Meaningful Use Will Force Doctors into ACOs

They have made this mu reporting so bad….as our doctor says…they do not want doctor’s to practice by themselves…They are doing all they can to get them into ACOS…

The above is a quote from an EMR and HIPAA reader who emailed me about the meaningful use requirements. The conclusion was what really caught my attention. There are a number of questions that should be asked based on the statement above.

Does the government want doctors to not practice by themselves?
No one in government would say this and this isn’t their thought process at all. What they do want to see is a reform to how we pay for healthcare. If that means that doctors no longer practice on their own, I think they’re ok with that. I don’t think that’s the conclusion they’ve come to yet, but I think that’s what the reader is insinuating in the above comments. Personally I think it will be a tragedy for the physician community if we no longer have solo doctors and small group practices.

Does the government want all doctors in an ACO?
Absolutely. They are pushing accountable care organizations and anything that will get us away from the fee for service model that we have today. Right now they think that ACOs are the path to get to a pay for performance system. That means they need every doctor in an ACO for it to work.

Is meaningful use designed to be hard to encourage doctors to move to ACOs?
No. Meaningful use was designed to be as hard as they thought they could possibly make it and still get a large number of doctors to do meaningful use. Of course, meaningful use’s intent is all about creating some accountability for the EHR incentive money. However, there’s little doubt that some of the other government goals have been incorporated into meaningful use in the process.

My conclusion is that getting doctors into ACOs certainly wasn’t the intent of meaningful use, but it might well be the result. Maybe doctors aren’t fond of that result. This could be part of why 17% of providers got the first EHR incentive check and didn’t show meaningful use for the second EHR incentive payout.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the, 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.


  • First, I think it is important to realize that the current health system model was designed by the government.
    The government “re-inventing” the system won’t help much…it especially won’t help the docs.

    Docs should know that as soon as their palm is turned upward to the government for a check (medicaid/medicare), they’ve lost control. Note: this is the case for any business that relies on the government.

    But – Meaningful Use isn’t the issue.
    MU is actually easy…depending on your EHR. Much of MU is dependent on whether you EHR is able to pull the relevant data – Oh sure, you need to change your ways to ensure you get the required “counters”, and THIS is really where many docs get frustrated.

    Add to the frustration that it generally takes clicking in 3 to 7 different places within an EHR to get ONE counter, and you can see why the frustration grows.

  • I truly don’t believe that MU was to force ambulatory practices to disappear and become part of major entities such as ACO’s of hospital owned practices. I think a lot of MU criteria make sense while some does not. Hence the reason why they have changed the criteria over time and will continue to. I truly believe that there is no free lunch and that MU is the payment for receiving their “free” money to assist implementing an EMR before payment adjustments kick in. Do I believe that this carrot and stick routine was the best way to get doctors to come into the 21st century? Maybe not but I don’t have a better scenario other than forcing docs to get on board or lose their license. That seems rather harsh but could have been done if there were not 800+ ONC certified EMRs instead of 1/2 dozen really good EMRs. Incentive money could have been spend much more wisely on developing a few great EMRs that really worked well in most practices instead of it being the Wild Wild West.

    We at Robert Half Healthcare are now providing the real broad and real depth staffing services to help ambulatory practices stay in business and from being bought out by hospitals and ACOs and staying in their communities and being albeit to do what they do best, practice medicine.

    Love to share more ideas.

  • John,
    That comment is worthy of a post. The reason it’s not easy is because of the changes to workflow. Sure, the practice of attestation is easy, but the process of changing the workflow to get the right data is the hard part. I think that’s what you meant too.

    I wish they would have focused on interoperability and let doctors choose whatever software they saw fit. This would have encouraged doctors to go electronic, it would have incentivized something that provides value to healthcare that doesn’t have any natural incentive for doctors. Oh well, too late now. MU is here to stay.

  • Totally agree on the workflow and the interoperability front.

    Doctors don’t want anything shoved down their throat and don’t belief that CDS is going to bring better healthcare.

    MU is here to stay; payment adjustments are coming starting with Medicare and will be even bigger with private insurance carriers.

    Very hard to do any change management whenever the participant is an unwilling partner. Funny how doctors still think that attestation money is revenue and not to be used to reinvest into their infrastructure, whether it be an EMR, better technology infrastructure, staff training, better RCM workflow and procedures, etc. etc. That is what we at Robert Half Healthcare are bringing to the table. Staffing familiar with new practice issues and pain points on a temp, part time or project based level. They just don’t have the manpower to make this work.

    I truly believe the root cause is not the software, in most cases, as well as the lack of interoperability. It is the doctor kicking and screaming and not wanting to do it because they don’t believe in it.

    How do we change that mentality?

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