government’s decision to implement the reimbursement penalty or not.

    Or maybe they are holding out for that one magical EMR to maximize their ROI .

  • Or maybe doctors, EMR vendors, and ONC being in a mexican standoff is a better analogy.

  • This is actually simple.

    An EHR does not provide an ROI…except that government check.

    Remember most docs already have the system in place that DOES provide an ROI, the practice management software.

    Docs view an EHR as a pain in the a$$. Especially since this is forced upon them.

    Many docs in my area who were “forced” to go EHR, still operate their paper practice in parallel.

    Add to this, many EHRs require 3 to 5 clicks to ensure 1 MU “counter”. These EHR vendors didn’t make MU tracking & reporting drop dead simple – Frustration is high.

    Also, don’t think the the government isn’t just a bit happy that every doc isn’t able to get a check.

  • To be honest, I am actually very happy at the rate ehr adoption is happening. EHR adoption is no different other industry that went throug similar type of adoption challenges and curves. Right now, we are getting to the end of early adopter phase where there are significant # of providers acutally using EHR. Not just using it but using it 100% with virutally no paper. I think we will hit the meat of the adoption and usage within the next 2 years.

  • We have a certified EMR and I’m wondering if folks are not selecting EMRs that aren’t certified. You need a system that’s certified AND makes MU easy.

    I disagree with Jim on the “EHRs require 3 to 5 clicks to ensure 1 MU “counter”. We have many that take only 1 click and some that are using that 1 click for multiple measures.
    Our goal is no additional clicks. So if we have to add a click somewhere we try to find another location to remove a click.

    I’m working with 5 Practices that have either attested or are close to attesting. But there are others in the community that aren’t there yet even though they use the same software and have the same opportunities.

    Some of them just don’t know nor spend the time trying to figure out how to do it. And they don’t have a champion on site to push it through.

  • @Don
    You can disagree, but it is fact…oh, and it was “many EHRs” – not all.

    I’ve seen it, I’ve counted.

    Yes, this is on certified EHRs, to mention anything else is pointless.

    I think the issue is for EHRs that were create pre-MU they are attempting to fix their process.

    Either way, if operating in a MU fashion is not made drop dead easy by the EHR, attestation rates will be low.

  • I believe many organizations (whether comprised of 30 Physicians or 300) do not understand that managing EMR selection & implementation requires an experienced FT resource; or they just are not willing to incur the cost of such. I am referring to a dedicated on-site resource in addition to the “spotty” assistance EMR vendors can deliver.

    This akin to buying a Maserati and then having no money budgeted for fuel and insurance. The car (or EMR) will just sit in the garage incurring monthly fees, but never reach its intended potential. This thinking, or lack of thinking, of course is more common in the smaller (under 50 EPs) practices. Short-change your practice in areas of selection, planning, implementation, training, etc…and you will really pay MORE to achieve LESS.

    The cost of this investment is exacerbated by the current state of supply / demand for experienced EMR resources.

  • The only problem with your analogy is that a Maserati is probably like a Ferrari and they’re a great investment. If you buy it, you should leave it in the garage so that it will appreciate over time. EMR software is of course not like a high end car though. If it’s sitting on your shelf, you’re not getting any value out of it and you can’t sell it to someone else later at a higher price.

  • @Wes
    Isn’t this just a classic situation?

    It doesn’t matter whether it is an EHR, a car, a house or your investment portfolio…some people understand they need help from the beginning and some people don’t.

    On the surface it seems simple enough to setup an EHR.

    Reality is otherwise.

    Much of the challenge is realizing that this piece of software is dumb…it doesn’t know how your practice operates. You must either convert your processes to the way the software wants you to work, or you customize the software to your processes.

    Either way this is a ton of work.

    The other reality it most docs don’t have formal processes. They’ve just been doing things “this way” for years and things keep moving along.

    It is hard work to map out every process from the moment a patient calls your office to the moment they leave…yet this is one of THE MOST IMPORTANT THINGS a practice can do to prevent the EHR from being a grand failure.

Click here to post a comment