Meaningful Use alignment efforts may drive docs, hospitals apart

There is no doubt that different stakeholders will have varying views about the proposed rule implementing Stage 3 of the Meaningful Use program.

But ironically, the rule, which is intended to further align two particular groups of stakeholders, physicians and hospitals, may actually drive them away from each other.

Sure, the proposed rule, for the first time, creates just one set of objectives for both physicians and hospitals, and everyone will be required to be at the Stage 3 level by 2018. Moreover, the objectives focus on collaboration, such as data sharing and coordination of care.

But that only works when everyone is playing together in the sandbox; and increasingly, the doctors are saying they don't want to. 

For instance, the percentages of physicians adopting EHRs is leveling off.

Moreover, a new survey found that while 71 percent of physicians are capable of meeting Stage 3 by 2018, only 38 percent said that the government did a "fair" job with the proposed rule. Many of them looked at the program itself with "disdain."

At the same time, 257,000 doctors already are being penalized for not successfully attesting to Meaningful Use, either because they tried and failed or because they didn't even bother. But the penalties themselves are almost negligible; many range from $1 to $250, and the largest "payment adjustment" imposed is only $2,000. Evidently, many doctors are saying that's a small price to pay to avoid having to deal with Meaningful Use. Some are dropping out of the program.

In contrast, the hospitals, which are subject to much higher penalties--and arguably rely more on EHRs--have a greater incentive to remain in the program. 

But if a high percentage of doctors don't participate, then some the goals of Stage 3 will be undermined. And the hospitals and doctors will no longer be working together to meet them.

This problem is not unique to the proposed rule. Look at the Medicare Access and CHIP Reauthorization Act (MICRA). While it's best known for repealing the sustainable growth rate (SGR) payment formula, it also makes significant changes to the Meaningful Use incentive program--for doctors.

For instance, physician incentives would be completely restructured as part of a merit-based incentive payment system (MIPS), and penalties would end for them in 2019. It also would set clinical quality measures, which appear to be different from the proposed Stage 3 objectives. It's as if the hospitals and doctors would now be in different Meaningful Use programs.

And while MICRA calls for interoperability by 2018, it doesn't specify how it should be accomplished.

These provisions also were in a similar bill introduced last year to repeal the SGR--but that bill ultimately failed. This year, it's already passed the House, and now is pending in the Senate. If it becomes law, will the two Meaningful Use programs be reconciled? And if so, how?

And could there be even broader implications? If doctors and hospitals aren't aligned on Meaningful Use, will this affect other things, such as health reform, alternative value-based payment models and the adoption of EHRs by ancillary providers?

Meaningful Use was always about hospitals and physicians. They were the providers chosen to participate, collaborating to lower costs and improve care. But laws and regulations cannot be created in a vacuum. You can't just tell hospitals and physicians to align; the environment and the proposals need to support alignment.

Otherwise these proposals may not work from a practical standpoint, and may unintentionally thwart the goals that are being set. - Marla (@MarlaHirsch and @FierceHealthIT)