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My Take on “Meaningful Use”
D. Kellus Pruitt DDS
Recently, lawmakers complained that the federal criteria for “meaningful use” of eHRs – usage required before providers who risk purchasing electronic health record systems can be reimbursed – aren’t strict enough to justify the billions of dollars in incentive payments that the government promised physicians and hospitals. Matthew DoBias, writing for ModernHealthcare, quoted Rep. Wally Herger (Calif.) – the senior Republican on the Ways and Means Committee’s health subcommittee – who said:
“The new HIT regulations are a step in the right direction and should put Medicare on a path to improved quality and efficiency. However; by watering down the final regulations, we have missed an opportunity to advance healthcare delivery and ensure wise use of taxpayer money.”
http://www.modernhealthcare.com/article/20100721/NEWS/100729995/1153
Rep. Wally Herger
“Improved quality” you say, Rep. Herger? That proves that politicians like Herger will say whatever it takes to get elected, even if it’s transparently misleading. Herger’s confident claim of improved quality of care from using eHRs is typical of Washington even though quality claims are widely disputed in most medical circles. And if eHRs were as efficient as Herger and his campaign donor’s claim, then the billions of dollars in incentive payments that have already been billed to our grandchildren wouldn’t be wasted to bribe physicians to purchase eHR systems that are too lousy to move off the shelves. If HIT stakeholders’ products offered value for Americans in the land of the free, they would sell for natural reasons of consumer demand and wouldn’t require a government mandate and Herger’s deception. Besides, what does any politician know about “wise use of taxpayer money” even outside of the medical field, Mr. Herger?
[picapp align=”none” wrap=”false” link=”term=doctor+computer&iid=107036″ src=”http://view3.picapp.com/pictures.photo/image/107036/medical-professional-using/medical-professional-using.jpg?size=500&imageId=107036″ width=”337″ height=”506″ /]
The Criteria
The criteria for meaningful use have been cut down to 15 issues allegedly because demanding all 25 risked improving care and saving money far too ambitiously. Tony Trenkle, director of the Office of E-Health Standards and Services at CMS, puts his special spin to the “watering down” of requirements. He is quoted in an article by Emily Long in NextGov:
“We set the bar where we felt it was appropriate and also signaled for future stages that we would be setting the bar much higher, We’re going along with ways we can modify to reflect real-life experiences we hit once the program begins.”
Why didn’t Trenkle just say, “We at CMS are making this sucker up as we go”?
http://www.nextgov.com/nextgov/ng_20100720_9874.php?oref=topnews
Dr. David Blumenthal
Dr. David Blumenthal, the national coordinator for health IT, has given up apologizing for bankrupt ideas like the CMS’s criteria for “meaningful use” of electronic health records – as if they made sense. They don’t, and Blumenthal must know that the clicking-for-cash busywork plan he inherited is a waste of time and money. Otherwise, the AMA wouldn’t be complaining.
(See “AMA Weighs in on ‘Meaningful Use’ Requirements For E-Records” – Wall Street Journal Blog)
http://blogs.wsj.com/health/2010/07/21/ama-weighs-in-on-meaningful-use-requirements-for-e-records/
Surely Dr. Blumenthal recognizes that naive lawmakers like Rep. Wally Herger are foolishly demanding unwanted and dangerous micromanagement of healthcare, not in the interest of patients’ welfare, but for political power. (Do Americans really want Wally Herger from California regulating healthcare?) Rather than attempting to sell systems to doctors based on disingenuous claims of unproven value, Blumenthal chose to punt. All he could offer was a lame appeal to pride: “Much more important than incentives will be a professional sense of obligation,” (Emily Long, NextGov, ibid).
The Oath
Doesn’t the Hippocratic Oath, as well as business survival trump the dangerous nonsense Dr. Blumenthal calls “professional obligations”? As if to emphasize that point, just hours ago, some relevant news was posted concerning the danger of eHRs: “A Massachusetts hospital is under scrutiny after hundreds of thousands of patient and employee records went missing earlier this year. The missing files underscore the problems health care providers face when balancing patient privacy and the need to store massive amounts of data, especially as new federal rules for electronic health records come into play.” (See “Massachusetts Hospital Reports 800,000 Personal Records Missing” by Brian T. Horowitz for eWeek, 7/21/10).
Assessment
How does risking such harm to patients rise to the level of a “professional obligation”? I think Dr. Blumenthal might be confusing professionalism with patriotism. They are both traditional, flexible buzzwords that start with the letter “P” and are often used for just about any bureaucratic chore – even so far as to prove diametrically opposing views.
