Margalit Gur-Arie, Co-Founder of BizMed provides an in-depth look at the Meaningful Use state of affairs for 2014.
Meaningful Use Stage 2 is now on the clock. Three years after the program began in 2011, and a year later than originally planned, the escalator has finally moved up one level. Surprisingly, the usually boisterous and highly hyped health information technology (HIT) media is largely silent on the subject. It’s almost like everybody gave up, or perhaps the entire Meaningful Use exercise is now assumed, and the buzz has shifted to sophisticated analytic apps, preferably mobile, that will utilize all the big data collected by EHRs to perform medical or fiscal miracles. Of course, the best engineered and the sleekest looking Ferrari cannot run without fuel, andAn floating around in the intelligent apps market, it may be useful to take a quick look at the Meaningful Use state of affairs for 2014.
Let’s get some numbers laid out first, so we can have an informed discussion.
- According to CMS, back in 2011, the first year of Meaningful Use, approximately 60,000 physicians attested to Meaningful Use of a certified EHR and 50,000 more attested to buying or upgrading to one. That’s at least 110,000 doctors that purchased a certified EHR in 2011, and probably more.
- By December 2013, 213,000 unique physicians attested to Meaningful Use in the Medicare program, over 20,000 for the first time in 2013, and most likely a bunch more newbies will be added in January and February of 2014. For Medicaid, 100,000 doctors attested to something so far.
- If everybody continues to participate in the program, we are looking at upwards of 350,000 physicians, not counting new ones in 2014, that will be needing an upgrade to a 2014 certified EHR, which is the only allowed EHR edition in 2014, whether one is attesting to Meaningful Use Stage 1 or Stage 2.
- The number of 2014 certified ambulatory EHRs is approximately the same now as the number of certified EHRs was in January 2011. While the supply is the same, the demand should be 3 times higher.
For anyone vaguely recalling the difficulties experienced by many in obtaining a “certified” EHR version in 2011, the three fold jump in demand should immediately become cause of concern. This is most likely why CMS is allowing all Meaningful Users to attest for only 3 months in 2014, regardless of the Stage they are at. Theoretically, one would have until the first week in October 2014 to begin this year’s attestation period. Unfortunately this is not exactly the case for everybody. If 2014 is your first year of Meaningful Use, you must complete your attestation by October 1st to avoid the penalty. You could roll the dice and start your reporting period as late as July 1st, hoping and praying that the reports will be satisfactory, planning to work late on September 30th to get all your stuff ready, and keeping your fingers crossed that there will be no snags with the attestation site that evening. If the stars fail to align, you will be penalized. I am not certain about this, but I wonder if the possibility exists that you will be both penalized and incentivized in the same year.
If this is not your absolutely first year of Meaningful Use, all attestation periods are tied to calendar quarters in 2014, so you can either start on January 1st, April 1st, July 1st, or October 1st. You cannot just run reports until you find a “good” 90 days period. If one of those four periods is not good enough, that’s too bad, you’re out for the year, and since this is a new EHR version, chances are some unexpected “glitches” may occur. In the past, people devised several “workarounds” to improve on Meaningful Use reports prior to attestation. Those workarounds included, retrospective data updates for things like problem lists or demographics, and the perennial favorite of “print to file”, where clinical summaries are sent to a virtual PDF printer to increment the EHR count with minimal deforestation effects. Since attestation periods are fixed now, and since those attesting to Stage 2 are looking at significantly higher thresholds, and some new ones to boot, one should expect a much higher incidence of innovative fixes to workflows.
Another thing to keep in mind is that clinical quality measures (CQM) reported this year, partly for PQRS, may become public. While in the past, the numerator for these measures was irrelevant to attestation success, good performance is very important now, and carelessness with the numbers may very well come back to haunt you in the not too distant future. Fortunately, CMS has increased the pool of CQM sanctioned for reporting, so everybody, including specialists, can pick measures pertinent to their practice. Unfortunately, with the exception of a handful of EHRs, most vendors chose to not certify for all possible measures, so this year, just like in 2011, most physicians will have no choice of CQMs. Keep in mind that the reporting requirements for CQMs in 2014 is the same for all participants (i.e. 9 measures, electronically submitted), regardless of Meaningful Use Stage, except for first year participants, who are exempt from the electronic requirement.
[Note: On 2/1/2014 HIMSS, the EHR vendors association, has posted a remark on the HIStalk blog stating that “CMS is permitting manual attestation on clinical quality measures for meaningful use in 2014, as has been done through 2013, not just for those in their first year”. The official CMS website is stating otherwise, but I am not one to dispute the insider information of HIMSS, so expect some changes.]