Frustration Prevails with ICD-10, Meaningful Use in 2015

January is a time for both reflection and planning for the upcoming year, which is why the Roman god Janus has twin faces that look both forward and back. As we prepare for 2016, Physician Practice asked industry leaders to look back on five of the leading issues in health information technology during 2015. Here is part one of that year in review. Part two will be coming tomorrow.

Meaningful Use

If he had to sum up the year 2015 in one word, Robert Tennant, senior policy advisor of the Medical Group Management Association (MGMA), said it would be “frustration.”

The year started with a blog post from Patrick Conway, chief medical officer of CMS, acknowledging that the meaningful use program needed modifications. Yet it was awkward that CMS released the Stage 3 proposed rule before the Stage 2 modification, Tennant said. “On one hand they say we understand the challenges you are facing, but here is another more challenging rule, so it sent mixed messages.”

Tennant said we are going to look back at 2015 as a lost year. “By that I mean a lost opportunity to keep moving the industry forward, because it added an element of doubt,” he explained. Creating rules that are “final,” but could be changed is tough on both providers and software vendors. “The whole industry is trying to do the right thing, but the regulations are hamstringing them,” he said.

Steven Waldren, a family physician and the director of the Alliance for eHealth Innovation at the American Academy of Family Physicians (AAFP), said there is a lot of frustration among AAFP’s membership, and anecdotally he is hearing from more members that they are fed up and deciding participation is not worth it. Many practices have found the Stage 2 measures that hold physicians responsible for patient actions to sign up and use a portal the most difficult to meet, and Stage 3 will require providers to work with patient-generated data for 5 percent of their patients.

“We believe that the patient engagement piece is critical for achieving the Triple Aim, increasing patient satisfaction and provider efficiency,” Waldren said, “but my concern is that with meaningful use, the focus is on compliance, not doing it in a way that is beneficial.” Waldren worries that without thinking through how to use that data to care for patients, providers will stick that data in their systems just to show they’ve got 5 percent of their patients involved.

Another problem, according to James Hook, director of consulting services for the Fox Group LLC in Upland, Calif., is that many practices are finding the EHR vendor they chose for Stage 1 failed to get its software certified for Stage 2.  Looking ahead, “more consolidation and switching of EHRs are likely,” he said.

Some providers would not have been interested in meaningful use, no matter how well it was run, Tennant said. But there is another group that would like to move ahead, but doesn’t want to make investment unless it is clearly going to pay off for them. “The government needs to find ways to bring those folks forward. We all agree that if is appropriately used, technology can augment the care delivery process.”

ICD-10

At the beginning of 2015, perhaps nothing on the technology front loomed larger than the ICD-10 conversion. It had the potential to impact 100 percent of physician practice revenue. Although a KPMG LLP survey found that 80 percent of organizations said the transition has proceeded fairly uneventfully, others say that there still may be physician productivity decreases in 2016.

Oct. 1 should be seen as the starting line, not the finish line, said Matthew Menendez, an executive with White Plum Technologies, a Birmingham, Ala.-based firm that has worked with more than 6.000 physicians across the United States to help prepare their practices for ICD-10. Because payers, including CMS, have delayed denying claims for less-specific codes, some physicians turned to last-minute and suboptimal workarounds, he said. As payers eventually make adjustments to their adjudication processes, coders and billers will go back to the provider to ask for additional information to get claims paid. This back-and-forth process is time-consuming, labor-intensive, and expensive.

“People who prepared over time and took that guidance to heart were not putting out as many fires at the end. Part of that is a disservice the government did by crying wolf so many times,” Menendez said. “They would say, ‘No we really mean it this time,’ and then delay it again. That pattern reinforces people delaying preparation. The people who spent money and time to get ready just to see it get delayed again - in effect, they were the ones who got penalized.”

Twenty-eight percent of respondents to the KPMG survey said the transition has been smooth and 51 percent described it as having "a few technical issues, but was overall successful."

“We have been hearing the transition has not been a huge issue, but I do have some concerns about productivity challenges if you can no longer just code a particular family,” said AAFP’s Waldren. “So I still hold my breath just a little bit.”

Menendez said the productivity declines could sneak up on practices if the payers have different dates to start asking for more granular data. It is like the old story about boiling a frog, he said. If you turn up the heat slowly, they don’t notice it. “All of a sudden they look up and say, what is happening? I am less profitable than I was last year. I am spending more time answering coding questions, which is not why I got into medicine to begin with.”

People who were preparing for ICD-10 last minute and took short cuts are not seeing the consequences yet. There is a good and bad side to that, Menendez said. “The good side is, they have got time to get that fixed. The down side is that most won’t make changes until they start to feel the pain.”