Conclusion
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Filed under: Health Law & Policy, Information Technology, Op-Editorials, Pruitt's Platform | Tagged: ADA, AMA, Brian T. Horowitz, CMS, David Blumenthal, EHRs, EMRs, Office of E-Health Standards and Services, Rep. Wally Herger, Tony Trenkle |
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MU Rules attacked by the GOP
http://thehill.com/blogs/healthwatch/medicare/109829-republicans-attack-new-hit-meaningful-use-rules-
Dr. Pruitt – the rules just don’t seem strict enough to them [politicians] – or me. What about you?
Blake
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Thanks, Blake
Rep. Wally Herger’s naïve effort to control free-market demand for healthcare is doomed to failure, and it is our duty as Americans to quit electing healthcare stakeholders like him.
I read “Republicans attack new HIT “meaningful use’ rules” by Mike Lillis for The Hill’s blog. It wasn’t lost on me when Lillis wrote, “To ensure that providers are actually using those tools to improve healthcare services, Congress required the agency to establish benchmarks for providers hoping to take advantage of federal incentive payments for HIT adoption.” The author’s assumption that interoperable eMRs will improve healthcare services is classic stakeholder.
Rep. Herger laments: “Much less is expected of healthcare providers receiving subsidies than what [the Centers for Medicare and Medicaid Services (CMS)] had initially proposed.” Herger is clueless about healthcare.
When I recall the arguably spotty success of government regulation of American businesses much less complicated and personal than medicine, it is clear that naïve, command-and-control politicians like the California Representative have carelessly assumed that stakeholder management of doctor-patient decisions will somehow outwit wary American consumers. What makes the bi-partisan healthcare blunder historically interesting is that it is relatively unusual for Republican lawmakers like Herger to interfere with business – even in California. Normally, it’s the Democrats who think they can build automobiles better than automakers.
In this week’s episode of Obama’s fanciful and expensive healthcare melodrama, appointee Dr.David Blumenthal trotted out a management style even more laissez-faire than Republican lawmakers’. Just goes to show that you can’t tell the actors without a program.
The Wall Street connection
At a recent White House Forum moderated by Nancy-Ann DeParle, Director of the Office of Health Reform, Allscripts CEO Glen Tullman, the nation’s largest electronic medical record vendor (MDRX), said “We need physician leadership to commit to making changes in their behavior…. It’s no longer about the technology, it’s about changing providers’ behavior.”
Never mind that the nation’s First Stakeholder said “it’s no longer about technology.” That low-hanging fruit is just too easy. When apologies are being made to our grandchildren, they should be told that Glen Tullman was Obama’s friend in Chicago several months before Obama was elected to the Senate. In addition, Tullman has bipartisan appeal because the Wall Street sweetheart let’s Republicans off the hook by shifting accountability to under-represented healthcare principals. When combined with stimulus money, the act increases employment in HIT-related industries as well as the price of MDRX stock.
It’s so clear now that when doctors’ and patients’ interests are ignored in decisions how to divide up our grandchildren’s money, the most fortunate stakeholders like Herger, DeParle, Blumenthal and Tullman all get whatever they want until the easy money runs out far sooner than expected because of unpatriotic doctors and patients.
A few years ago, Tullman revealed to audiences the motivation behind his character when he announced in an interview that providers should borrow money to purchase Allscripts eHR products “so they’ll have some skin in the game.” Being wishy-washy doesn’t seem to be a problem for Glen Tullman.
But that’s enough about half-baked fantasies of political power funded in part by Allscripts political contributions. Let’s return to the real world: If my child is in desperate need of unbiased medical attention, I expect the doctor to shut the operatory door hard on administrative “meaningful use” criteria that Mr. Herger demands as a “receipt” to show voters.
On occasion, it’s been made clear to me that my opinion of eHRs is unpopular – especially among stakeholders – even when the economy was better. The stimulus jobs created in the nation by clicking-for-cash in healthcare is so politically correct right now for Wall Street reasons that few are ready to admit we’ve been had … again.
D. Kellus Pruitt DDS
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Mostashari replaces Blumenthal at ONC
Hours ago, Joseph Goedert, writing for HealthDataManagement posted an article announcing that HHS Secretary Kathleen Sebelius named Dr. Farzad Mostashari as national coordinator for health IT replacing outgoing head Dr. David Blumenthal.
http://www.healthdatamanagement.com/news/onc-office-of-the-national-coordinator-mostashari-42277-1.html
Goedert writes: “With training in internal medicine, Mostashari is a recognized expert in investigating disease outbreaks and electronic disease surveillance. He has held positions in the Centers for Disease Control and Prevention and the Agency for Healthcare Research and Quality, and established the Bureau of Epidemiology Services at the New York City Department of Health.”
Though there is a mountain of trouble between where we are now with EHRs and effective disease surveillance, I applaud Sebelius on her choice. Pestilence caused in part by the rising cost of measuring such trends in healthcare may not be too far off.
D. Kellus Pruitt
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