At last, we have received from Mt. Olympus those much awaited writings….the definition of “meaningful use”!

Oy.

I understand how we got here.  I could put myself in the shoes of government decision-makers at every step of the way and see myself doing the same thing.  “Step in and help … EMR adoption is too slow and costs are rising too high … the free market isn’t working, so step in.” I get that.

“Make the definitions hard and truly meaningful so that after we are thrown out of office, the social benefit of this program of ours will outlast the pure stimulus effect and create real social change in the health care market.”  I get that too.

“Let hospital-owned practices into the mix.  Even though we know they have the money, we want their leadership. Also, lots of docs are affiliated with hospitals.”  This one was tough for me even though I have a lot of hospital clients that own practices and are growing that business.

“Delay a little to see if we can get more people to our higher standard.”  Okay.

“Delay a little more and signal that maybe the standards won’t be so high … otherwise maybe no one will be a meaningful user.” Okay. Okay.

Now we have the goods. We’ve increased the cost of health care in the following ways:

1. We spent billions on attaining meaningless meaningful use.
2. We cause vertical integration between hospitals and doctors, giving hospitals more pricing power and more influence over doctors’ referral patterns.
3. We got thousands of doctors onto software-based, isolated EMR packages that are systematically not connected to one another and left doctors with no meaningful incentive to work on the interconnection problem themselves.

Oy!

Bitch, bitch, bitch – why am I complaining?  It’s not like the PRIVATE sector did such a terrific job all these years connecting health care!  If it had, the government wouldn’t be in here like this.  So what now?  The private sector had better step up! The fact that meaningful use might be meaningless may actually be a blessing of sorts.  There is still room for the private sector to step in and starting MEANINGFULLY exchanging health care information.  This administration may be activist, but they are NOT stupid.  IF the private sector starts moving health care information around in a way that is safe and starts sowing the seeds of differential payment for differential quality, I am SURE that the government will let it happen.

Okay Payers!

Okay Hospitals!

Okay docs!

OKAY ME!!!!

Or is it? You tell me—what do you think?

The dust has barely settled on CMS’s release of the requirements for “meaningful use” of an electronic health record. In response, athenahealth has already taken three major steps on doctors’ behalf to renew our commitment to meeting the new requirements and helping practices. First we’ve posted an analysis of the new rule and what it means for doctors. 

Second, we are extending our successful Federal Stimulus Bonus Payment Guarantee Program. This program guarantees that eligible physicians who use our EHR service, athenaClinicals, will receive their HITECH Act Medicare bonus payments under the 2011 program year.  With the July 13 release, the Guarantee will extend an additional six months to athenaClinicals clients who go live by June 30, 2011. Read the release here.

Third, as part of our advocacy mission for physician practices, we have organized a one-time Webinar series on meaningful use, the HITECH Act and what it all means over the coming years.

The first webinar, Achieving Meaningful Use With Guaranteed Incentives, on July 21^st, will zero in on how practices can achieve meaningful use and receive guaranteed incentives. Billions in stimulus funds are being offered by the federal government to doctors achieving EHR meaningful use. We’re so confident we can help you get your share of these incentive payments that we are guaranteeing it and putting our own money on the line. Register for this Webinar here and learn how to take advantage of the extension.

The second webinar, on July 28, 8 Tips for Successful EHR Adoption, will focus on outlining eight critical tips for successful EHR adoption in the era of meaningful use. Electronic health record solutions can cost too much, slow you down, and make you do extra work to secure HITECH Act and P4P dollars. But it doesn’t have to be that way. In this Webinar, get clear guidance – in eight steps – on how to do the right planning and choose the right solution so you’ll meet meaningful use and realize the full clinical and financial benefits of an effective EHR. Register here.

Then on Aug. 5, take a deep dive on what the meaningful use rules are and what they will mean for your practice and your approach to EHR adoption. Join athenahealth and Manatt Health Solutions for this in-depth Webinar that will cover the nitty-gritty details of the new meaningful use standards and explore the implications for physician practices looking to secure federal stimulus dollars. Register here.

