James O'Connor, MD

EHR vendors, consultants, regulators, and even some CIOs have giddily promoted the EHR incentive program (“meaningful use”) for nearly a year. Countless businesses and blogs have been born to fulfill the need to ingest and digest compliance information. In-your-face marketing has been a powerful current sweeping doctors towards choosing an EHR system or meaningful use consultant.

Physicians’ responses are all over the map. A surprising number of our colleagues still don’t know about meaningful use. Some doctors plan to ignore it altogether. (It appears that the fewer the number of years to retirement, the greater the apathy towards meaningful use.) Some practices are optimistically and enthusiastically making plans. Others are revealing their ambivalence, wrestling with the question “should we or shouldn’t we?”

I whole-heartedly support the adoption of electronic health records. I was an early adopter in my own practice and have spent a good deal of time in the industry. I am aware that the majority of my colleagues remain resistant to EHRs. Government incentives are a positive way to initiate widespread adoption. Meaningful use has its flaws, but the stimulus will fuel innovation in healthcare IT, potentially creating a powerful engine for economic recovery.

On the other hand, meaningful use places a burden on doctors with little direct return on investment. In most cases, the incentive will not cover the real cost of adoption, which includes more than just hardware and software. There is a well-documented productivity loss in the first 12 to 18 months after adoption of an EHR. It is widely reported that compliance with meaningful use will require medical practices to hire additional staff. Experts predict a shortage of staff with requisite skills. Meaningful use coincides with the planned elimination of the consult code and looming 21 percent cut in Medicare reimbursement.

Nonetheless, the pros and cons of meaningful use are not really the problem. The problem is that, once again, we physicians are subject to a mandate over which we have little control and no choice whether to comply. Is this surprising to you? Consider these facts:

1. CMS penalties begin in 2015.
2. What if you won’t or don’t accept Medicare/Medicaid patients (13 percent of practices in 2009, up from 6 percent in 2004? In August, four major insurers (Aetna, Highmark, United Health Group, and Wellpoint) announced that, at a minimum, they will link their pay-for-performance programs to federal meaningful use criteria. Other insurers are likely to follow.
3. Do you run one of the increasing number of “boutique” or VIP practices that work on a cash-only basis? The American Board of Medical Specialties (ABMS) released a statement in August saying that they intend to link meaningful use of health information technology into the ABMS Maintenance of Certification© program.
4. You don’t care about being board certified? (Sound of crickets chirping.) The Final Rule gives states the authority to impose additional requirements that promote compliance with meaningful use. As reported in Physicians Practice, 

the state of Massachusetts may take away your license to practice medicine in 2015

 unless you demonstrate meaningful use of an EHR system. In Maryland, private insurers will be required to build incentives for acquisition of EHRs and penalties for not adopting them into their payment structure.

OK, so technically, we do have a choice. We could stop taking Medicare and Medicaid patients, accept cash only, give up our board certification (and thus usually hospital privileges), and move to a state (or country) that doesn’t impose EHR requirements. But is that really a choice? No. Our only real choice is action. Here are a few suggestions:

1. Submit comments to the Office of the National Coordinator (ONC). Although meaningful use is not likely to be repealed (even with the recent change of guard in the House), the 276-page Final Rule shows that ONC is at least considering and responding to comments. Some comments actually yielded changes in the Final Rule. 
2. Contact your specialty organization and initiate a grassroots movement to push back against the ABMS mandates. Larger specialty organizations, such as those for family practice and cardiology, may be able to influence ABMS to repeal the requirement or at least gain reprieve.
3. Get your state medical association involved. Those in Idaho, Wyoming, and Texas may even be powerful enough to prevent state involvement in meaningful use.
4. Call your state legislators and let them know you expect them to protect doctors’ interests.

The final choice - watchful waiting - may seem like capitulation. But there are two reasons this may be the wisest course. First, there are many who doubt CMS’ ability to deliver on the incentives. Small practices can probably wait until early- to mid-Spring 2011 to see what develops and still have enough time left in the year to choose an EHR and qualify for the 2011 incentive. Second, EHR vendors have a huge stake in this market. Vendors will have to introduce innovation into their offerings in order to distinguish themselves and win your business. The right innovation could make this pill easier to swallow.

James O'Connor is an OB/GYN, founder of MDcohort LLC, and co-chair of CCHIT's Clinical Research Group. 

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The pros and cons of the meaningful use incentive program are not really the problem. The problem is that, once again, we physicians are subject to a mandate over which we have little control and no choice whether to comply.

Author | James O'Connor, MD

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