An overwhelming number of physicians say changes that may be necessary to meet more than two dozen "meaningful use" criteria proposed in a Medicare electronic health record (EHR) incentive rule would lead to decreased provider productivity, according to the Medical Group Management Association.
In responses to a MGMA questionnaire, physicians expressed confusion about the proposed rule, and its potential impact. Some said the program is unworkable, according to the MGMA.
The concerns are about CMS' proposed rule to implement provisions of the American Recovery and Reinvestment Act of 2009 that provide incentive payments for the meaningful use of certified EHR technology, which could amount to as much as $27 billion. The comment period for the rule ends March 15.
Specifically, physicians have expressed concern that the goals for implementing 25 meaningful use criteria would not be met because they aren't doable, according to William F. Jessee, president CEO of MGMA. Some providers believe that the administration plan is too rushed, there are too many regulations involved, and the use of the computerized records timetable is unrealistic.
Under the CMS proposal, incentive payments would be made to "eligible professionals and hospitals" to adopt, implement or upgrade certified EHR technology for meaningful use in the first year of their participation or for demonstrating meaningful use during each of five subsequent years. CMS' meaningful use focuses on electronically capturing health information in a coded format, track key clinical conditions, care coordination, and reporting of clinical quality measures and public health information.
The MGMA's questionnaire asked its members about how meaningful use criteria will impact productivity. More than two-thirds of the respondents—67.9%—said physician productivity would decrease, with another 31% saying that physician productivity would increase by more than 10%.
Jessee indicated that improvement in administrative efficiencies within a medical group would only justify the "high cost of software, hardware, and staff training" in a deployment of an EHR system.
"If the final rule mirrors those outlined in the current proposal, there is significant risk that the program will fail to meet the intent of the legislation, and that a historic opportunity to transform the nation's healthcare system will be missed," said Jessee in a statement.
The MGMA recommends that the Obama administration significantly revise the proposed rule.
The MGMA remains "strong advocates for the adoption of EHRs in medical groups and urge the administration to significantly streamline the incentive program requirements in the final rule to permit dramatically larger numbers of practices to embrace this important technology," Jessee added.
Through EHR incentive programs, CMS said it hopes to expand the meaningful use of certified EHR technology. Certified EHR technology used in a meaningful way is one piece of a broader health information technology infrastructure needed to reform the healthcare system and improve healthcare quality, efficiency, and patient safety, CMS officials said.
Physicians expressed concerns over several of the proposed criteria for meaningful use. In the MGMA questionnaire, 45.9% of the physicians stated the proposed criteria, which would require 80% of all patient requests for an electronic copy of their health information be fulfilled within 48 hours, would be "difficult" or "very difficult" to achieve. Nearly 54% stated that it would be difficult or very difficult to reach the criteria of having 10% of all patients be given electronic access to their health information within 96 hours of the information being available.
In the MGMA analysis, physicians offered several views, elaborating on their concerns, according to MGMA records.
"For the various percentage requirements, obtaining number or data through an EHR will not be the problem," one physician wrote. "It will be tracking the denominator data that will be difficult since it may require manually tracking to calculate the percentage."
"Given there is not an EHR out there that currently meets all the criteria of meaningful use, 2011 is not enough time to get a new/upgraded system in place and adopt all the new processes that will be required for meaningful use," stated another physician.
"I have great concerns about the feasibility of complying with the [requirements]," opined another physician. "So much so, that I am re-focusing efforts with our physicians on the long-term benefits of EHR for improved workflow, patient safety, productivity, etc. and not at all on qualifying for the stimulus funds since the ability to do so seems very questionable at best."
MGMA conducted the research in January and February 2010, and data include feedback from 445 respondents representing providers in medical group practices throughout the United States.
Joe Cantlupe is a senior editor with HealthLeaders Media Online.
