One problem for physicians is that many EHR products that earned Meaningful Use Stage 1 certification have not gained Stage 2 certification
Growing numbers of physicians are deciding that continuing in the federal government’s electronic health records (EHRs) incentive program is not a winning proposition. This is not an auspicious development for the nation’s clinical laboratories and anatomic pathology groups.
After all, every medical laboratory in the United States is spending time and money to interface their laboratory information systems with physician clients’ EHR systems to enable electronic lab test ordering and reporting. Thus, if substantial numbers of physicians decide to opt out the federal EHR incentive program, this will create a variety of problems for clinical laboratories providing lab-testing services to these physicians.
Benefits Do Not Offset the Cost of the EHR for Many Physicians
Many physicians tell researchers that, when it comes to incentivizing doctors to adopt electronic health records (EHRs), the numbers don’t add up. Consequently, association surveys indicate that more physicians seem likely to pull ou of the federal program, rather than continue struggling to meet Meaningful Use Stage 2 requirements.
There are at least two reasons why some doctors will pull out of the program and take financial penalties instead, reported Modern Healthcare in a recent story.
One reason is the questionable financial rewards for transitioning beyond Meaningful Use Stage 1. The second reason is physicians have uncertainties about the clinical benefits of EHRs.
The cumulative payment amount depends on the year in which a provider begins participation in the program. Physicians who began in 2013 may receive up to $39,000 in payments. Physicians starting this year, however, will only receive up to $24,000.
Recognizing some of these issues, the Centers for Medicare & Medicaid Services announced in December 2013 an extension of Stage 2 implementation through 2016, with beginning Stage 3 in 2017 by those providers that had spent at least two years in Stage 2. In a recent report published by Politico, CMS officials explained the delay, saying that due to timing, backlogs and certification case load, many EHR products were certified later than hoped, making it difficult for hospitals and other providers to meet the Stage 2 deadline.
Some Physicians Willing to Pay Financial Penalties to ‘Opt Out’
But even with the aforementioned incentives in place and extension of the Stage 2 deadline, the federal program appears to be turning many physicians off. Some healthcare informatics experts blame physicians’ reaction on the complexity of the Stage 2 MU requirements. Providers earn different levels of certification (and federal incentive payments) across the three stages of implementation:
• Stage one: Internal electronic systems.
• Stage two: Electronic sharing with multiple providers.
• Stage three: Demonstration of outcome improvements.
One big problem for many physicians is finding an EHR vendor capable of developing their EHR systems through each of the three MU stages. For example, one industry expert estimates that 450 EHR products were federally certified for Stage 1, and at this time, only about 75 had earned certification for Stage 2.
Many Physicians Would Need to Purchase Stage 2-Certified EHR Systems
This situation leaves many physicians with a tough choice. After paying for an EHR product that was certified for Stage 1 but not Stage-2 , do they want to incur the time and expense required to purchase and install a different EHR system compliant with Stage 2 Meaningful Use?
In explaining why medical practices may decide to take penalties in lieu of participating, Jason W. Mitchell, M.D., former Director of the Center for Health Technology at the American Academy of Family Physicians (AAFP) pointed to a scenario of the average family doctor, who receives about $100,000 annually in Medicare reimbursements.
Federal Penalties Don’t Represent Large Amounts of Money
“So, a 1% penalty for failing to achieve Meaningful Use Stage 2 in 2014 will cost about $1,000 in 2015. These penalties escalate to 2% in 2016 and 3% in 2017—a combined three-year total of just $6,000,” noted Mitchell. “Add that $6,000 in Medicare penalties to additional incentive payments they won’t receive by failing to achieve Stage 2, and it doesn’t represent a catastrophic loss of income.” Mitchell was quoted by Modern Healthcare, and his comments were made before CMS announced the extension to the Stage 2 deadlines.
There are other reasons physicians have delayed entry into e-health. These include high cost of EHR systems, technical complications, practice disruption, and resistance to office change, according to a report published by Crain’s Detroit Business.
A National Ambulatory Medical Care survey of physicians released earlier this year by the Centers for Disease Control and Prevention found that only 13% of office-based doctors said they intend to continue participation in the federal EHR program and that their EHRs are capable of supporting 14 of Stage 2’s 17 “core” objectives.
Nationally, 48% of doctor offices have adopted an EHR, according to the federal Office of the National Coordinator (ONC) for Health IT.
Issues for EHR Certification
Complicating matters regarding technology’s certification is an ONC proposal that would revise EHR certification criteria. It may mean that technology developers certified to 2014 requirements would not need to recertify to the 2015 edition.
“The proposed rule could create confusion for family physicians regarding what level of certification would be required for their EHRs to qualify to attest to meaningful use,” said Dr. Jeff Cain, AAFP board chairman, in an association news release.
In summary, the federal EHR Incentive Program faces challenges as it goes forward. That is one reason why the rules were amended to allow more time for physicians to adopt and use an EHR system that is certified to Stage 2 requirements.
Of course, it is essential that every clinical laboratory and anatomic pathology group maintain interfaces between their LIS’s and the EHRs of the client physicians. Electronic ordering of medical laboratory tests and electronic reporting of lab test results are key elements in how providers must meet meaningful use criteria.
—By Donna Marie Pocius