Why Doctors are Declining Meaningful Use

October 30, 2015

Why is the dropout rate of the EHR Incentive Program getting higher and higher? Experts say there are multiple reasons.

It appears that the EHR Incentive Program is losing some of its early momentum. “At present, we have 52 percent of all of the Medicare Eligible physicians receiving a 1 percent penalty on all of their claims from Medicare because they are not participating in the MU program,” said Steven Stack, president of the American Medical Association. “And we have 10 percent to 11 percent of physicians who are at stage 2 of the MU program.”

According to Stack, one of the main reasons why doctors do not participate in meaningful use is because, “It is designed in such a way that it mandates a number of very specific things be done and be done in ways that doctors do not find helps their patients. It also does not help them be efficient and effective in their patient care. It creates real challenges in the medical practice because the physician is turned into a typist and clerk.”

According to a 2014 Deloitte survey, three out of four physicians surveyed report that EHRs increase costs and do not save time. “Many organizations, particularly smaller practices, do not have the technical and leadership resources to effectively deploy and optimize EHRs or complete necessary process changes,” said Harry Greenspun, director of Deloitte’s Center for Health Solutions. “They fear they will be unable to maintain productivity or achieve a reasonable return on investment by any measure.”

Once implementation of meaningful use begins, according to the Deloitte survey, few physicians report intentions to stop or abandon moving to the next stage. Of those who have not yet started implementation, most plan to stay put. Out of the 18 percent who had not started meaningful use, 70 percent had no future plans to reach any stage of meaningful use.

Stack said the incentive program is less attractive to physicians who haven’t yet attempted meaningful use since, “It’s an all or none paradigm, so you have to successfully complete the entire meaningful use program as defined by the government or else you fail. So if you get 19 of the 20 elements correct, you’ll get a penalty and you’ll be deemed to be a failure in the program, which really seems fundamentally unreasonable and certainly does not encourage people to incur the great cost and expense necessary to fulfill the program when the likelihood of success is uncertain and the possibility of failure is substantial.”

Stack said the complexity of the measures and the stringent requirements to meet specific measures actually acts as a deterrent for many physicians. “It [meaningful use] is overly complex, it’s overly proscriptive, and it has an unreasonable threshold to determine success or failure that actually serves as something of a disincentive to participate,” said Stack.

Another significant detractor for physicians who have chosen not to participate in meaningful use is the overall cost involved can be substantial, often approaching tens of thousands of dollars. “This is going out and buying an expensive software program, installing it and then you have to pay for extra work to be done to make it communicate and connect with other electronic health records,” said Stack. “So this is not plug and play.”

Many physicians and practices are finding that the cost of entry simply doesn’t add up. “A lot of smaller practices aren’t financially motivated to continue with meaningful use after stage one,” said Shaun Conrad, manager in the healthcare advisory practice at Ernst & Young. “With additional incentives difficult to obtain and penalties being low, smaller practices don’t believe the juice is worth the squeeze in continuing with meaningful use. The implementation, practice effort, and administrative costs are outweighing the overall financial gain.”

Conrad said some physicians are taking a cautious approach to their meaningful use strategy because frustration levels remain high for those who’ve already committed. “Doctors are frustrated with meaningful use and the frequent changes in direction,” Conrad said. “The path from stage to stage continues to evolve and many are waiting until the dust settles before committing to a direction and meaningful use strategy. Having patients involved in meaningful use and getting them engaged with a patient portal and electronic messaging has proven too difficult for doctors.”

Rodney J. Moore is a healthcare writer, ghostwriter and medical copywriter based in Nashville, Tenn.