Obsession With Meaningful Use Could Backfire

"Meaningful Use should not be seen as a financial incentive, but rather as a milestone that helps define a successful EHR [electronic health record] implementation." Those words of wisdom from Ferdinand Velasco, MD, the chief medical information officer (CMIO) at Texas Health Resources in Arlington, Texas, bring to mind an even more pressing issue: MU isn't the end of the story, only the beginning. And if an IT team is obsessed with meeting the letter of the law, they may ignore its spirit. Such shortsightedness will mean you'll be ill-prepared for the much bigger initiative about to hit the streets--namely, accountable care organizations (ACOs).

While the goal of ACOs is to improve clinical outcomes and reduce costs, it's hard to know at this early stage whether they'll accomplish that feat. But when the former head of the agency that oversees the Medicare and Medicaid programs raises doubts about their financial viability, one has to worry.

Gail Wilensky, the former administrator of the Health Care Financing Administration, recently reviewed the results of the Physician Group Practice Demonstration Project, which is supposed to serve as a model for ACOs. While the project showed that large group practices met quality standards designed to improve patient care, the practices had a much harder time reaching their financial goals.

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In Wilensky's words: "Even with all their experience, only two of the [Physician Group Practice] participants were able to exceed a 2% savings threshold the first year of the demo and only half managed to surpass that threshold after three years." While there are all sorts of variables to take into account here, the bottom line is obvious: If the big boys--including practices affiliated with the University of Michigan and Dartmouth--can't get this right, how are the rest of the nation's practitioners going to make accountable care happen?

Nonetheless, if your hospital or practice wants to work within the Medicare/Medicaid system, you'll have to play by the new rules. The long-awaited final regs for ACOs were recently published, containing 33 quality measures, half of what an earlier proposal called for. The rules are divided into four domains: patient/caregiver experience; care coordination and patient safety; preventive health; and caring for at-risk populations. According to Centers for Medicare and Medicaid Services (CMS) administrator Donald M. Berwick, the idea is to "create a more feasible and attractive onramp for a diverse set of providers and organizations to participate as ACOs."

The ACO initiative is part of a plan known as the Medicare Shared Savings Program. And while it doesn't demand EHR implementation, the program does require healthcare providers to collect and share data. One of the best ways to collect that data, of course, is via EHRs. In fact, the final rules state that "ACOs, ACO participants, and ACO providers/suppliers are encouraged to develop a robust EHR infrastructure."

So yes, meeting the MU requirements will help you qualify as an ACO, but if you reach only the bare minimums outlined in the MU rulebook, that won't be enough. The ACO standards require more than the minimum.

And then there's that other issue that healthcare organizations don't like to talk about: false attestation. Currently, it doesn't appear as though CMS will make a vigorous effort to audit practices or hospitals that say they have met all the MU requirements.

Jonathan Bush, the CEO of Athenahealth, told InformationWeek Healthcare that it's his understanding CMS will audit a practice only in reaction to a complaint. "Who would complain that a doctor attested inappropriately? No one, so no one will be audited."

Looks like a perfect storm to me: Providers attesting to quality improvements they've never made to obtain financial incentives they don't deserve, in preparation for an even larger healthcare initiative--ACOs--that may or may not reduce America's obscenely high medical tab.