7/21/09

Meaningful Use (MU) and Incentives to adopt Health IT

The term Meaningful Use has gained special significance as a result of the early 2009 ARRA legislation. A tremendous amount has been written about MU in the last 5 months. The Office of the National Coordinator for Health IT (ONC) and the HIT Policy Committee has been honing in on a final definition that is due to be delivered by the end of the year. This floating definition has stirred considerable concern for organizations involved with health IT in numerous roles. A major challenge for those determining strategic plans will be to decide to what extent to align with MU requirements.
The financial incentives for clinicians under ARRA apply primarily to the treatment of Medicare and Medicaid patients. Overall this may represent up to 40% of medical care in the U.S. Incentive payments are tied to Meaningful Use of electronic medical records (EMRs.) Since ARRA is front-loaded the greatest rewards are only available for those who become meaningful users in a very short period of time. But later, financial penalties kick in. Many knowledgeable health IT professionals, aware of current EMR adoption rates by providers and hospitals in the U.S., standards implementation limitations, infrastructure needs, and other technical requirements, believe that the timelines are unrealistic.
The question is whether ARRA and decisions determined by ONC and the advisory committees will become the backbone for strategic planning by clinicians and their organizations with respect to health IT over the next four to eight years. This is the course that provides the greatest opportunity for financial rewards for adoption of EMRs. However, relatively few providers are positioned to take full advantage of the incentives. Those most likely to be able to take advantage of the incentives are those that have already adopted EMRs. On the other hand, ARRA and MU have the potential to significantly distort the health care ecosystem. Many subsets of patients and providers are not even considered in the legislation (changes to HIPPA under ARRA is another issue that I am not considering here.) Some examples are children, behavioral health patients, and those in long term care facilities. Perhaps an approach that considers ARRA as just one of many components to consider in planning for the future will be best.
My viewpoint is that there is danger that the health IT agenda in the Obama administration will be driven primarily by a few bureaucrats with limited outside input. My sense is that the ONC position under President Bush put much more credence in public-private collaboratives. I think this was a good thing. Many of the organizations established during the past four years run the risk of being marginalized by the current approaches the new administration is taking.