AMA provides blueprint for making meaningful use more physician friendly

The American Medical Association (AMA) released its blueprint for the future of the meaningful use (MU) incentive program, a proposal that includes greater physician flexibility in attesting and addressing physician usability challenges.

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The intention of the letter, according to the AMA, is to evaluate what is working and what is not before moving ahead to stage 3 of the MU program. In a letter to the Centers for Medicare and Medicaid Services (CMS) and the Officer of the National Coordinator for Health Information Technology (ONC), the AMA recommended a number of changes to the MU program.

• Adopting a more flexible approach for physicians to meet MU. The AMA recommends the program’s “all-or-nothing” approach be removed. In it’s place, the AMA recommends adopting a 50% threshold for incurring a penalty and a 75% threshold for earning an incentive in stages 1 and 2.

• The government should make the most challenges measures optional, including viewing, downloading and transmitting records, transitions of care and secure messaging.

• Expand hardship exemptions for all stages of MU, including expanding the “unforeseen circumstances” hardship, an exemption or hospitalists and physicians close to retirement.

• Provide an exemption for physicians who successfully participate in the Physician Quality Reporting System (PQRS) from the MU quality reporting requirements.  In addition, the MU program should improve its alignment with the PQRS program.

•  Address physician EHR usability challenges by revamping the certification program to focus on interoperability, quality measures reporting and privacy and security.

• Remove the requirement that only licensed medical professionals and credentialed medical assistants are allowed to enter orders.

The AMA has advocated for more flexibility in all stages of the MU program to encourage physicians to continue to integrate electronic health records into their practices. That flexibility includes removing penalties for physicians who are making an effort to take part in Meaningful Use but are not meeting 100 percent of the program’s stringent requirements. The AMA recommends that physicians who meet at least 50 percent of the requirements in the current stages be able to avoid financial penalties and that Stage 3 include just ten required measures.

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“It is clear that physician use of EHRs has progressed considerably,” writes James L. Madara, MD, the AMA’s executive vice president and chief executive officer. “Despite these achievements, the MU program has faced significant challenges. After three-and-a-half years of provider participation, we are at a critical crossroads.”

“The whole point of the EHR incentive program was to build an interoperable health information technology infrastructure that would allow for the routine exchange of important medical information across settings and providers and put medical decision-making tools in the hands of physicians and patients, yet that vision is not being realized and the lack of interoperability is stifling quality improvement,” said AMA President Robert M. Wah, MD, in a news release. “While more than 78 percent of physicians are using an EHR, thousands have not participated in the Meaningful Use program or attested to Stage 2, in large part because of the program’s all-or-nothing approach. Physicians should not be required to meet measures that are not improving patient care or use systems that are decreasing practice efficiencies. Levying penalties unnecessarily will hinder physicians’ ability to purchase and use new technologies and will hurt their ability to participate in innovative payment and delivery models that could improve the quality of care.”