$15+ Billion of Ongoing Meaningful Use Spending Will Change Nothing

In case you missed it, Jeb Bush put out his healthcare plan and called for termination of the meaningful use program. Here’s that section of his plan:

Promote private sector leadership of health information technology adoption: Lead private sector collaboration, rather than government mandates, to establish national standards for electronic health record features and data interoperability; eliminate government mandates and penalties for health care providers who do not use government-approved electronic health records; protect health information from hackers and cyber attacks; and enable patient ownership of their medical history and records. Individuals should have access to their longitudinal medical records, which will help providers offer more personalized and timely treatments for individuals.

This sounds a lot like my plan to blow up meaningful use and focus on interoperability. I think it’s the right strategy and the more I think about the future of meaningful use, the more I’ve realized that it needs to end (at least in its current form).

I’ve been talking with a lot of people lately and I’ve been asking them this fundamental question: If the government chose not to spend the ~$15 billion of meaningful use money that remains would it change the trajectory of EHR adoption and EHR use at all?

There are a number of ways to look at the answer to this question. First, all of the remaining meaningful use money has basically been spoken for. I can’t think of anything anyone can do to change which companies are going to get the EHR incentive money. Everyone that’s going to get future EHR incentive money has already purchased their EHR and that $15 billion is already more or less committed to the various EHR vendors. Meaningful use has essentially locked practices into their current EHR and that’s not going to change (give or take a few hundred million).

Second, what major benefits will continued participation in meaningful use bring healthcare? This is an important question. If the government’s going to continue spending $15 billion on this program, don’t you think we should be able to trace that spending to specific benefits we’re going to receive? One way to look at this is to consider the benefits we’ve received from the first ~$20 billion (Medicare) (and another $10 billion for Medicaid) spent on meaningful use. We’ve seen adoption of EHRs. That I can’t argue. However, it’s hard for me to argue much benefit beyond it. Looking at the future meaningful use stages, I’m not optimistic of the benefits future meaningful use compliance will bring either. I’d love to hear if you have a different perspective.

I do know hundreds (probably thousands) of doctors who would argue that continuing the meaningful use program will not only not provide us any benefits, but will actually cause harm to health care. They would argue that meaningful use is a tax on their time and it provides no actual value to them or their patients. This is evident when you consider the number of doctors who have chosen not to participate in meaningful use even though they know doing so is going to cause them to incur penalties. Think about that. Many doctors think the cost to participate in meaningful use is more expensive than the guaranteed penalties for non-participation.

Returning back to the government perspective, is it wise for the government to spend another $15 billion on a meaningful use program which will actually do more harm than good?

The one challenge with the idea of discontinuing meaningful use is that it will make some organizations that were planning on the money angry. I get it. If you’re a hospital that just spent a few hundred million dollars on an EHR with the expectation that you’d be getting paid the meaningful use money, meaningful use being terminated would be quite a blow. Same goes for small practices that have invested in an EHR with the hope of EHR incentive money. I’m sympathetic to this challenge.

The solution is simple though. You find another more meaningful (pun intended) way to spend the $15 billion so these organizations can still recoup some of the investment they made in their EHR software. The meaningful way to do this is to pay them for being interoperable. Disregard all the other prescriptive elements of meaningful use and create a much simpler program that’s focused around healthcare organizations sharing data. Incentivize healthcare organizations to do something we all know is the right thing to do but which has no natural incentive. Focus the incentive on the outcome.

Am I optimistic this will happen? No. Unfortunately, I think it would take some legislative action for CMS and ONC to be able to do this. They can’t just do it on their own (I believe). Given the state of affairs in Washington, I can’t imagine congress caring enough about $15 billion here or there. It’s sad to say, because so much more could be done to improve healthcare as we know it if that $15 billion were part of the right incentive program. As it is, if the meaningful use program were cut today or the money is spent, I don’t see either action changing the trajectory of EHR and healthcare IT in a significant way.

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.


  • John you really blew it on this post.

    Guess Jeb doesn’t realize that HITECH was drafted under his daddy’s administration? That is also who stood up ONC? Anyhow

    Poor fact checking.. Everyone who actually works in industry vs just writes about it knows that interoperability was baked into MU from stage 1 forward.. https://www.healthit.gov/public-course/interoperability-basics-training/HITRC_lsn1069/010301—-.htm#

    Also CMS not ONC makes the rules (vs policy) and it has spent about 30 billion so far.. It is the largest corporate welfare program we have seen in ages.. What other industry do you have to pay to adopt computers?


  • BA,
    I’m sure Jeb knew the relationship to his daddy and brother. Nothing wrong with him having a different view.

    It wasn’t poor fact checking on interoperability. The key difference is our definition of “interoperability baked into MU.” Certainly we all know that meaningful use has included overtures related to interoperability since the start. However, as you know, it has done almost nothing to move the needle when it comes to interoperability. It’s in name only. My suggestion is to move the incentives from talking about interoperability to actually paying organizations for being interoperable.

    It’s a good point about CMS. They have responsibility for the final rule, but they do it with lots of support from ONC.

  • As for the $30 billion, I was referencing the $20 billion for Medicare: https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/August2015_MedicareEHRIncentivePayments.pdf I should have added the other $10 billion for Medicaid: https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/August2015_MedicaidEHRIncentivePayments.pdf I’ll update the post. The principle is still the same.

    We’ll see how the $15 billion projection I made plays out.

  • I like your “. . . blow up MU and focus on interoperability” but patients can make this happen.

