Physicians Question Health IT Stimulus RequirementsPhysicians Question Health IT Stimulus Requirements

The Medical Group Management Association, a professional organization representing thousands of U.S. physician practices, has sent a letter to the National Coordinator for Health IT recommending steps that should be taken in the implementation of the federal government's $20 billion health IT stimulus program.

The MGMA said that while it supports physician practices' adoption of health IT, the group is "very concerned about the implementation process for the Medicare and Medicaid electronic health record (EHR) incentive programs currently under development," in a letter to national health IT czar Dr. David Blumenthal dated Nov. 12.

"We believe that an inappropriate definition of meaningful use and inefficient administration of the program will lead to failed implementation of the American Recovery and Reinvestment Act of 2009 (ARRA) and result in the needless squandering of resources and significant disruption to the nation care system," said the letter.

There are several factors and unknowns about the upcoming meaningful use of health IT requirements that are worrying physician practices, said Robert Tennant, a MGMA senior policy advisor in an interview with information.

Beginning in 2011, healthcare providers who meet the federal government's criteria for the meaningful use of health IT such as e-medical records, are eligible for additional payments from the Centers of Medicare and Medicaid. Those payments could total in the tens of thousands of dollars for doctor offices between 2011 and 2015.

However, much of practices' anxiety about the upcoming meaningful use programs are due to how the federal government has run other quality reporting programs in the past, most specifically the Physicians Quality Reporting Initiative, Tennant said.

Under PQRI, doctors are also eligible for additional Medicare and Medicaid payments for reporting specific measurements related to the care of diabetic, heart disease and other patients. However, studies have shown that only about 50% of doctors who expected a quality reporting reward actually received the government bonus, he said.

That's in part because while doctors report the PQRI data all year, there's no feedback from the government whether the doctors are meeting the requirements. Mistakes in reporting or other problems that could be addressed by the practice go unnoticed until doctors fail to receive the previous year's bonus the following year, Tennant said.

With physicians' skepticism about upcoming meaningful use criteria, MGMA's letter to Blumenthal suggests several steps the federal government should take in the administration of the federal stimulus HIT program to help make the rewards program a success.

Among the MGMA recommendations is instituting a pilot program in late 2010 so that flaws or other weaknesses are identified before doctors formally attempt to demonstrate meaningful use in 2011.

"Institute a pilot -- Once the final [meaningful rule] is published [at end of 2009,] and well before to the 2011 program start date, we believe that the government should conduct a pilot with a small number of vendors and in a variety of physician practice settings to ensure that the process of demonstrating meaningful use is achievable and practical," the MGMA letter states.

"This pilot could assist in determining potential roadblocks to program success and identify solutions to those roadblocks."

Also, MGMA is urging the federal government to notify doctors when there are problems with meaningful use quality reporting.

"Ensure timely responses from CMS to physicians once data are submitted in support of their meaningful use reporting requirements," said the letter.

"The government must be ready to accept meaningful use data in late 2010 in order for physicians to send test data, receive feedback from an appropriate government agency and still have sufficient time to take the appropriate action to modify their system should they encounter data content or reporting problems."

So far, MGMA has not received a reply to its letter from Blumenthal's office. However, MGMA will submit its recommendations as part of the public comment process when the meaningful use definition is released by the federal government in December, Tennant said.