Viewpoint

EHR and MU2: Bait and switch?

FROM THE CHIEF MEDICAL EDITOR

Larry E. Patterson, MD

The government desperately wanted us to implement electronic health records (EHR), so they intervened with a carrot-and-stick approach. The carrot: A $44,000 bonus per doctor if you started EHR by 2012. The stick: fines each year you don't implement it, with no end in sight as to the duration or degree of penalties.

The carrot came with a pathogen: meaningful use (MU), referred to in many circles as “meaningless use”. The goal of MU, according to the government's website, is “to promote the spread of electronic health records to improve health care in the United States.” Of course, MU does just the opposite. It's so burdensome to comply with that some practices have chosen to forgo EHR and take the penalty. Some have had EHR for years, but are forgoing the bonus because the extra aggravation doesn't make financial sense. Others are selling out to larger entities, and physicians are simply retiring early.

With that upbeat introduction, let me share with you a new problem. PQRS requirements are increasing in 2014, with the need to report nine measures to get the shrinking bonus. ICD-10 starts later this year, and it will be a very difficult transition for most of us. But these are within your control. (See the cover story, “Marking out the regulatory milestones for 2014,” page 14.)

Not so with the new MU stage 2. You are now required to obtain e-mail addresses of 50% of your patients. Then you have to get 5% of them to access their account through a patient portal (that you have to pay for). While patient portals have all sorts of positive features, this is being forced upon us. AAO, ASCRS and other specialty groups complained to CMS about this provision. To my knowledge, CMS never responded.

Note this is a core measure; it's not optional. If you don't meet this requirement, you don't get the full EHR bonus you were counting on when you ran the financials for that expensive hardware/software combo. We've been collecting e-mails for months. In our most urban office, we got 45%. In a more rural setting, we collected only 17%.

Patients don't want to give up their e-mails, and a surprisingly large number (especially seniors) don't have them! (Seriously, my own mother doesn't have an e-mail.) Our IT director won't give out his personal e-mail to his doctor. Who wants the risk of more spam? Target stores just had 40 million credit cards breached. I'm pretty sure their security is better than mine.

Again, even if you're successful in gathering 50% of your patient's e-mails, you have to ensure 5% access the portal. A doctor friend of mine says the staff time spent educating thousands on how to use the portal has become a nightmare.

Obviously I'm not a fan of government intrusion into our practices. But we now have a situation where many spent hundreds of thousands of dollars on EHR in large part due to the bonus, even though the rules had not yet been written. We now have the rules, and find one of the core measures is out of our hands. My IT guy thinks the government wrote them this way to get us all to buy into EHR and still not have to pay the bonuses. Bait and switch?

Wishing you a happy New Year nonetheless. OM