EMR challenge: Tough road to reach "meaningful use"

The final CMS regulation for electronic medical records has some of the flexibility physicians need to be successful adopters, but not nearly enough.

Posted Aug. 16, 2010.

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Electronic medical record systems have the true potential to transform the practice of medicine in ways that will improve patient care. But physicians must be secure in knowing that they will have the necessary support when they make the leap into the paperless world.

Congress and the White House have recognized the need for that support by getting behind Medicare and Medicaid incentives for physicians who undertake the daunting and costly process of adopting EMR systems. A final rule issued in July outlines how doctors can become "meaningful users" and receive the bonuses needed to help offset such a major investment.

Fortunately, federal officials are listening to some physician concerns about the government setting the bar too high for doctors to clear. Based in large part on advice from the American Medical Association and others in organized medicine, the final meaningful use rule has some greater flexibility for physicians. For instance, it allows them to defer some EMR requirements in the first two years and makes others easier to fulfill.

But despite the improvements, the bonus requirements are still going to make adoption a tough sell for many practices, especially the smallest ones. Obtaining a Medicare or Medicaid bonus in 2011 or 2012 still will require physicians to meet 20 EMR objectives, each with its own measure to determine whether doctors are compliant. Miss just one of them, and a physician who has spent tens of thousands of dollars on an EMR system might lose out on as much as $18,000 in a Medicare bonus for the year.

The margin of error is not wide enough for physicians. A requirement for doctors to maintain up-to-date diagnosis lists on their EMRs, for instance, mandates that such lists cover more than eight out of every 10 patients -- a tall order. And if the government determines that a practice did not qualify for a bonus, no appeals process exists for those physicians to argue that they made the grade.

Physicians also are dealing with a tight deadline for EMR adoption. Because the federal government's meaningful use rule on EMR systems is so recent, not a single vendor so far has been able to offer a product that will meet the requirements.

Officials expect such products to start reaching the market this fall, but that doesn't leave physicians much time to research, purchase, implement and test such systems before the incentive program launches in 2011. Getting on board with a paperless system involves much more than simply plugging in the box and booting it up.

And as for those dedicated physicians who are ahead of the curve on EMRs? Some of them might not find out until fall that their costly systems are not going to be deemed government-certified for meaningful use.

The AMA is calling on the federal government both to establish a bonus appeals process and to deem early adopters' systems as certified if they meet the meaningful use requirements. Heeding that advice would help allay some physician concerns.

But with all the uncertainty in the air, too many physicians -- especially those in smaller practices -- might conclude that the risks of failure are not worth the potentially outside chance of reward when it comes to EMR adoption. That would serve only to widen the gulf between those who have entered the paperless world and those who are still struggling to do so.

That gap will have consequences. The EMR incentives are voluntary -- but not for long. Unless Congress changes the plans, in a few years Medicare bonuses will be replaced by penalties for vulnerable physicians who have not been able to overcome the barriers to EMR adoption. Those cuts will be on top of any deep reductions that might be required under the broken Medicare sustainable growth rate payment formula.

Physicians are ready to be teammates with the federal government in the shift to a better way of handling patient records. But federal officials must realize that if they are too strict in setting the rules of the game, they risk shutting out too many valued players.

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