Republicans angling for stricter rules on meaningful use of electronic medical records opened fire on the Dept. of Health and Human Services’ new regulations during congressional hearings July 20.
Despite industrial groups and experts praising the new regulations, including the American Medical Assn. saying the rules are impractically stiff, the GOP seized on the issue as another front in its fight against the Patient Protection and Affordable Care Act — even though the incentives were funded by the HITECH Act, part of the American Recovery and Reinvestment Act, not the healthcare reform legislation.
"Much less is expected of healthcare providers receiving subsidies than what the Centers for Medicare and Medicaid Services proposed initially," said Rep. Wally Herger (R-Calif.), the ranking Republican on the Ways and Means Health Subcommittee.
"[B]y watering down the final regulations, we have missed an opportunity to improve patient care and reduce waste,” Herger said.
Originally, the rules required doctors to e-prescribe 75 percent of pharmaceutical orders to meet meaningful use incentive requirements. The final rules now have a 40 percent threshold.
The new EHR criteria also include 15 "core" tasks and 10 “a la carte” menu items, from which a doctor needs to choose five. Initially, the HHS called for 25 requirements to be met by eligible professionals and 23 for hospitals.
Meanwhile, the American Medical Assn. sent a memo (PDF) to its board of trustees regarding the new health information rules. The organization still sees the meaningful use adoption requirements as too strict. In March, the organization suggested that congress reduce the number of requirements in meaningful use criteria from 25 to five.
AMA CEO Michael Maves wrote that while the administration made several changes favorable to the AMA, the association "believes that it will be challenging for many physicians to participate successfully in the program. This will be especially true for those physicians in solo or small group practices who have not previously utilized an EHR."
At the congressional hearing, HHS HIT coordinator David Blumenthal said, "The speed of ascent must be calibrated to reflect both the capacities of providers who face a multitude of real-world challenges and the maturity of the technology itself."
Dr. John Halamka, CIO for Boston’s Beth Israel Deaconess Medical Center and Harvard Medical School, echoed Blumenthal’s statement:
"Overall, a very good day for [the Office of the National Coordinator for Health Information Technology and] HHS and stakeholders. The final rule means Meaningful Use will be achievable by many. The Standards and the process to certify their use are sufficiently specific. I’m impressed.”
For his part, Herger questioned whether the federal government’s incentive of $44,000 for physicians was too high saying he expected a better return on the $36 billion investment in incentive payments to providers.
According to a January 2010 report in the New England Journal of Medicine, less than 10 percent of practices with one to three physicians, a group comprising 46 percent of all physicians in the U.S., have adopted EMRs. And physicians who work in practices of 10 or fewer doctors comprise 82 percent of the country’s physician population.
Practice Fusion, which offers a free, ad-supported EMR system to doctors in smaller practices, this week released an index of the amount of incentive money available to doctors through Medicare by state. With the $44,000 available for individual doctors, every state has millions, or billions, up for grabs pending demonstration of meaningful use.
“The EHR incentive plan was created, not to just dramatically improve the safety and quality of healthcare, but also to provide an economic stimulus to the country,” said Practice Fusion CEO Ryan Howard in prepared remarks. “By providing incentives to physicians, ARRA has already created a booming health IT sector with opportunities for health IT professionals, hardware manufacturers, technology companies, medical providers and local healthcare organizations."