Viewpoint

What’s worse than changing the rules?

FROM THE CHIEF MEDICAL EDITOR

Larry E. Patterson, MD

People are finally discussing what this column warned about exactly one year ago. (See “EHR and MU2: bait and switch?” Ophthalmology Management, January 2014, http://tinyurl.com/OMViewpoint1401.)

As of August, only 1,898 professionals across all branches of medicine had attested to meaningful use stage 2, a surprisingly small number. Industry groups representing healthcare interests are calling for CMS to provide more flexibility in meeting stage 2 criteria. In a November press release, AMA President-Elect Steven J. Stack, MD said, “The stringent pass/fail requirements. . . combined with a tsunami of other overlapping regulations, are keeping physicians from participating in the meaningful use program.”

The problem is the patient portal and requirements for patient interaction. One example: During the attestation period for stage 2, more than 5% of patients seen in unique visits must send a secure message to the practice. Successful attestation, then, depends on patient participation, a variable we can’t control. A few months ago, CMS provided an answer: Cheat. Well, it didn’t actually say “cheat.” Because online portals can provide patients with their medical information and a means for secure messaging, CMS recommended you hire a person (at your cost) to meet with patients in your office, sign them up to your portal, log them in, and then get them to send a question to your practice through the portal. Yes, that will help you attest, but is it “meaningful”?

THE SCORE: PATIENT MESSAGES 0, PENALTIES 1

Despite CMS’s “disingenuous encouragement,” our practice decided to abide by the rules. The results? Around 35% of patients, about 3,500, supplied e-mail addresses. (About half of the portals offered by EHR vendors require patient e-mail addresses for log in.) Of these patients, all of whom received portal invitations, 75 logged in. And the number who asked a question? Zero. Not a single patient. Surprised? Not really. If I were a patient, I’d ask a question during my office visit. If I forgot the question, I’d call the doctor’s office. Now the government will penalize me because my patients didn’t participate in a venture they felt wasn’t worth their time or potentially risked their privacy.

Please read the article in this issue on page 50 by Daniel Patterson, my firstborn and our practice’s IT director. Then take this editorial and his article and send it to your representatives in Congress. They likely have no idea what’s going on at CMS. It’s one thing to make rules and change them mid-stream. It’s even worse to wait until we’ve spent painful amounts of time and money, and then make the rules. It’s a great way to promise to pay doctors for installing EHR, yet not have to follow through with the complete payment. OM