The EHR Incentive Program Game

The EHR Incentive Program Game

Up until recently, there were actually 2 games.

• Medicare EHR Incentive Program
• Medicaid EHR Incentive Program

These programs began in 2011.  The idea behind these programs was to get physicians to purchase and use computer programs to place their patient charts on the computer.  The program was entitled “Meaningful Use”.

To quote their definition:

“Meaningful use is using certified electronic health record (EHR) technology to: Improve quality, safety, efficiency, and reduce health disparities. Engage patients and family. Improve care coordination, and population and public health. Maintain privacy and security of patient health information”.

So, to motivate doctors to do this, they paid (and are still paying) each doctor tens of thousands of dollars (of your tax money) to “comply” with the program’s requirements.

The update is that:

• The Medicare branch of the program is done and is no longer paying out the incentive money.
• The Medicaid branch did not receive the same degree of reception by the doctors as did the Medicare branch of the program.

To keep the Medicare branch of the program alive and the doctors engaged in it, the government has changed the rules, making it easier for doctors to get their incentive money.  Now:

• Clinicians won’t have to demonstrate to the Centers for Medicare & Medicaid Services (CMS) that they met the requirements of the program every single day in 2018 as originally planned.
• The reporting period has shrunk to 90 days.
• Clinicians will be able to achieve Medicaid meaningful use of EHRs in 2018 if their software is certified for 2014 or 2015 as opposed to just 2015 certification.
• A combination of EHR technologies with some of it certified for 2014 and some of it certified for 2015, also works.

Since 2011, the number of clinicians receiving payment for these programs is:

• Medicare 312,000
• Medicaid 198,000

One factor responsible for more clinicians completing the Medicare requirements compared with the Medicaid requirements was that the Medicare program included penalties to physicians for noncompliance with this program.  If you didn’t comply with the Medicare program, not only did you not receive the bonus money, you had to pay back to the government a penalty; a percentage of the money you received for the services you performed.  Sounds like the Obamacare method of charging people a penalty if they didn’t buy health insurance.

So, let’s break this down further.

Certification of an EHR

For the clinician to meet the requirements of meaningful use, he must use a “Certified EHR”.  CMS has a list of features/requirements that an EHR must have in order to be certified.  This looks good on paper, but the reality is quite different.  EHRs are massive computer programs containing an enormous list of routines and functions.  They most often are used across most, if not all, of the medical specialties.  Good luck trying to test every possible permutation of a routine or function.  So what happens is, the EHR companies tell CMS that they have the routine and it works.  They get their software certified for having it.   Multiply this times the full list of CMS requirements (computer program routines/functions).  The physician’s buy the “certified EHR”.  It doesn’t work for them in their specialty they way they have it set up. Too bad.  The company has their “CMS certification” and has other fires to put out; other priorities.  You can wait an awfully long time for the “Certified EHR” to actually provide the functionality for you that CMS has already certified that EHR for.  Then try explaining to CMS that your practice cannot meet the Meaningful Use requirements because the program they certified doesn’t work.

Why did CMS Ease the Medicaid Program Requirements? 

I don’t know this for a fact, but I strongly suspect it is a result of other “incentives” built into the structure of the program.  These programs are massive, expensive, and require a lot of personnel.  I know for a fact that the government contracted out many people to help physicians navigate their way through the system.  I know this, because for years we used their “free” services in our office.  Guess who paid for that?  You, the taxpayer.   I suspect those intermediary people had their own incentive programs.  They probably got incentives and bonuses for government set milestones in addition to needing to “keep their jobs”.   If not enough clinicians participated, people could have their incomes drop or even lose their jobs.  So, to optimize their income and job security it was necessary to change the rules of the program, making it easier for clinicians.

Does the Program Work?

• A large percentage of clinicians already had EHRs.  Why did the government need to pay those physicians an incentive to do what they had already done?
• The process of certification of an EHR is flawed.  A company can get certified even though the software doesn’t really do what it is certified to do.  Or it can break (no longer provide the function) after it has been certified.  It’s like the difference between grades and learning.  Like going to school and getting high grades,  without those grades correlating to how much you actually learned.
• It isn’t good enough that some of it works as intended.  If it is going to take up 50% of my time, energy and resources, there better be a good reason for it.   I have thought many times that the government could take their incentive money and stick it where the sun doesn’t shine; just get off my back and let me do my job.

The Tail Wagging the Dog

These programs are very invasive.  They are very complicated and confusing.  They are extremely expensive at many levels:

• Cost to the Government/Taxpayer
• Cost to the Doctor (increasing overhead expenses)
• Cost to the Patient (In contrast to what the government tells you, somebody has to pay for it.  This is eventually passed on to the patient, either directly by increased fees, or indirectly through increased insurance premiums, reduced insurance coverage, or reduced services.)
• Cost of time wasted.

“Meaningful Use” is extremely distracting, drawing attention away from the primary task (patient care), and diverting it to government red tape.  Your job is to comply with meaningful use.  The patient is the means to do that.  Yes, backwards.

What Could the Government Do Instead?

I think the role of the government should be more of an infrastructure development, and less of a micromanagement function:

• Make the EHR companies responsible for their software. That it does what they say it will do and penalizing them if they don’t correct the bugs/faults in a timely manner.
• Give incentives to EHR companies to develop software with better interfaces that actually help clinicians do their jobs, rather than interfere with those jobs.
• Mandate a common inter-computer language interface and a deadline for using it so that the different EHRs from different vendors can communicate easily with one another.
• Perhaps get more input from clinicians about program ideas they have early in the developmental and implementation stages before imposing these schemes on everyone.
• Avoid implementing any strategy which puts an excessive burden on the healthcare system, distracting it from its purpose of patient care.