Meaningful Use: A Patient’s Post-Mortem

Goodbye to Meaningful Use

Goodbye to Meaningful Use

In January, 2016, Andy Slavitt, the Interim Chief of the Centers for Medicare and Medicaid Centers (CMS) announced  to healthcare stakeholders that Meaningful Use is “effectively over” and will be “replaced with something better”.  Unfortunately, the “something better” will still be designed and implemented by the same  leadership at the U.S. Department of Health and Human Services (HHS) that caters to the interests of for-profit healthcare businesses over those of individual Americans, Meaningful Use’s primary beneficiaries. You can bet that  “something better” does not deliver any meaningful provision for a reduction in healthcare costs or greater  patient-engagement”.

The Medicare and Medicaid EHR Incentive Programs (from which Meaningful Use comes) was ill-designed from the very beginning. The control of shareable electronic health records was placed exclusively in the hands of 200,000+ for-profit healthcare business professionals whose financial conflicts of interest thwart any sharing of health records that potentially reduces income.  These professionals can block the sharing of any patient health records that they feel with reduce their income. These business-controlled EHR patient portals can be manipulated to frustrate patients and deliver limited access to health records because our government is not auditing them properly.  The use of individual proprietary software programs for EHRs instead of public application programming interfaces, open standards, interfaces, and protocols (i.e., one standard software package) doomed “interoperability” from the start and enriches medical software companies at the expense of taxpayers and patients.

In the world of government bureaucracy, there is no mechanism for admitting flawed program design and starting over without jeopardizing program sustainability and funding. The Office of the National Coordinator for Health Information Technology (ONC) did what any government department tasked with creating and implementing this flawed program would have done…it simply glossed over the problems, dispersed incentive payments to health professionals and hospitals, and wrote reports that painted rosy pictures. When the program stalled because healthcare professionals and hospitals failed to deliver, the bureaucrats simply relaxed program requirements.  Lax and flawed auditing practices kept the existence of problems under wraps.  Delivery of the final Meaningful Use products was very much of secondary concern to the dispersal of incentive payments.

The government bureaucrats at ONC have been unofficially winding down and distancing themselves from the poorly designed Meaningful Use program long before Andy Slavitt’s announcement. The last head of the ONC (Dr. Karen DeSalvo) stepped down in October 2014 to become Acting Assistant Secretary for Health U.S. Department of Health and Human Services. She only keeps her ONC secondary title because no other medical doctor wanted the dead-end position. Over the past two years, ONC continued to write rosy reports and promised renewed efforts to correct the uncorrectable  “interoperability” problem they had created and ignored for many years.

The Andy Slavitt announcement came shortly after the watered down Meaningful Use Final Rule (in October, 2015) put the final nail in the Meaningful Use coffin. With 95% of the incentive payments paid out or allocated to healthcare professionals, the fact that shareable electronic health records had not been created, evaluated, and audited became someone else’s problem. No funds means the bureaucrats at ONC must begin their exit strategy. The ONC has no idea what health records the for-profit healthcare businesses have even placed within their business-centered EHR patient portals and the only people (the patients) who know are not being asked. If my experiences with the content found in the EHR patient portals is typical, then I can see why the government wants to bury this program and move on.  The government bureaucrats are not being held accountable for non-delivery of Meaningful Use and will not learn from mistakes they do not own up to.

As the bureaucrats at the Centers for Medicare and Medicaid Centers (CMS) put the final nail in the coffin of Meaningful Use, one might ask what has been accomplished over the past six years? I have identified the two major accomplishments as of April 2016 below:

  • Our government has given out $33.9 billion to health professionals to “incentivize” healthcare businesses to convert their health records into shareable electronic health records.
  • More than 498,000 health care providers received payment for participating in the program (maximum incentive amount is $44,000 per eligible professional across five years of Medicare program participation, more for Medicaid participation)

If success were only measured by the dispersal of taxpayer dollars to private (well-paid) healthcare professionals, then the Medicare and Medicaid EHR Incentive Programs would be resounding success stories. In its Fiscal Year 2015 Annual Performance Report and Performance Plan (released March 2014) , the U.S. Department of Health & Human Services (HHS) reported that they had “exceeded” their Meaningful Use goal by qualifying and delivering an incentive payment to more than 325,000 eligible providers, registering 73% of Medicare Eligible Professionals, 137,136 Medicaid Eligible Professionals in 49 States, and 91% of eligible hospitals”. Audits verifying what private healthcare professionals “self-attested” they were delivering were pushed aside to make sure that the incentive payments remained free flowing.

From the patient’s (and taxpayer’s) perspective Meaningful Use is NOT about the successful transfer of taxpayer money to healthcare professionals and hospitals, but rather about delivering shareable electronic health records to patients (and their designated recipients) for improved coordination of care, reduced healthcare costs, and improved patient outcomes. The government bureaucrats may pretend they have delivered Meaningful Use, report peripheral rosy statistics, and write long, reports that say little about the important outcomes but we know better. For the final beneficiaries—the American patients and taxpayers, the $33+ billion handed out to private healthcare professionals and hospitals was free taxpayer money used to improve internal Electronic Medical Records (EMRs) and further private business interests over patient interests.

I can’t help but contrast the Meaningful Use program with the Manhattan Project which cost the equivalent of $26 billion in 2014 dollars and took a total of 4 years to develop and manufacture an atomic bomb during WWII!.  Back in the 1940s, the scientists started from scratch (the bomb didn’t even exist) while the Information Technology (IT) needed to implement this program has largely existed for decades. Unlike its present way of doing business, our war-time government needed to get the job done so they funded and tasked a group of experts who worked diligently for the American people first. They were “incentivized” not by money but by their commitment to the American people. Times have surely changed.

The Future of Meaningful Use?

I am not optimistic about the future application of Meaningful Use. The “carrots” (incentive payments) have been largely dispersed before delivery of the Meaningful Use products have made it to patients.  The “sticks” (Medicare payment penalties that started in 2015) are set to disappear in 2019.  Meaningful Use is being bundled into the new Merit-based Incentive payment system (MIPS) as only one component in a formula for Medicare reimbursement.  Meaningful Use is being repackaged with a new bureaucratic name, Advancing Care Information (ACI), so that its original undelivered goal can die with it. Annual self-attestation and audits that do not include patient verification continues the rubber stamp compliance process assuring that patients continue to not get the shareable health records they need.

The Bottom Line

As our government says goodbye to the $33+ billion Medicare and Medicaid EHR Incentive Program (Meaningful Use), everyone is happy except those who were supposed to benefit the most from it—the present and future American patient. This program gives control of timely shareable electronic health record delivery to for-profit healthcare businesses who have a conflict of interest when it comes to improved coordination of care, reduced healthcare costs, and improved outcomes for all.  All of these Meaningful Use goals are aimed at reducing healthcare provider income and business. Do you think they will sit back and let this happen? Through their healthcare business-controlled EHR patient portals, they will incorporate the Meaningful Use parts that benefit them financially and discard or limit the functionality of those features that limit income and profits.  I see this process in my EHR patient portals already.

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