Finding Meaning in Meaningful Use

If you have not qualified for meaningful use it seems you are in the majority. That's right. Through the end of 2012, a mere 33.9 percent of eligible physicians had attested to meaningful use, according to the New England Journal of Medicine and CMS. Surprised? And you thought you were the uncool kid. If you review HHS statistics, that percentage may have increased to more than 50 percent in mid-2013, as  the number of physicians qualifying continues to grow and as CMS revised downward its projected number of eligible physicians. 

Incentive dollars have been dangled by the government to those who participate; financial penalties have been threatened by the same government to those who don't. Yet, only one in every two or three physicians has attested to Stage 1 of meaningful use, which is considered to be much easier to achieve than Stage 2 or Stage 3. This leads me to ask three questions:

1. Why has participation been so low? Remember, many EHR vendors guaranteed achievement of meaningful use.

2. If participation in the "easy" stage has been so low, is it realistic to assume participation will increase in Stage 2?

3. Where is the "tipping point" - when enough practices are participating to bring "meaning" to meaningful use?

Low participation

Stage 1 of meaningful use has come and stayed. We remain in Stage 1, and those participating in 2013 are required to conform only to Stage 1 requirements, just like last year, just like the year before that.  Despite this constancy, only 172,612 of approximately 509,328 eligible physicians had achieved Stage 1 of meaningful use through the end of 2012.  

The Regional Extension Centers (RECs) were not the panacea CMS had hoped - only 15.9 percent of eligible providers who enrolled in REC programs have achieved meaningful use. The focus of the RECs was meant to be smaller primary-care practices (fewer than 10 providers), which, in many communities, remain the underpinnings of private practice.

Prospects for Stage 2

Physicians who have qualified for Stage 1 for each of the past three years have earned $36,000 of the maximum award of $44,000. However, their future incentives could likely be offset by the cost of preparing for Stage 2 of meaningful use. Why continue? It's a fair question. The hurdles of Stage 2 are much greater. The primary motivation at this point may be to avoid financial penalties.

Advanced Data Management has surveyed physicians for several years on EHR adoption and interoperability. I spoke with their CEO Jon Jenett regarding a recently completed survey of smaller, independent practices. Their findings are interesting. The percentage of eligible physicians planning to participate in Stage 2 of meaningful use has dropped from 65 percent in June of 2012 to 41 percent in June of 2013. Further, the percentage of physicians not planning to participate in Stage 2 has increased from 15 percent to 26 percent.

One might suspect that smaller practices may be more likely to use EHRs that will not be ready for Stage 2 of meaningful use, but that is only part of the reason according to Jenett. "That's a piece of the puzzle," noted Jenett, "but many small EHR vendors have worked hard to prepare for Stage 2. There's also the information overload that comes with interoperability. One physician [said] the average file size of a patient of hers that was discharged from the hospital was 105 pages … She worries that she is responsible for digesting all of this information and will be held accountable if she doesn't."

The tipping point

The government's goal is to have one in two eligible physicians achieve Stage 1 of meaningful use by the end of 2013. But, can any system operate effectively at 50 percent efficiency? It will be difficult to improve access, lower costs, and improve quality of care without efficient and effective interconnectivity.

I believe we are likely to see a geographic dichotomy in the next two years, with some areas of the country approaching 75 percent to 80 percent meaningful use participation, and other areas remaining below 50 percent. This dichotomy will permit us to measure quality-of-care differences and, for the first time, assess the value of the meaningful use initiative.

Financial penalties may be the strongest incentive to pursue meaningful use.  Physicians who do not achieve meaningful use in 2013 face a 1 percent payment penalty from Medicare in 2015.  Similarly, failing to achieve meaningful use in 2014 and 2015 will result in payment reductions of 2 percent and 3 percent, respectively, in 2016 and 2017.

Other payers follow Medicare’s lead and may incorporate meaningful use attainment as a quality/payment metric. Even physicians with a low Medicare payer mix should study the broad impact of eschewing meaningful use in making their decisions.  

Lucien W. Roberts, III, MHA, FACMPE, is a consultant and a former practice administrator. For the past 20 years, he has worked in and consulted with physician practices in areas such as compliance, physician compensation, negotiations, strategic planning, and billing/collections. He can be reached at Lucien.roberts@yahoo.com.