AAFP Works to Identify, Correct Barriers
July 03, 2013 12:45 pm Sheri
Porter – As U.S. physicians continue to embrace electronic health
records (EHRs), data on CMS' EHR incentive program holds both positive and
troubling news regarding family physicians' participation and success in
achieving meaningful use of their EHRs.
According to CMS' recently published EHR meaningful use attestation data(healthdata.gov), 23,636
family physicians became first-time meaningful users in 2012. The number
represents a 180 percent increase compared to 2011 EHR statistics.
In an interview with AAFP News Now, Jason
Mitchell, M.D., director of the AAFP's Center for Health IT, said the latest
report confirms family medicine "still has the greatest participation both
by percentage and by the numbers."
However, the report also revealed a drop in the retention
rate of attesting physicians. In fact, of the 11,578 family physicians who
attested to meaningful use in 2011, only 9,188 did so in 2012, a 21 percent
drop in participation.
Mitchell and Steven Waldren, M.D., the center's senior
strategist for health care IT, crunched the raw numbers -- buried deep in the
April attestation data -- and determined that the overall meaningful use dropout
rate among all physician specialties was 20 percent.
STORY HIGHLIGHTS
- Recent
EHR meaningful use attestation data published by CMS show family
physicians participate in the program at higher rates than physicians in
other specialties.
- Among
all specialties, about 20 percent of first-time meaningful use attesters
in 2011 did not attest to meaningful use in 2012.
- Reasons
for the tumble in numbers could include a change in the reporting period
from 30 days to one year and misunderstanding about -- or lack of
attention to -- the two-month attestation period in early 2013.
Why the Tumbling Numbers?
The new data raise a key question: Why were a good number of
physicians unable to maintain meaningful user status, especially since no
changes were made in the meaningful use stage one requirements from 2011 to
2012?
Although there's no way to know for sure, Mitchell and
Waldren cited some possible reasons for the decline.
Looming large on their list is the length of the reporting
period. In 2011, physicians only had to report on measures for 90 consecutive
days and could start, stop and shift dates to make that happen. However, during
year two, the reporting period stretched to a full year. The extra reporting
burden may have discouraged physicians. Others simply may have lost track of
their progress during the year.
"For some physicians, the issue likely was a lack of
ongoing monitoring of their meaningful use numbers throughout that entire
year," said Mitchell.
And unfortunately, some physicians simply missed the
two-month attestation window for 2012 reporting that ran from Jan. 1 to Feb.
28, 2013. "A physician could have been a meaningful user the whole year
and then missed the attestation deadline," said Mitchell.
"Don't be that guy in the next round," said
Waldren. "It's very important to check the timeline for 2013(www.cms.gov) and
understand the deadlines for meaningful use."
In addition, 2012 saw a decrease in function of the
federally funded regional extension center (REC) programs. According to
Mitchell, the state-based organizations were designed to sign physicians on
with a REC, assist physicians with EHR implementation, and then help them
become meaningful users and successfully attest to MU.
The first year, the RECs were offered incentives to get
physicians on board, but there was no built-in incentive for RECs to maintain
physicians through the second year, and many of the RECs already were running
out of funding to sustain their work, said Mitchell.
TELL THE AAFP YOUR MEANINGFUL USE STORIES
The AAFP wants to hear from family physicians who are among
the 21 percent of FPs who failed to qualify for a meaningful use bonus in 2012
even though they successfully attested in 2011.
If that sounds like you, send a quick e-mail to Jason Mitchell, M.D., or Steven Waldren, M.D., with details of your
particular situation. Identifying meaningful use barriers will help the AAFP in
its work with CMS and other stakeholders to resolve those issues in the future.
AAFP Working to Resolve Issues
To help ensure family physicians' future success with the
meaningful use program, the AAFP already is working with CMS and the Office of
the National Coordinator for Health IT to investigate, find answers and fix
problems.
"Is there one particular measure that is tripping up
physicians? If so, let's look at changing that," said Waldren. "Is
the 12-month reporting period an obstacle? Do physicians need software that
provides a 'dashboard' to enable them to track their progress?
"Let's work on identifying the problems and see what
corrections can be made, because we want to be sure that 20 percent of our 2012
meaningful users don't drop off in 2013," said Waldren.
Mitchell and Waldren said physicians could ease the
meaningful use burden by taking a few steps. For example, they encouraged
members to
- plan
ahead by checking requirements and deadlines and then stay on top of those
obligations,
- crank
out electronic meaningful use reports on a continuous basis to show
progress toward meeting standards, and
- ensure
that an EHR's internal tracking mechanism for certain measures, such as
the drug formulary and interaction features, are turned on for the entire
reporting period.
"Such features could inadvertently be turned off by the
vendor during a routine system update," said Waldren.
Mitchell expressed concern about physicians' desire to stay
in the game when meaningful
use two rules are applied in 2014. "The rules do change significantly,
and technology has to be more sophisticated," said Mitchell.
And although the reporting period window collapses back down
to three months for the first year of meaningful use two, the reporting must be
done quarterly, so there can be no "shifting and shuffling" of dates
to attain a consecutive 90-day reporting period. In 2015, meaningful use stage
two will once again shift users to that full year of reporting, said Mitchell.
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