Is Meaningful Use important even if I don’t take Medicare?

Meaningful Use of certified Electronic Health Record (EHR) technology is set to be in play in 2011. The bonus moneys that were funded by the 2009 American Recovery and Reinvestment Act(ARRA), under its HITECH section, are to be distributed through the Centers for Medicare and Medicaid Services (CMS) – this bonus money can be up to $44,000 per “ eligible provider” via Medicare, or up to $62,000 via Medicaid, paid out over several years.

But what about physicians who do not accept Medicare assignment? Or who do not have at least 20% of their practice in Medicaid (or, for pediatricians, 10%)? Is Meaningful Use relevant to these physicians?

In a recent article in Health IT News, David Blumenthal, the National Coordinator for Health IT, wrote about how the private sector is also taking CMS’s lead and supporting Meaningful Use. In a recent meeting on Advancing EHR Adoption and Meaningful Use (sponsored by Health Affairs and Brandeis University’s Health Industry Forum at the National Press Club), several private healthcare payors announced plans for aligning their incentive programs with Meaningful Use criteria – these major players in the private health insurance market included Aetna, Highmark Blue Cross and Blue Shield, United Health Group, and Wellpoint.

Each of these private insurance payors have Pay For Performance programs of their own, and in some instances the amount of money paid to physicians who can demonstrate good performance can be substantial (e.g. 20-25% of their income). Wellpoint, for example, announced alignment of their programs with Meaningful Use, and plans to accept the self-attestations of Meaningful Use compliance, which CMS also uses, for 2011 reporting. They subsequently plan to accept electronic submission of quality information in 2012, in alignment with federal plans.

This represents a growing tide of private insurers who, along with CMS, embrace the need for widespread usage of EHRs as necessary to improve the quality of healthcare delivery in this country.

Of even greater note, the American Board of Medical Specialties (ABMS) – which is the central hub for its 24 member Medical Specialty boards – announced its plan to align specialty certification and re-certification activities (Maintenance of Certification, or MOC) with the objectives contained within Meaningful Use. The health priorities, upon which the Meaningful Use criteria were developed, are (1) improve quality, safety and efficiency, and reduce health disparities; (2) engage patients and their families; (3) improve care coordination; (4) improve population and public health; (5) ensure adequate privacy and security protection for personal health information; and (6) report on clinical quality measures. These are aligned with the six core competencies that are continually measured by the member Specialty Boards. As stated by the ABMS, “The meaningful use of EHRs – a skill that was virtually unheard of when many of today’s practicing physicians were first Board Certified – is an excellent example of the importance of physician commitment to lifelong learning and the value of MOC.”

Even physicians who are not board-certified are impacted by Meaningful Use. The Federation of State Medical Boards (FSMB) – a non-profit organization that represents all 70 state medical and osteopathic licensing boards in the United States and its territories – also announced its intent to align Maintenance of Licensure (MOL) with Meaningful Use. The newly-proposed framework for MOL envisioned by the FSMB can be summarized as (1) reflective self-assessment, (2) assessment of knowledge and skills and (3) demonstration of performance in practice. For physicians, these components can be framed as three clear-cut questions: (1) What improvements do I need to make?; (2) What do I need to know and be able to do?; and (3) How am I doing? This approach is beyond what has historically been the tradition of attesting to Continuing Medical Education units and answering a questionnaire indicating absence of (or explaining, if present) any adverse actions or events relevant to licensure.

Clearly, Meaningful Use of Certified EHR technology is directly relevant to all physicians, regardless of whether one accepts Medicare, or Medicaid, or not. Private health payors, specialty boards, and medical licensing boards are all looking to incorporate the meaningful use of certified EHR technologies into all their programs as well.

Of course, that puts the onus on developers of EHR technology to create tools that will, in fact, allow physicians to do everything that is envisioned. These tools need to be nimble, portable, yet powerful. They need to be accessible from every location of care, yet need to be private and secure. They need to be within the reach of all physicians – after all, everyone, not just the well-funded clinics and large institutions, need to have access to (and demonstrate meaningful use of) EHR technology.

As we continue to develop our own suite of products on a web-based platform (Practice Fusion EMR, Patient Fusion PHR, and affiliated API plug-in web-apps), we must keep a balance between the roadmap toward Certification, on the one hand, and usability and feedback from physician users, on the other hand. Within the EMR product, we recently added a Forums section, where users can engage with each other, ask questions, share common solutions that have been “field-tested”, and suggest features that would make the EMR ever-more-useful. We believe that a physician-based Forum for idea exchange is another stepping stone toward creating a “meaningful use culture” that will become part of the mainstream of healthcare – not only for CMS, but also for private payors, specialty certification, and even licensure itself.

Robert Rowley, MD
Chief Medical Officer
Practice Fusion EMR