Wednesday, January 16, 2013

Meaningful Abuse

Sometimes, the money made for pursuing bureaucratic pursuits is not worth the time required to fulfill them.  This is becoming especially true for "meaningful use" criteria that have been developed by the government to penalize doctors if they don't use the Electronic Medical Record in a "meaningful" way.  The roll-out of punitive measures to "encourage" doctors use of EMRs began with varying "stages" of required compliance and threatens to implode upon itself:
For Stage 1, physicians have to meet a total of 15 core (required) measures, select five measures of their choice from a menu set of ten, and also meet six clinical quality measures. For Stage 2, physicians are required to meet more measures: 17 core measures, an additional three measures of their choice from a menu set of six measures, and starting in 2014, meet nine clinical quality measures. The Health IT Policy Committee’s proposal for Stage 3 would nearly double the number of measures physicians would have to meet for each patient in order to avoid meaningful use financial penalties. Failing to meet just one measure by  one percent would make a physician ineligible for incentives and face the same financial penalties during the penalty phase as those physicians who make no effort to adopt EHRs.
You read that correctly.  If you do all the clicky computer things the government wants with each patient visit, you will not have time to care for your patients.  So never mind if you don't have a clue what all these "stages" of computer use actually mean because I can help you:

With the proposed Stage 3 Meaningful Use criteria coming down the pike, you will be penalized for using the Electronic Medical Record because you don't use it well enough no matter how hard you try.  After all, patient care is not the priority, computers are. 

Any questions?

(Yeah, it's hard to make this stuff up.)


Reference: AMA Letter to the Office of the National Coordinator for Health Information Technology


Anonymous said...

How about you just send me the EMR page and let me do the clickety click part and send it to you by e-mail or facebook/twitter(it will be as acurate and private as my medical record is now). You can sign it electronically and e-prescribe whatever fits the guidelines for my clicks. This way we can make the EPA happy too by saving me the 80 mile round trip to your office (my car only gets 30 mpg). Then you can e-bill for your services and I can e-pay from my bank account.

Neither of us ever have to leave home and we get the job done---right?

Anonymous said...

i am a solo gyn practitioner in Piermont NY,
20 miles northwest of NYC. Being a solo medical provider makes me a 'dinosaur' (I have not decided which one yet).
My overhead is close to 70%.. I have been in private medical practice for 26 years. I love what i do, but everyday I wish I could either semi-retire or create a 'product' that would give me retirement money.
In any event when I first learned of the monetary incentive from the government for instituting EMR in my office, I was all gun-ho. I even found a free EMR called Practice Fusion, obtained over the internet, which probably will not be free for very long.
And then as I read more, and realized the complexity of the requirements, I became increasingly discouraged. Because I do not have a large Medicare population I have decided to just take the 'financial hit'. As Dr. Wes points out this has become more of an exercise in'abuse' and threatens to interfere with patient care, if what the government requires in using an EMR system is implemented.
I recently spoke to a geriantologist who has a huge medicaire
population and she would rather take the 5% reduction, then participate in this ridiculousness.

Anonymous said...

Love the AMA's recommendation that specialists be exempted from requirements to enter so much worthless data, and that only primary care docs should shoulder that burden!

If docs are going to whore themselves out, it's the Johns who get to make the rules.

Anonymous said...

I could not find an email address for you, so I thought this might be the easiest way to contact you.

I thought you might be interested in this press release.

Think Tank Medical Releases CMS ICD Application on iTunes for Cardiologists to Determine Patient Eligibility for Implantable Cardiac Devices

DrWes said...

Anony 02:33 pm -

While I don't usually approve these types of comments when I moderate them, because your app is "free" to download from the app store, I posted it.

And yes, I tried it out. Seems legit.

Unknown said...

As a hospitalist/ internist, it seems to me that to be judged a quality provider we must become good bureaucrats, i.e. it is the quality of our bureaucratic adherence that is really measured.
About 10 months ago I (with a little help from several other MD's) put a patient with severe AS into pulmonary edema. The issue was managed, I discussed it frankly with the pt and family, taking full responsibility. I still have a bad feeling about it. Within 3-4 weeks, I heard prom our hospital's Peer Review committee. I was cited for failing to dictate 1 admission H & P within 24 hours. Never heard about the entirely preventable episode that placed my patient's life in jeopardy.
Though merely an anecdote, I seriously doubt that a bureaucratic framework can ever actually improve patient care. Worse, when I am distracted from a patient's actual care with calls about quality measures or inpatient vs observation status, pt care will inevitably suffer.
I would like to know if there is any pushback in organized medicine to counter this trend.