Maybe It’s Time To Phase Out The Meaningful Use Program

Since Stage 1 of the Meaningful Use incentive program kicked off in 2011, the level of health IT adoption has risen dramatically across the United States. As publicly-funded programs go, it’s had quite a ride.

A few years in, nearly 97% of U.S. hospitals had achieved Stage 1 or higher of the HIMSS EMR Adoption model (as of Q1 2015). And a plurality (roughly 57%) were at Stage 5 or higher.

Meanwhile, 83% of office-based doctors are now using EMRs, according to a recent report from ONC.  The percentage drops to 74% when counting only physicians using certified EMRs, but that’s still a very substantial increase over the 57% of office-based docs using EMRs in 2011.

Whether this progress was worth the $28.1 billion paid out (as of December 2014) is anyone’s guess, but clearly, the program had a huge impact. In fact, it’s hard to argue that MU payments helped to trigger a major change in how medicine is practiced.

That being said, some critics are floating the idea that it’s time to retire Meaningful Use, or at minimum, pull back its implementation dramatically. For example, HIT superstar John Halamka contends that Meaningful Use programs “have served their purpose.”

In his blog, Halamka — who serves as CIO of both the Beth Israel Deaconess Medical Center — suggests that Stage 3 of MU is little more than a multi-train pile-up (the following quote is long but deserves to be read in full):

 Stage 3 makes many of the same mistakes as Stage 2, trying to do too much too soon. It requires patient accessible Application Programming Interfaces (APIs) without specifying any standards.   It requires sending discharge e-prescriptions although pharmacies cannot widely support the cancel transaction that is essential to discharge medication management workflow.   It requires public health transactions but CMS has no authority to require public health authorities to standardize the way they receive data.

Clinicians cannot get through a 12 minute visit, enter the necessary Stage 3 data elements, reconcile problems/allergies/medications from multiple institutions, meet the demands of the  Stage 3 clinical quality measures, make eye contact with patients, and deliver safe medical care.

Having read the above, you won’t be surprised to learn that elsewhere, Halamka argues that Stage 3 of Meaningful Use should be dropped completely. Instead, he’d like to see the government offer merit-based rewards for positive outcomes and innovative approaches.

While Halamka’s arguments make a lot of sense, another group of people want to address the fact that the Meaningful Use program incentives have never been available to most mental health providers. As readers may know, mental health facilities such as psychiatric hospitals and substance abuse treatment facilities currently aren’t eligible for Medicaid and Medicare MU incentives. Also, front-line mental health professionals such as psychologists and licensed social workers are not included in the current definition of “eligible professionals.”

A bill progressing through the U.S. House of Representatives, H.R. 2646 (“Helping Families in Mental Health Crisis Act of 2015”) proposes to add clinical psychologists to the list of eligible professionals, and psychiatric hospitals, community mental health centers, residential or outpatient mental health and substance abuse treatment facilities to the list of eligible providers. While I’m not suggesting that Meaningful Use as currently structured is the only way to address the mental health industry’s HIT needs, those needs shouldn’t be forgotten. In fact, John would argue that not being involved in meaningful use might be the best thing that happened to mental health EHR.

I’d agree that eliminating — or at minimum transforming — the existing Meaningful Use program may be a good idea. Better to try something new than drag providers through a wasteful, painful rout.

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.