Could you imagine the IRS allowing the average American to simply tell them how much income he/she made for the year without getting third party verification (e.g., 1099s, W2s, etc.)? Of course, not! There would be massive tax dodging (on top of the legal tax dodging currently practiced). I am not saying that Americans are a dishonest bunch of people– it is simply human nature to want more for ourselves while rationalizing why the federal government doesn’t deserve the amount they want. This, therefore, begs the question: why does our government think that healthcare professionals and hospital personnel are different from other people? In the Medicare and Medicaid EHR Incentive Program (also called the Meaningful Use program), healthcare professionals and hospital personnel simply self-attest to various program requirements and are paid up to $44,000 (for Medicare participation) or $63,750 (for Medicaid participation). This Meaningful Use self-attestation process is seriously flawed.
Meaningful Use Self-Attestation, Audits and Patient Engagement?
Third-party verification in the Meaningful Use program was accomplished by an outside sub-contractor (Figliozzi & Company) and largely involved contacting a small fraction (5%?) of the eligible professionals/hospitals for more documentation of compliance. Audits by the Office of Inspector General were announced in Work Plan Fiscal Year 2015. Both of these verification measures fall under the category of too little too late.
I have many questions about the longer running Figliozzi & Company audits with just a few listed below:
- What percentage of all eligible health professionals/hospitals has been audited?
- What percentage of this group was found to have false or unsubstantiated meaningful use claims?
- What exactly was audited?
I find it very suspicious that the auditing statistics by Figliozzi & Company have not been made public by the government. I would like to think that our government didn’t hand out $3+ million to this sub-contractor without getting some data back.
These audits will not reveal what is actually being delivered to patients and when it is being delivered. In the 5+ years that this program has been in progress, patients were never asked patients for their input and, in fact, were intentionally kept out! Patients, who are supposed to be the primary beneficiaries of shared Electronic Health Records (EHRs), have been given little to no information about how EHRs worked, their benefits, or even if they were available. If my observations, from my first EHR Patient Portal to those over the past four years are at all typical, then I suspect that there has been a large misappropriation of taxpayer funds. In my limited experience with Electronic Health Records, I have even come across a possible shady scam to take EHR incentive payments without sharing anything with the patient at all.
Just the other day, I asked by eye doctor (he received $37,600 from 2012-14) if he had an EHR Patient Portal for me to access…the answer was no. I am beginning to get the impression that healthcare businesses (in agreement with the government?) have no intention of sharing my protected health information with me for improved coordination of care, reduced healthcare cost, and improved patient outcome if they can get away with it.
My EHR Patient Portals today contain little to no meaningfully useful health information and have many non-operating (disabled?) functions. The medical professionals, hospitals, and their software providers are very good at creating an EHR Patient Portal Potemkin Village (see picture below) that fools auditors into thinking that they are actually sharing health records that have meaningful use. This situation is described in more detail below.
Shared EHR Patient Portals Today
intentional blocking (or simply intentional foot dragging)
Since the government promoted all eligible professionals and hospitals to Stage 2 Meaningful Use at the end of 2015, the majority of EHR Patient Portals today have entered the Pretending to Share phase of the Medicare and Medicaid EHR Incentive Program. Most of us will now be able to go to our EHR Patient Portals and download and/or send the very limited and incomplete PDF files that represent an extremely small fraction of our Protected Health Information (PHI) found in internal Electronic Medical Record (EMR) databases. A typical “sharing” screen will look like the one given below from one of my EHR Patient Portals with the download and send capabilities indicated with the pink arrows.
Looks good, but guess what happens when I tried to download or send either of the two visit summaries entitled “Historical Upload”? I was greeted with the message shown below.
Is this intentional blocking (or simply intentional foot dragging) so that the typical patient gives up on shareable electronic health records and the healthcare businesses can say the patients do not want EHRs? This reminds me of my earlier experience with another EHR Patient Portal when I accessed the message center, was told that communicating with the practice electronically was currently unavailable to me, and was instructed to use the telephone.
Practice to Fool the Auditor?
The Meaningful Use audits are not geared at catching the common(?) practice of information blocking . With auditors only looking on the surface of meaningful use (screenshots of EHR Patient Portal websites), medical businesses can easily fool CMS and its auditors for EHR incentive payment and compliance. How? I have multiple files listed that contain duplicate information under different file names. I have to sift through the dummy files to see what is what. How many Americans will spend the time I do to sort this out and find out that the information in the end does not contain very much meaningful use?
This reminds me of a practice that I observed during my college years many years ago when homework was still given to professors in paper form. One professor was known for giving a large amount of homework and because he was too lazy (or simply didn’t care about the content), it was “rumored” that he simply weighed the sheets of paper and assigned a grade accordingly. Several students inserted thin strips of metal inside their homework and surprise, surprise they got higher grades than students who delivered the same homework without the metal strips! Both the students who inserted the metal strips and the healthcare businesses that post dummy electronic health files are trying to get away with circumventing what they are supposed to do. These practices are successful because the person(s) responsible for policing (the professor or the bureaucrats at the Centers for Medicare and Medicaid Services (CMS)) are not as smart as the deceiver, bureaucratically lazy, or simply do not care if the content is worthwhile or not. Whatever the reason, both the student and the patient/taxpayer are short-changed in the long run.
Call To Action
If any of the Meaningful Use self-attestation practices described above are happening to you, I urge you to contact one (or all of) the online complaint or auditor websites I gave in an earlier blog post and again below:
- Health IT Complaint Form— As expected, this complaint form is under the “Provider & Professional” tab and not under the “Patients & Families” tab of the government site.
- U.S. Department of Health and Human Services’ Office of Civil Rights
- Figliozzi and Company – Figliozzi & Company; 100 Garden City Plaza Suite 225; Garden City, NY 11530 (516) 745-6400 ext. 302; firstname.lastname@example.org
Unfortunately, there is no dedicated website devoted for patients to complain about the fact that they are not getting what the doctors claim to be delivering through Meaningful Use self-attestation.