Is Meaningless Use Ending?

A lot of what drives the skeptical cardiologist mad about office electronic health record (EHR) usage comes from CMS requirements for what they term “Meaningful Use” (MU) and what I consider “meaningless use.”

Physicians who don’t meet MU criteria will be penalized by reduced reimbursement.

The criteria for MU are arcane and confusing and very few busy clinicians have the time or interest to study them in detail.

I’ll cite two examples which represent only the tip of the MU iceberg: patient education and BMI counseling.

One of the 23  measures for  Stage 2 MU according to CMS is designed to stimulate physicians to “Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate.”

The measure is reached if “More than 10 percent of all unique patients seen by the EP are provided patient- specific education resources.”

In order to satisfy this measure, my office staff have been instructed to print out allegedly educational information on one of the diagnoses the patient carries and hand the print out to every patient that is seen. The information comes from a patient education database that is connected to our EHR and I have not had the time or interest to review whether it is correct or helpful.

I get no sense that this is helping my patients in any way but I know that more trees are being uselessly sacrificed on a daily basis because of this MU requirement.

If one reads closely the CMS document on this measure, it says you only need to do this once per year, but in practice, it is easier to give every patient information at every visit rather than take the time to go back through the record and see if the patient was provided with “patient-specific education resources.”

The second example is that of BMI counseling. This measures requires:

“a follow-up plan is documented within the past six months or during the current reporting period.” for patients whose BMI falls outside what CMS considers normal:

Normal Parameters:
 Age65yearsandolderBMI≥23and<30  Age 18-64 years BMI ≥ 18.5 and < 25

I spend time talking with all my patients about the importance of regular aerobic exercise and a healthy diet and I provide them with my recommendations through this blog.

This MU measure doesn’t make it any more likely that I will be counseling my patients on diet and exercise but it means that somebody has to click on the sequence of items in the EHR which will put the statement “BMI counseling provided.”

With all the time, money, paper and energy that has been spent on meeting these MU criteria, I don’t think my patients have been helped and now according to a tweet from an official with CMS, meaningful use may be ending.

CMS Promises Meaningful Use Replacement This Year

According to Medscape:

“In 2016, MU (meaningful use) as it has existed — with MACRA — will now be effectively over and replaced with something better,” tweeted Andy Slavitt, the administrator of the Centers for Medicare & Medicaid Services (CMS).

I’m happy these onerous requirements may be ending but fearful of what meaningless requirements may follow.

patient-specific resourcefully yours

-ACP

3 thoughts on “Is Meaningless Use Ending?”

  1. I wonder, what was the original rationale behind the CMS regulations in the first place? For those of us who are unfamiliar with the history of EHR.

    1. Even for those of us who daily use EHR, the history is murky and the rationale obscure, David.
      Your question stimulated me to do a quick search for an answer. This article aimed at OB/GYN practices is a reasonable summary but probably gives you much more info than you want (http://www.obgmanagement.com/home/article/the-affordable-care-act-and-the-drive-for-electronic-health-records-are-small-practices-being-squeezed/51ca8c8c4946b2ba1e53a7252afeb61c.html)
      it appears the push to EHR began a few years before the AFA or Obamacare but was accelerated by the AFA and moved from incentives to penalties. The rationale according to this writer:

      Clearly, a lot of effort and taxpayer dollars have been dedicated to drive efficient use of HIT and EHRs in the hopes that they can:
      help make sense of our increasingly fragmented health-care system
      improve patient safety
      increase efficiency
      reduce paperwork
      reduce unnecessary tests
      better coordinate patient care.

      There is little evidence that it has accomplished these goals.

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