Meaningful Use Stage 1 attestation struggles represent big problems for CMS

There is a growing realization that providers are still struggling to meet Stage 1 requirements for the Meaningful Use incentive program--and officials with the Centers for Medicare & Medicaid Services know they have a potentially huge problem on their hands.     

Sure, registration for the incentive program has been increasing as word gets out. But the truth is that a lot of providers are failing at attestation. According to Physicians Practice's latest survey, discussed in their recent webinar and due to be released in July, only a little more than half of eligible professionals who tried to attest to Meaningful Use earned the incentive payment. Fifteen percent who failed were so disheartened or frustrated that they may not even try again. These results are similar to those reported by the Medicare Payment Advisory Commission in its latest report to Congress. And it's not just physicians; hospitals also are having trouble successfully attesting.  

Part of the problem is fundamental: transitioning to electronic health record systems is not a simple process. It completely changes the way a provider operates. Some EHR systems aren't designed very well; some are expensive, and some providers have had inadequate training.  

But the truth is that the attestation process, even in Stage 1, can be daunting, especially for providers who are not early adopters of EHRs and less familiar with their systems and the attestation requirements.

For instance, in the Physicians Practice webinar, speaker Robert Anthony from the Center for Medicare & Medicaid Services' Office of E-Health Standards and Services, pointed out that many providers were confused about how to attest correctly. According to Anthony, areas where providers seem to be tripping up the most include:

  • Figuring out which eligible professionals meet the objective for electronic exchange of information. Many physicians are not aware that eligible professionals in one's own practice do not meet the objective.
  • Entering computerized physician order entry (CPOE) medication orders. Physicians are tripping up on the specified licensing and other requirements for that objective.
  • Whether a physician can be excluded from an objective if he/she doesn't regularly perform it as part of one's practice. There's just not a lot of leeway there; if there's no exclusion or if the provider can't meet the exclusion, then one needs to meet the threshold in the objective.
  • Meeting clinical decision support measures. Drug-drug and drug-allergy interaction alerts cannot be used to meet the CDS measure; one needs to meet these measures separately.  

Because of this, CMS has quietly launched an education campaign to help providers understand the program better. The agency has been sprucing up its website, speaking at provider sponsored webinars, running articles in provider-oriented journals.

The fact remains, though, that the HITECH Act requires CMS to impose increasingly more stringent requirements in the latter stages of the program. CMS officials know that if providers can't make the first rung of the program ladder, it does not bode well for the rest of the program. And CMS will be stuck trying to pick up the pieces. - Marla

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