AAFP's Waldren calls meaningful use, quality reporting the foundations of payment reform

Primary-care practices, if you're thinking about not adopting an EMR, you could be putting yourselves in a very bad position for the inevitable future transition to a quality-based reimbursement system. 

"If physicians don't adopt technology to support them in this paradigm shift, they're at a much higher risk at not being able to keep up with the demands of quality reporting in order to thrive in this new model," Dr. Steven Waldren, director of the Center of Health Information Technology at the American Academy of Family Physicians, says in an interview with InformationWeek.

But Waldren also has concerns with the federal government's parameters for "meaningful use" of EMRs, the standard by which physicians will qualify for Medicare and Medicaid bonus payments under the American Recovery and Reinvestment Act. "The uncertainty right now is the biggest challenge. When we get the final rule, we still won't know what'll be required for Stage 2 in 2013 or Stage 3 in 2015. So as people are trying to select vendors, you can quickly say you can achieve Stage 1 compliance, but there's uncertainty you'll be able to do Stages 2 or 3," he says. "Another big challenge with Stage 1 as the rule's proposed is the 'all or nothing' rewards. I have to do all 25 HIT functions and potentially eight [quality] measures for primary care, and if I miss one of those, I get no money."

Although EMRs are expensive, physicians that are just looking at the incentives as a way to cover their costs could be setting themselves up for difficulties later, Waldren cautions. "In my view, if you try to get the cheapest technology you can to meet the meaningful use Stage 1 check list, you'll probably spend more money than if you say, 'I want to deliver high-quality care for my patients, and I want to use technology to do that,'" he says.

Waldren also worries that CMS could administer this incentive program the way it's run the Physician Quality Reporting Initiative. "A lot of physicians submitted this data for a year and never received their checks, or if they did, it was two years late. It's been a poorly managed process. And there's worry that this will be the same," Waldren tells InformationWeek. "We've talked to folks at Centers for Medicare and Medicaid Services and Office of National Coordinator, and they assure us that they recognize this problem, and they won't have that same problem with meaningful use. But doctors already have that sour taste in their mouths."

For additional details:
- read this InformationWeek Q&A with Waldren