I think it's fair to say that for the American Medical Association (AMA), the gloves officially are off.
AMA has begged the Centers for Medicare & Medicaid Services and the Office of the National Coordinator for Health IT for years to reduce the burdens that Meaningful Use and other programs place on physicians, to stop the reimbursement hemorrhage to and take steps--like improving EHR design--that impact how doctors treat patients. Increasingly frustrated, AMA has tried to take matters into its own hands, creating its own framework for EHR usability and a blue print to improve EHR systems.
Now, AMA executive vice president and CEO James Madara has sent a letter to CMS Administrator Marilyn Tavenner, warning about the consequences of the current tsunami of regulations and policies.
But look closely at the language used; past pleadings from the AMA have "expressed concern" and "urged" fixes.
This time the AMA minces no words. Madara says that, among other things:
- The Meaningful Use, Physician Quality Reporting System and Value Based Model program have "incomprehensible, conflicting requirements and flawed implementation processes"
- CMS' contractor help desks are so overloaded that physicians usually can't even get through to ask questions; on the rare occasion that they can, the contractors don't know the answers
- The misalignment of Meaningful Use with other programs "pose a risk to the stability of the Medicare program that many policymakers do not seem to appreciate"
- CMS needs to reverse proposals that increase penalties and stop following a "regulatory checklist"
- CMS' current plan to move "beyond MU" is "highly imprudent"
Then Madara really lays it all on the table.
"[T]he current strategy of aggressively moving forward with policies that place an ever increasing burden on both CMS and physicians, combined with the flawed roll-out of the Medicare claims data release and Open Payments program and the problems with these programs, threatens to do serious damage to the agency's image and to physician confidence in the government's stated goal of achieving a health care system that delivers more value for the dollar," he says.
And let's not stop there. In what could either be incredibly insulting to CMS, a sincere gesture, or both, Madara expresses "a great deal of sympathy for CMS and the position it finds itself in" and offers to help the beleaguered agency reassess its programs and resources.
I'm not sure whether to admire the AMA for its blunt honesty, or to question whether this strategy will backfire. Is this the desperate move of an association that feels it has no choice but to go for broke? Or is it a savvy tactic to take advantage of an agency currently in flux due to the exodus in leadership, backbreaking demands and insufficient resources, vulnerable to loss of power and increased attention by Congress and other stakeholders?
AMA is not the only organization that has wondered if the feds have made serious errors in recent months. And the association may not have the ultimate power to effect change.
But it's pretty vocal--and getting louder.
It will be interesting to see if this increase in crescendo has the impact the AMA is hoping for, or if it ends up being seen by CMS as merely noise pollution. - Marla (@MarlaHirsch and @FierceHealthIT)