HHS needs to acknowledge the risks of Meaningful Use Stage 3

I'm sure I'm not the only person who wants to know what the U.S. Department of Health and Human Services' vision of Stage 3 of Meaningful Use looks like.

The proposed rule implementing Stage 3, which was received by the Office of Management and Budget (OMB) from HHS Dec. 31, 2014, will remain a secret until OMB concludes its review and HHS displays it in the Federal Register. HHS provides some clues about the content of the rule in its accompanying statement to OMB, which is public. For instance, it says that the rule focuses on the advanced use of electronic health record technology to improve outcomes; changes reporting periods, timelines and the structure of the program. HHS also acknowledges that it will use a single definition of Meaningful Use.

But there's something else in HHS' statement to OMB that's more interesting--and perhaps more troublesome. It is the agency's assessment of the costs, benefits and risks of the rule. Under costs and benefits, HHS states that the rule will realize cost savings to Medicare, qualitative benefits in the quality of care and improved outcomes and potential savings in the reduction of the cost of care.


Now, check out what HHS said were the risks of the rule:

"[The Centers for Medicare & Medicaid Services] anticipates many positive effects of adopting EHR on healthcare providers, apart from the incentive payments to be provided under this proposed rule. We believe there are benefits that can be obtained by eligible hospitals and EPs, including: reductions in medical recordkeeping costs, reductions in repeat tests, decreases in length of stay and reduced errors. When used effectively, EHRs can enable providers to deliver healthcare more efficiently. For example, EHRs can reduce the duplication of diagnostic tests, prompt providers to prescribe cost effective generic medications, remind patients about preventive care, reduce unnecessary office visits and assist in managing complex care."

Seriously? Those aren't risks. They're more benefits. Does HHS really think there are no risks of forging on to Stage 3 of Meaningful Use? I can think of a lot of risks of this proposed rule. Here are a few:

  • The proposed rule's objectives are too ambitious and costly to providers, many of whom already are struggling to meet Stage 2's requirements and may not be able to meet the higher bar of Stage 3
  • Stakeholders could disagree with the focus and objectives in Stage 3 and challenge, rather than embrace, them
  • More vendors may drop out of the program and/or consolidate, reducing competition and innovation in EHR products offered
  • If the timelines for development and implementation are too short, vendors and providers will have to scramble--again--causing Congress and/or HHS to delay Stage 3, just like Stage 2 and ICD-10
  • Physicians, already frustrated with the Meaningful Use program, could simply opt out, thwarting efforts to achieve greater national interoperability
  • Policy makers, fed up with perceived or apparent problems with Meaningful Use, could decide that the proposed Stage 3 rule is incorrect and is step in to shape it themselves
  • Congress could use the proposed rule as a catalyst to pull the plug on some or all of the program altogether, on the grounds that it is wasteful, poorly managed, inadequately designed, no longer needed or irrelevant
  • HHS could lose face, and ONC could lose clout (ONC already seems to have anticipated this risk, downplaying Meaningful Use in its strategic plan)

Maybe HHS is not obligated to list any risks in its statement to OMB about its new proposed rule. Or perhaps the agency didn't want to focus on the potential downsides.

But to pretend that there aren't any risks to this rule is disingenuous. We know better. And so does HHS. - Marla (@MarlaHirsch and @FierceHealthIT)