Potential new measures may put Meaningful Use out of reach for most physicians

Meaningful Use is supposed be, well, meaningful.

Stakeholders have been all over the board regarding what the Meaningful Use program should evolve into. Some believe the focus should be on interoperability. Others want to make it less punitive and restrictive. The Institute of Medicine has suggested that more social and behavior data, such as stress and household income levels, be collected.

But if the new list of potential measures for the Meaningful Use program published by the National Quality Forum's Measure Application Partnership (MAP) is any indication, for eligible professionals, the program is either getting customized or going haywire.

MAP is considering 31 measures that would relate to eligible professionals in the Meaningful Use program. A few are pretty universal, such as closing the referral loop by providing critical information with a request for referral.

But many are so specific that to require it of all eligible professionals seems illogical and wasteful. Here are just a few:

  • Attention deficit hyperactivity disorder
  • Gout
  • Total knee replacements
  • HIV
  • High blood pressure
  • Risk behavior assessment/counseling by age 13
  • Intimate partner violence screening
  • Cognitive impairment assessment among at-risk older adults
  • Chronic pain due to osteoarthritis

All of these are laudable measures. And MAP, an esteemed body of 150 healthcare leaders and experts, does not recommend every measure before it. MAP is focused on identifying measures that matter.

But how can some of these proposed measures be applied across the board to all eligible professionals? Just look at the different areas of specialty represented. How would this work? How many exclusions will physicians be allowed? Is an ophthalmologist going to have to ask how a patient's knee replacement is doing? Will there be enough new core elements to go around?

And should some specialties be highlighted more than others with more new measures than other physician specialties, based on participation in the program, or some other criteria? For example, pediatricians are not the biggest participants in the incentive program. They can't even get their leading set of guidelines, Bright Futures, in electronic format. But a number of the proposed measures pertain only to pediatricians. So is this illustrative of the disconnect between the Meaningful Use program and what physicians really need from their EHRs to improve patient health?

And will this just put Meaningful Use out of reach of most physicians?

After all, it's one thing for all physicians to ask about a patient's tobacco use or race/ethnicity, even if it's not really relevant to certain specialists, who are collecting the information with no intention of using it to improve patient care. And arguably it doesn't hurt for every doctor to inquire about social isolation or physical activity levels, although I'm not sure if my dermatologist will find this data all that helpful.

But if the Meaningful Use program is really aiming to tailor measures to different physician specialties, that would be, at best, very ambitions, and at worst, a logistical nightmare for the Office of the National Coordinator for Health IT. And if it's not, then the program is straying farther than ever from goals of increased efficiency, lower costs and better patient outcomes.

This is a good opportunity for the public to weigh in on the measurements and influence the shape of the Meaningful Use program--before a measure becomes more set in stone in a proposed rule. MAP's recommendations will be available for public review and comment from Dec. 23, 2014, through Jan. 13, 2015. Let's take advantage of this chance to make our voices heard. - Marla (@MarlaHirsch and @FierceHealthIT)

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