For all us Medicare contractors, which is what most physicians are in reality, how is stage 2 Meaningful Use going? The AMA recently sent a protest letter to CMS, decrying the abusive terms of MU Stage 2. Only 50 physicians in the entire US passed the first quarter of 2014 and I suspect only a small fraction of US Medicare physicians will pass Stage 2. I have passed both years of Stage 1 and found it challenging. Now I am looking at the criteria for Stage 2 and find it abusive, onerous and obviously written by a young computer tech person who does not understand older Americans or the current state of computer technology in the US healthcare system.
Stage 2 Meaningful Use demands that at least 5% of Medicare patients send the physician a message via the secure portal in writing. This is obviously out of my control and many of my older patients do not own a computer and if they do, are not interested in using an internet patient portal to long on so they can write to me. They just want an old fashioned phone call to my staff and immediately access my staff who knows them, face to face. Older folks hate computers and few use smart phones.
Another Stage 2 stipulation is that 30% of radiology orders must be sent via electronic messaging, not fax which has served me with 100% reliability for over 20 years. Whether it is 1% or 100%, “electronic messaging” isn’t just simple email. It requires the radiology group accepting the order to pay for an interface between my EMR and their EMR to allow bidirectional radiology orders and results.
The cost of this interface is astronomical. My EMR vendor now wants to force any radiology vendor to pay $5,000 to write the interface ( grossly inflated per local tech experts) and then a $900 annual maintenance fee! My two radiology groups cannot afford this fee just for me, as they take orders from hundreds of MDs. They would go bankrupt if they cover all the interface costs.
But even if they were to cover all the costs, this is where regulation comes full circle to ensnare us: physician referrals to a radiology group that has paid for the interface will red flag all those referrals as a violation of Stark laws. The other radiology competitors will have a legal complaint to refer to the Justice Department for Stark violations as they can say I am being paid to make referrals. So then I am stuck with a $5000+$900 cost to meet MU stage 2 , which rebates only $7840 if 100% all criteria are met.
Then there are the Menu options, one of which is setting up a reporting mechanism to report controlled drug use to the WA State Dept of Health. This would require a $600 HIE (Health Info Exchange ) fee just to make one report! The local state governments are in turn overwhelmed with MU as they are forced to accept numerous reports that they have no extra funding for, no extra staff to interpret the data, and forced upgrades of their own computers to take all the new MU reports.
The AMA letter asks CMS to drop the 100% pass rate to 75% and also drop the 5% patient portal use as it is beyond physician control. We can only pray the new Secretary Burwell will change this policy. The computer industry lobbied for Meaningful Use during the 2009 ARRA bill writing. They are now reaping that harvest as they now have physicians cornered with the costs of meeting Meaningful Use.
Ken Lee MD is an internist in private practice in Washington state.