Researchers assess providers’ views on government incentives for electronic health records.
Electronic health records give health care providers easy access to patient records containing health and clinical data. According to the Department of Health and Human Services, access to this information can help reduce medical errors and duplicative care.
However, a recent study conducted by researchers at Inland Northwest Health Services, Dartmouth’s Geisel School of Medicine, Qualis Health, and the University of Washington School of Public Health found that many health care providers have doubts about the government incentive programs designed to encourage providers to integrate electronic record systems into their clinical practices. More than half of the providers participating in the study believed that the programs contribute to the decline of the art of medicine.
Through multi-stage incentive programs that began in 2011, the Centers for Medicare and Medicaid Services (CMS) encourage providers serving Medicare and Medicaid patients to use electronic health records by paying eligible providers to adopt, implement, or upgrade their electronic record systems, and then demonstrate or “attest” to “meaningful use” of the systems. In addition, under the Medicare program, CMS can penalize providers who do not demonstrate meaningful use by reducing the amount it reimburses those providers for health services rendered to Medicare patients.
The government defines meaningful use as the use of certified electronic health record systems in a manner that can be evaluated qualitatively and quantitatively. Under meaningful use regulations, providers must meet certain standards when adding electronic records to their clinical practice. Examples of standards include keeping a list of active diagnoses for each patient in the record system and transmitting prescriptions to pharmacies electronically.
CMS is implementing the meaningful use programs in three stages. Each stage has different core objectives. The first stage set standards that focused on data collection and the second stage emphasized clinical coordination. The third stage is scheduled for 2017 and will focus on the ultimate goal behind the program: better patient outcomes.
To gauge how a broad range of current and potential meaningful use participants view the federal programs, the researchers surveyed eligible providers in Washington and Idaho for their impressions of the programs to date. Respondents included physicians and other providers who had attested to meaningful use and received incentive payments (participants) and those who had not yet attested to meaningful use (non-participants).
The study found that providers who had attested to meaningful use viewed the meaningful use program more favorably than non-participants. A majority (59%) of survey respondents who participate in the programs believed it would help improve the quality of patient care. Significantly fewer (40%) non-participants shared that view. A majority of non-participants (70%) also felt meaningful use would “contribute to the decline of ‘the art of medicine,’” and half of those who attested to meaningful use shared that concern.
Individual program participants may receive up to $44,000 in Medicare incentive payments or $63,750 in the Medicaid program. Yet survey results showed providers’ dissatisfaction with incentive payment amounts. Program participants and non-participants felt that CMS’s financial incentives failed to justify the investment costs required for compliance with meaningful use. Two-thirds of participating providers (66%) viewed the payments as inadequate, and 83% of non-participants agreed.
The survey also revealed some providers’ skepticism about the programs’ benefits. For example, one program objective is to reduce health disparities. A majority of physicians (62%) did not think that the meaningful use standards would accomplish this goal.
CMS also aims to improve care coordination, quality, and safety through meaningful use. However, 70% percent of respondents did not think complying with meaningful use would improve the accuracy of patient records. A slight majority of respondents did believe that meaningful use could make it easier to notice patterns across patients.
With these findings, the study authors express concern that providers may not readily participate in new stages or expansions of the meaningful use programs without more education and support from the government. They recommend that policy makers take steps to get greater provider engagement and buy-in to the meaningful use program and provide a mechanism for providers to give feedback about their experiences with the programs.
CMS is currently soliciting comments from stakeholders on a revised list of criteria to define what will ultimately be the meaningful use benchmarks for the third stage of the incentive program. Comments on this last stage of the incentive program are due May 29, 2015.