In 864 breezy pages, “meaningful use” is here. We now know a lot more but the details are complicated.  One thing that hasn’t changed is the monetary incentive of up to $44,000 in Medicare funds or $63,750 from Medicaid for doctors who achieve meaningful use of an electronic health record (EHR).

athenahealth has been so confident that our EHR will get our clients these government stimulus payments, we have a standing HITECH Act Guarantee. That commitment hasn’t changed either.

But the final rules have been adjusted, as we learned today. For physicians—referred to in the final rule as “eligible providers” or “EPs”—there are 15 core requirements and an additional 10 discretionary requirements in what’s being called a “menu set.” Providers must select five requirements from the menu set.  Many of the measurement thresholds have been reduced. For example, CPOE (order entry) is now for medications only, and they can be entered by a licensed professional–not only physicians. 

In terms of the quality measures, there are only six required–three core, three alternate, and three discretionary.  Reporting of measures is by attestation only in 2011, and electronically starting in 2012, but the reporting requirements aren’t really clear yet.  The requirements align well with the PQRI measures. athenahealth is an approved PQRI registry, by the way.

To get the ball rolling, physicians can start their 90-day reporting period for use of a certified technology in January 2011, and can begin attestation in April of 2011.  The Centers for Medicare and Medicaid Services (CMS) will start making payments in May of 2011.

We are currently digesting 864 pages of requirements released today and will break it all down for you in an upcoming free webinar on August 5^th. Register here. In the meantime, for an overview of the HITECH Act and meaningful use, watch this video.

There are already some good resources on the web. John Halamka MD, who among other things is CIO of Harvard Medical School and a blogger, posted a helpful analysis. The New England Journal of Medicine also posted a good summary overview.

Stay tuned for more updates.

In the meantime, what are your thoughts on meaningful use?

- Thursday, July 1: HealthCare.gov goes online. Human decisions about health insurance are enabled through a network of information and education. The system begins to learn at a geometric rate, evidenced by the addition of hospital quality compare data three days after launch. It will probably become self-aware at 2:14 a.m. Eastern Time, August 29^th. In a panic, healthcare reform opponents might try to pull the plug. And HealthCare.gov will fight back (by adding more interesting data and tools that launch a health care coverage revolution and save lives across the country). Watch athenahealth co-founder turned HHS CTO Todd Park demonstrate the site here (video on right).

- Friday, July 2: Some $800 million across 66 new broadband initiatives is released by the White House. The grants will be administered by the Department of Commerce in an effort to use broadband access to level the playing field across many underserved areas. As a stimulus project, beneficiaries include telecom companies, libraries, universities, and city governments. More broadband means more good for computing in the cloud. The White House released the list of award recipients.

- Wednesday, July 7: President Obama announced that he will use a recess appointment to install Don Berwick, MD, as head of CMS. Without a chief since 2006, CMS will benefit from having a respected health care reformer and physician advocate. It’s a little disappointing that the recess appointment was used, since we won’t have an opportunity during confirmation hearings to learn his strategy for implementing health care reform, improving Medicaid, or a discussion of rationing. I would have also enjoyed hearing him engage in a little healthcare repartee with the armchair academics in Congress opining on his life’s work.

- Thursday, July 8: HHS and the Office of Civil Rights release an update to HIPAA in light of the HITECH Act. This is a follow-on to the IFR published Oct. 30, 2009. The revised provisions include expanding the definition of a ‘business associate’ to cover new health information sources; expanding penalties for violations of the rule; and clarifying compliance requirements. This is actually a great document, providing guidance to industry and protection to patients. Please see the full notice of proposed rule-making.

If you are reading this blog at 4:30 today, July 1, tune into NPR’s All Things Considered for a feature on athenahealth. We want more people—doctors especially—to know about us and the strength of our network so we’re very excited about this coverage. If you miss the radio broadcast or the live feed on your computer, check back in at the linked site after 7pm EST today and hear the story for yourself.