Will Meaningful Use Be Used by Payers?

I was on a call recently with someone who started to state that it was inevitable that the payers would start requiring doctors be meaningful users of a certified EHR. I wouldn’t say that it’s 100% sure that payers won’t adopt meaningful use, but I think it’s far from a forgone conclusion that they’ll jump on the meaningful use bandwagon as well.

Before I get into some of the various rationale for why they will or won’t, I’d love to see what you think in the poll embedded beloww:

Those who think that payers will start requiring meaningful use if you want the highest reimbursement rate usually point to the fact that the payers have often followed whatever Medicare is doing. This is true and so it is possible that they’ll piggyback the meaningful use train.

Those who say they won’t do it will say that meaningful use doesn’t really align with what the payers want to accomplish. There are elements that interest them, but it goes too far in many areas.

I’d say that most payers will probably not hop on the meaningful use bandwagon. However, I’m sure that they’ll let Medicare take the lumps while they sit back and watch how doctors react to meaningful use. If a large portion of doctors opt out of meaningful use, then I can’t imagine payers hopping on that train and making all of those doctors angry. I see payers just sitting back and watching how MU plays out before making any firm decisions.

In the end, I think payers will adopt something that may include some elements of MU that align with their business interests. I’ll just be very surprised if they just take MU on in its current state.

What do you think?

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, 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, EXPO.health, 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.

6 Comments

  • The train has already left. There’s no looking back. The percentage of non-compliant eligible providers will continue shrinking. I agree payers are watching. At a certain tipping point, they will jump on. First, it provides data for analytics, second, (consider me a cynic) the non-compliance penalties are attractive. Payers always looking for ways to pay less.

  • John:
    PHASE-I They will definitely NOT pay for using some EMR or filling meaningless boxes( unless they are stupid enough to hire retired CMS consultants and doctors ). Insurers will look at medicare generated big data and weed out high spenders and withdraw from high risk markets.This is the low hanging fruit.
    PHASE-II : They will make their offerings cost prohibitive with very high deductibles and force meaningful “value-based” purchasing at consumer level. Lobbyists have no power when individuals have to decide how to spend their own money, especially if employers push health insurance purchase on to the consumers and fail to subsidize insurance purchase in a “meaningful way”. The high deductibles may make services more competitive for a while. This may briefly bring down prices for major services.
    PHASE III: Tiered system of care. The smartest of physicians will gravitate to cash only ( Harley Street ) model and work in private clinics and hospitals handling all but real emergency cases on cash or pre-paid model.
    The vast majority of mid level physicians will be salaried and work on the clock ticking off patients, as they have done in the United kingdom. Most primary care will be in community health clinics staffed by non-physicians. ( FQHC model).
    Private insurers will continue to serve the middle group with burdensome cuts while government slowly withdraws from this sector and focuses on the third group..ie to serve voting blocks with sub-prime care.This may force many small hospitals out of market. Hospitals will have to consolidate and size-down( ie. buy on cheap and close small hospitals) to command the prices they want.
    All this will happen in less than 5 years.

  • Payers should be weary of putting such onerous restrictions on their own plans. Some doctors may bite back and refuse those plans, making those payers out of luck.

    The bottom line is that MU does not by itself increase the value or productivity of a practice. It is quality software and good operations that do so.

    MU are toxic standards that have served their purpose of getting the EMR market started. Now they need to step back and get out of the way.

  • John-
    There are practicing doctors who cannot qualify for the MU program, due to its relationship to government payment–some pediatricians for example–so it is a less than 1:1 fit for payers. Massachusetts has a MU condition for licensure, scheduled for a couple of years from now, which is exposing other issues about using MU as a condition. Those issues may not apply to payers, but it highlights the need for “something else” if they want an IT-fluency condition.

    Randy Bak, MD JD

  • I’ve wondered if liability insurance companies will require MU? From their perspective, the more standard and transparent a medical record the better. That’s not to say that the MU standards are the be all and end all, but it’s what’s there.

  • Thanks for all of your insights. Although, I’m not seeing a clear picture of what they’re going to do. It sounds like most think they’ll do something, but probably not MU?

    Carl,
    That’s another good topic I haven’t covered in a while. Is EHR a benefit or a liability for a liability insurance company?

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