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Your EHR Should Not Be a Federally-subsidized “Hardship”

by Dan Haley, SVP and General Counsel

At HIMSS 2014, the health information technology’s (HIT) largest annual confab, the bestest-best news we heard from a policy perspective, and maybe even an industry perspective, was the Centers for Medicare & Medicaid Services’ (CMS) dual announcement that there will be no further delays for either Meaningful Use Stage 2 or ICD-10. Perhaps we should have immediately directed our gaze skyward in search of the second shoe preparing to drop.

As it turns out, CMS de facto back-doored a Meaningful Use Stage 2 delay by issuing broad “hardship” exemptions from scheduled Stage 2 penalties. To wit: any provider whose EHR vendor is unprepared to meet Stage 2 deadlines, established lo these many months ago, eligible for a “hardship” exemption.

Of course athenahealth clients will never need to apply for a “hardship” exemption. On our single-instance, multi-tenant cloud platform, every one of our clinical providers started using the 2014 Certified version of our EHR immediately after we certified—back in June 2013. There were no upgrades they needed to make or additional software they needed to purchase.

In fact, we turned on a Stage 2 prep program for our providers this past fall, and made sure our Meaningful Use Resource Center was updated with the latest and greatest info on Stage 2 in advance. Our cloud platform and commitment to preparation meant our providers were able to start meeting Stage 2 metrics on January 1st, 2014.

Unfortunately, athenahealth is very much an exception to the unprepared rule in the overall health IT vendor community. Worse, current policy unintentionally rewards technological laggards by continuing to subsidize technology platforms that are falling short of the standards of the very program under which they are subsidized—and now the government is defining use of those federally-subsidized platforms as a “hardship!” Oy. No wonder the Government Accountability Office (GAO) recently issued a report eviscerating the Meaningful Use program.

Few would disagree with the notion that it is unproductive to criticize policy without offering constructive ideas to fix the underlying problems. Here, happily, the underlying problem is easy to define: it is, in point of irrefutable fact, fundamentally unfair to penalize care providers for their vendors’ failings—especially when the very government proposing to penalize them put the seal of approval on the vendors’ foreheads to begin with when they certified their EHR for Meaningful Use in 2009. CMS’s move to exempt providers from those penalties is correctly motivated, but it seeks to ease the provider pain without addressing its cause.

Instead of issuing a blanket exemption for use of unprepared vendors, CMS should:

  1. Waive penalties only for those providers who take steps to replace their inferior technologies with systems that can meet the demands of the 21st century’s information economy;
  2. Publish lists of health IT vendors whose systems are the basis for a hardship exemption, along with an accounting of how much government money has been paid to subsidize those vendors’ products; and
  3. Immediately initiate a reevaluation of the MU certification of any vendor whose products form the basis for a hardship exemption.

This proposal might seem bold. But, if we’re truly looking to advance health care through the application and use of EHR, then the above simply represents necessary and sound public policy. Current practice rewards vendors whose products fall short by perpetuating subsidies for those products.

The federal government should stop paying doctors to implement health IT that cannot meet the standards of the program under which the payments are issued. That’s just a no-brainer.

An EHR should not be a federally-subsidized “hardship.”

The proposal above would both correct for the unintended consequences of current policy and advance one of the few truly bipartisan goals of health reform: modernization of our care delivery system and the information technologies that enable it.

A version of his post originally appeared on The Health Care Blog.

Check out Dan Haley's Google+ Profile. Follow @DanHaley5 on Twitter.

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