Government Rules for EHR Incentives Rile Some Hospitals, But They're Unlikely to Fight Them

You can't make some people happy, no matter what you do. That's the quick read on the healthcare industry's initial reaction to the government's final rules on "meaningful use" of electronic health records (EHRs), which doctors and hospitals must demonstrate to obtain federal subsidies worth up to $27 billion. Despite the significant changes made in the regulations after overwhelming criticism from industry groups, those same groups were hostile or skeptical toward the final rules, which they'd still like to soften further so that providers can get the money with minimal effort. Yet it seems doubtful that they'll fight on, except in trying to influence how the regulations are implemented.

Take the American Medical Association position, for example. The AMA said it's reserving judgment while it analyzes the 864-page document, yet it couldn't refrain from slamming the Administration yet again for not figuring out how to maintain or increase doctors' Medicare reimbursement. "Costly EHR systems are out of reach for many physicians because of low Medicare payments and the prospect of steep cuts in December," cautioned AMA board member Steven J. Stack.

American Hospital Association President Richard Umbdenstock went further, saying:

The AHA is concerned that the requirements may still be out of reach for many of America's hospitals and more analysis is needed to determine the overall impact on hospitals. Unfortunately, CMS continues to place some barriers in the way of achieving widespread IT adoption by our nation's hospitals and physicians.

In other words, MGMA will try to find some way to get more money for physician groups by influencing the Centers for Medicare and Medicaid Services (CMS), which will implement the regulations.

The final rules already reflect the industry's key demand, which is to throw out the "all-or-nothing" approach to meeting the meaningful use criteria. Instead of the 23 requirements that doctors had to meet in the draft version, the final regs mandate that they comply with only 15 "core" objectives in 2011. Then they can choose any five optional measures from a list of 10 and show that they're using their EHRs to meet those goals by 2012. For hospitals, there are 14 core measures, down from 25 in the draft regulations, and they also can select five goals from the optional menu by 2012. In 2013 and 2015, additional requirements will be added, as the government planned from the outset.

Here are some of the detailed changes in the rules:

• Doctors have to write and transmit only 40 percent of their prescriptions electronically, rather than 75 percent.
• The requirement that they bring 50 percent of lab results into their EHRs in searchable form is now on the "optional" menu, and the benchmark is now 40 percent.
• Instead of having to use computerized physician order entry to place 10 percent of all lab, diagnostic and medication orders, ambulatory care and inpatient physicians now have to use computerized order entry systems to order medications for 30 percent of patients who have at least one prescription.
• The amount of quality reporting has been drastically reduced.
• There's no longer any requirement to submit claims or check insurance eligibility electronically.
• There are new requirements regarding patient education materials and advance directives.

In a commentary published in the New England Journal of Medicine, Blumenthal and Marilyn Tavenner, principal deputy administrator of CMS, said that the final rules "will enable significant progress toward improving care -- but are also achievable by average practices and providers in the early years." That's theoretically possible, says Erica Drazen, a managing partner with CSC Consulting. But she doubts that the increased flexibility and decreased requirements in the regulations will change anybody's mind about whether it's worthwhile to pursue the government incentives. As much as everybody would like to get the money, a large percentage of hospitals and doctors are not willing to invest the funds and the effort required to show meaningful use.

Image supplied courtesy of jlblue at Flickr. Related:

• HHS Will Choose Criteria For EHR Certification
• MGMA Calls For Careful Design and Testing of Meaningful Use
• Biggest Health IT Users Have Issues With Meaningful Use
• Chorus of Critics Promise Changes in EHR Incentive Regs