    Jeb’s plan goes off the rails at “. . .lead private sector collaboration”.

    Since when do we get good results when the “leading” is done by people who collectively know virtually nothing about the domain?

    I don’t like “. . .establish national standards for electronic health record features and data interoperability” for much the same reason.

    The “standards” will end up being defined by lobbyists. Same old, same old.

    Why not reimburse on performance?

    Patients stay in system too long/relapse too often, the reimbursement goes down. Bad players either shape up or go out of business.

    When clinics unnecessarily duplicate tests, reimbursement goes down.

    For any business it’s a bad idea to have bureaucrats dictate how the owners/stakeholders should manage their operations.

    Clinics/hospitals spend years developing competitive advantage, they want to run their workflows, use their forms.

    When the focus if on “features” your only choice is to use them.

  • The other problem with ‘features” as opposed to “functions” is unsuspecting buyers can easily end up with a “hollywood stage” where you have a “nice” look/feel that links back to 1960 database technology.

    I won’t name any vendors. They know who they are.

  • The future, based on the past. All this bailout will run out. 90% of the then only 120 or so vendors were Clearly GOING OUT OF BUSINESS, then Came MU and even more and more VC’s. That said, there are a lot of VNC’s out there that are not very happy, they have 20-50 Million Dollars invested in EHR’s that have less then 2000 end users. These companies blew through money, and now the MU Stimulus is all but ended, MU Stage II Money is minimal, and many Providers (Over 40% are taking the stick). So my prediction:

    We will be back down to under 200 vendors by the end of 2019. Frustrated Users will have picked different EHR’s and Venture Capital Companies will shut down the EHR’s.

    Why do I say this. Facts, and the fact is, 75% or more of the EHR’s that were developed to get certified have terrible UI (User Interfaces) and moreover Physicians Hate them. They will stop being used at some point. This is my prediction, I am sticking with it, and I have been in this business way too long.

  • 15 Billion is about the amount the department of defense wants for its IT program. So we need to multiply that by 100 to really estimate the cost to implement across all patients in US. So lets think 1.5 trillion. 15 billion is nothing. Truly. And all of it is going to EHR vendors in an artificial market. Epic and Cerner have headquarters that are like amusement parks with lavish conference rooms, meals, massage stations, etc. Its disgusting.

    And I am speaking as a front line provider. Our group gave up on MU. We are taking penalties as its too inefficient, unsafe, ridiculous data entry, all under threat of audit, for peanuts from CMS. And only CMS. You could see the artificial market explode after MU was announced. Most providers took the stage 1 money as it was click boxes (we did not). Stage 2 failed and keeps failing Stage 3 as proposed is an absolute joke. As providers, we really do NOT have time for all this BS. Anyone that used EHRs prior to MU can tell you, that the EHRs that focused on the provider usability and efficiency and safety were awesome. MU destroyed that. The market would HAVE worked maybe not as fast, but it would have been better. ONC and CMS should have JUST focused on how we can interoperate, skip all the other niggling EHR details to the ones using the EHR, the vendor and provider.

    Lets look at Stage 3 as proposed:

    1. Renaming measures, objectives and then piling on multiple measures under each objective does NOT simplify NOR improve the program.
    2. Requiring 365 days of reporting will never happen. EVER.
    3. Increasing patient engagement threshold to 10 percent, including APIs, are you serious? Will NEVER happen, unless forced upon our poor patients to send us a “hi” message from the waiting room. As for APIs, sounds great to IT folks but we are PROVIDERS!! Do you understand we provide care, not APIs.
    3. TOC threshold will never happen
    4. Bidirectional exchange with immunizations and public health registries, 6 measures no less, will NOT happen.
    5. SOC and Patient education must be electronic, are you NUTS? Our patients want printouts. The do NOT want us to electronically send them anything. Stupid.
    6. CQMs electronically submitted won’t happen.
    7. Include patient generated data? Are they simply out of their minds or is this a joke?

    There is not a SINGLE vendor that will have this ready by 2018. No way. Again, I am a front line provider in a group that has ALREADY given up on MU. I thought maybe Stage 3 would bring me back in, but its a deceitful lie that its less measures, and the thresholds and counting numerators and denominators and attesting and all this clicking will NEVER happen. All under the threat of audits.

    Any database programmer would tell you that they already failed at step 1 of making an interoperable database. You need a unique ID. Without that foundation, its a mess. OCN, with these somewhat barely practicing clinicians are out of their minds if they think Stage 3 will be successful as proposed. They need to actually talk to front line providers, not sycophant informantic providers that click all day. They need to get in a room and get honest. And stop this madness. If you walk into a clinic or hospital, look around. Look at how much patient care is happening vs providers and staff at the computer monitor. Its scary. Interns and residents literally sit at computers all day, 95% of the day. The exact opposite of when I trained. I would argue we did better care back then too. The time is now that we are starting to scream, that enough is enough. There is nothing about medicine that gets better with providers that are angry, burned out, disgusted with the current state of medicine. And there are many at that level already.

  • “Anyone that used EHRs prior to MU can tell you, that the EHRs that focused on the provider usability and efficiency and safety were awesome. MU destroyed that. The market would HAVE worked maybe not as fast, but it would have been better.”

    I agree. It’s unfortunate how drastically that’s changed.

    I don’t agree with you when it comes to APIs. I don’t think the government should be the ones mandating them and it’s true that doctors won’t ask for an API. However, doctors will ask for this new genomic medicine program they want to use be integrated into their EHR. An EHR API will facilitate that and hundreds of other similar innovations that come.

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