Chorus of Critics Promise Changes In EHR Incentive Regs

"It ain't over until the fat lady sings." That is true of many things, including the rules on "meaningful" use of electronic health records. The period for commenting on those regs and an accompanying set of rules on EHR certification extends through March 15. Judging by the reaction of some leading organizations to the draft regs, as well as the remarks of experts in a webinar sponsored by the eHealth Initiative (eHI), it appears there will be plenty of comments and a number of changes made in the rules before they go into effect sometime in the spring.

As noted in my last post on this subject, the Medical Group Management Association (MGMA) objects that the requirements are "overly complex" and present daunting challenges to physician groups. The American Hospital Association has also blasted the proposed regs for not rewarding hospitals that have made strides in health IT, and the College of Healthcare Information Management Executives (CHIME) says that tight deadlines and quality reporting requirements might make it impossible for many providers to garner government EHR incentives.

Specifically, CHIME complains that the proposed reporting requirement would overburden providers by forcing them to use a combination of electronic and paper methods of data collection. Also, CHIME, like AHA, notes that too many hospital-based physicians would be ineligible for government subsidies.

Both of these criticisms were heard in the eHI webinar. Glen Tullman, CEO of Allscripts, said that paper-based attestation-required for two-thirds of the meaningful use criteria--is problematic, and he suggested that vendors report instead on the use of EHRs by their customers. He also said the reporting requirements are too vague, especially for large multispecialty groups. Hospital-based physicians, particularly those in academic medical centers, are totally confused about who is eligible and what they need to do, he said.

Karen Bell, a senior vice president of Masspro, the CMS-contracted quality improvement organization in Massachusetts, estimated that 27 percent of physicians wouldn't be eligible for subsidies, partly because of how hospital-based physicians are defined. "That leaves out a significant portion of the delivery system."

Bell, who used to be a key HHS official in the information technology area, also pointed out that many small practices are waiting for the health IT regional extension centers to come online to help them implement EHRs. But, while nearly $600 million has been allocated for the extension centers, she noted, they have not yet been selected or funded. As a result, she said, many doctors won't get help in 2011 and won't be able to apply for incentives until 2012.

Bell criticized what she called "the overemphasis on premature reporting of existing CMS quality measures." Not only does the burden of this reporting fall unequally on different medical specialties, she said, but few of the quality measures are reliable, especially when applied to individual doctors during the 90-day reporting period required in 2011.

Mickey Tripathi, president/CEO of the Massachusetts eHealth Collaborative, contended that neither set of regulations properly addresses the issue of lab result delivery. Noting that 75 percent of test results come from small lab firms or hospitals, and that each lab reports results differently, he said the opportunity to standardize this area should not be missed.

The panelists-who also included Dr. Neil Calman, a Bronx, NY, family physician who is on HHS' Health IT Policy Committee-split over a question about how many physicians are likely to qualify for EHR incentives in 2011. Bell predicted they would be mostly doctors who already have EHRs. But Calman forecast that many physicians who don't have them will acquire the systems in time to apply for the subsidies in 2011; he added that vendors are getting better at helping practices implement EHRs speedily. Tullman, of course, agreed. Ray Scott, the moderator and also CEO of Axolotl Corp., an electronic connectivity firm, predicted that 20-25 percent of physicians would qualify for incentives next year-which falls right in the middle of the range provided by HHS in its notice of proposed rulemaking.