Changes in practice operations deemed necessary to meet the 25 “meaningful use” criteria proposed as part of the federal electronic health record incentive program would lead to decreased provider productivity, according to the Medical Group Management Association.
Respondents to the MGMA’s survey were asked to estimate the change in provider productivity resulting from the implementation of all 25 criteria, not including the temporary decrease in productivity that occurs with any implementation of a new EHR.
“For the incentive program to succeed, the meaningful use criteria must be practical and achievable,” said William F. Jessee, MD, the MGMA’s president and CEO. “If the final rule mirrors those outlined in the current proposal, there is a significant risk that the program will fail to meet the intent of the legislation.”
More than two-thirds of respondents (67.9 percent) said physician productivity would decrease, with 31 percent saying productivity would decrease more than 10 percent.
“I think it is important to note how complex these proposed rules are,” said John O’Connor, practice administrator for Five Valleys Urology in Missoula, Mont. “When things get needlessly complex, they become a deterrent to implementation. And frankly, most medical practices just don’t understand all these rules.”
“We’re worried the administrative burdens in the proposed rule will make it nearly impossible for us to meet the definition,” he added. “And that in attempting to meet the requirements we’ll get caught in a quagmire of tasks that completely take away from the whole purpose of adopting in the first place.”
The MGMA survey highlighted specific criteria that many respondents said would be “difficult” or “very difficult” to achieve. These include:
- The proposed requirement that 80 percent of all patient requests for an electronic copy of their health information be fulfilled within 48 hours (45.9 percent); and
- The proposed requirement that 10 percent of all patients be given electronic access to their health information within 96 hours of the information being available (53.5 percent).
“The proposed rules make the assumption that some of the criteria are going to be easily met, but that is simply not the case,” said O’Connor. “For example, our small practice has been attempting to use electronic prescription for over a year, but the system is fraught with problems and we spend more time trying to electronically prescribe than we did just calling in or faxing in a prescription.”
“As a small practice we have limited resources and staff, so every slow-down increases our overhead, and with the current climate that is something we cannot tolerate,” he said.
“If the meaningful use guidelines are implemented, productivity will definitely dip,” said Mona Reimers, director of revenue services at Orthopaedics NorthEast PC in Fort Wayne, Ind.
Reimers said she could see redundancy or questions – for example, in the requirement that BMI and height and weight data for children be gathered.
“We are in the midst of deploying an EMR, but can’t really finish the workflows under the incentive rules until they’re finalized,” said Reimers. “We can only proceed with what we assume is the right way to do it.”
Reimers further pointed out that no one knows which vendors are certified for meaningful use or who will be doing the accreditation.
“(Meaningful use) requires a patient portal – all well and good, but we just got the HIPAA security guidelines. Now how are we going to protect this information?” she asked. “It would be nice if the government gave us more direction on this requirement.”