What did you want to be when you were growing up? I wonder how many of today’s physicians, knowing what they know now, wish they could turn back time and change that childhood ambition. That calling. That innate drive to help people. Because after devoting countless grueling hours to schooling, internships, and residencies… after earning a reputation based on providing personalized care, one patient at a time… after building a business based on an immeasurable combination of talent and knowledge, suddenly the field of medicine is being commoditized. No wonder physician burnout is on the rise—up 16% in two years, according to this Medscape Physician Lifestyle Report.
The government is telling doctors that an EHR can absorb mass data and spit out the right answer better than they can. Doctors are paying more to run their practices, earning less, and are still expected to provide quality care for record numbers of patients. And those patients have no idea what is going on behind the scenes, so their satisfaction levels are at risk. As physicians aim to fulfill their Hippocratic Oath in this world where they also are required to mitigate their own legal risks, direct their attention away from humans and toward technologies, and follow data directives based on masses instead of their own professional insights, the people on both sides of the examination table are feeling it.
In a recent survey, PhysiciansPractice.com published a list of things physicians wish patients knew. Here are some of the findings:
• “I wish they knew why physicians usually run late.”
• “I wish they knew that I do care about the pain they are having… even if I seem busy or preoccupied.”
• “I wish they knew how often we have to fight with their insurance companies just to get paid for services we’ve rendered.”
When it comes to practicing medicine, there are no limits to the differences that can exist between cases—and allowing physicians to discern those nuances is critical to providing the best patient care. Rather than getting caught up in the negativity surrounding these ongoing changes, I’d like to ask these professionals for whom I have tremendous admiration to weigh in.
Doctors: What changes would make practicing medicine more in line with the reasons you chose to become a physician?
In the inimitable style of government-speak, CMS recently announced its “intention to consider proposals” to shorten the 2015 meaningful use reporting period from a full calendar year to 90 days. While I would advise providers to be cautious about changing their plans until the relevant rule is published (anticipated in the spring), I think it is fair to assume that CMS would not have issued even such a noncommittal-sounding announcement if it were not planning to actually implement this change.
CMS has finally yielded to the relentless lobbying by the AMA and an alphabet soup of other professional societies and HIT organizations, all of which remain concerned about provider readiness and the challenges presented by an insufficient infrastructure to support Stage 2 requirements. Objections to full-year reporting for 2015 date back to last spring, when comments were submitted in response to the (then-proposed) 2014 Flexibility Rule. At that point, CMS adamantly rejected the overwhelming number of comments that recommended—or pleaded for—quarterly 2015 reporting. Currently, however, in addition to this external pressure, the dismal number of Stage 2 attestations to date has got to have CMS worried about the future of its MU program.
The devil, as always, will be in the details:
- When will the rule be available, and will its timing be early enough to avoid creating the aura of uncertainty that characterized last year’s mid-year revisions? (We are already one month into the 2015 physicians’ reporting period, four months into the hospitals’.)
- Would quarterly reporting be available to all providers, even those still at Stage 1?
- What happens to “harmonization’ with PQRS, which remains a full-year program? (This has been one of the reasons CMS has stated for its resistance to quarterly reporting.)
Even more intriguing to me than the change in reporting period is the second of the three proposals enumerated as being under consideration—that is, the intention to “modify other aspects of the program to match long-term goals, reduce complexity, and lessen providers’ reporting burdens.” Is it possible that CMS is taking the advice of the AMA and other organizations to increase flexibility, reduce the number of measures, add more choice, and maybe even eliminate the all-or-nothing nature of MU? Wouldn’t that be something!
Let us know what you think by submitting a comment below.
OK, I’ve taken some liberties with one of John Lennon’s most famous lyrics, but it’s the first blog post of the year, so I thought I’d need a little extra attention-getting power to break through the post-holiday fog. Chances are, only a few days ago you were pondering how you would implement change in your life in 2015. You may even have proclaimed those resolutions loudly and proudly as the ball dropped in Times Square. Seven days in, how well are your new year’s resolutions doing at becoming reality? I’ve kept mine so far . . .
All kidding aside, we’re doing more than just hoping that the changes we want to effect at SRS will happen this year—we know they will happen, because we have a system in place to ensure that we keep our promises to ourselves and to others. It’s not complicated, and it’s something anyone can use at home or at work to help ensure that their “Say/Do Ratio” remains high. Simply, there are four key elements: communication, transparency, collaboration, and accountability.
Lose weight. Work out more. Eat better. Since health is always one of the top New Year’s resolutions, let’s start with that example. Experts say it takes 21 days to turn something into a habit, but why do some resolutions become habits while others become failed attempts? Because commitment must be systematized for maximum success. So if my resolution was to get to the gym three times each week, the first thing I’d do is communicate that goal . . . to everyone, not just to whomever happened to be around on New Year’s Eve. It’s easy to tell yourself something and then forget about it. By telling my whole support network—my family, my friends, my team at the office—my motivation to do what I said I’d do is increased immeasurably. In terms of transparency, I’d start posting somewhere (perhaps on Facebook) each time I worked out as a proof point. I’d collaborate with others by starting or joining a workout group, maybe even implementing some sort of competition within the group. Finally, I’d enable true accountability, empowering my supporters to check in on my progress.
At SRS, healthcare is our core focus—and so our corporate fitness is critical to helping our clients strengthen their productivity while remaining focused on the wellbeing of their patients. At our User Summit in October, we discovered what was most important to our customers and then we created a system of actionable initiatives to ensure that our promises become the change we all want to see. And we are doing it by following this same four-step system.
No matter what your resolution is, big or small, by supporting it systematically with these four key elements, you’ll do more than wish for something to be different . . . you’ll turn a resolution into a revolution.
Never before have healthcare professionals operated in a time of such rapid technological change—and faced the great uncertainty of today’s complex industry regulations. Unfortunately, it’s not a trend we see ending anytime soon. It’s getting harder and harder to even understand what the government is asking us to do, let alone satisfy those requirements. Does data collection have to mean data distraction—taking the focus off of what matters most to each physician: the patient?
At our annual User Summit last month, big data was the big topic of discussion. While our users recognize there can be very real benefits to elements of meaningful use, there is a lot of friction surrounding its integration into medical practices. It often feels like the data we are being asked to capture—the data that is supposed to make everything more productive—interferes with what we are trying to accomplish. Physicians can find themselves required to ask questions that make no sense, that take up valuable office visit time, and that possibly cast a little doubt in the patient’s eye. Where is the ROI on that?
Medical professionals need more, because that’s what MU is asking of them. HCIT companies have to provide more than technology—they have to provide expert guidance to help navigate the MU waters. Together, technology and expertise can help physicians satisfy government regulations while also achieving their industry and business goals. From strategic planning through product execution, we must provide more predictable solutions. This goes beyond “certified solutions”—this is about creating working solutions that allow medical professionals to be compliant without interfering with their practice goals.
It all comes down to ECR: Efficiency . . . Care . . . and Revenue. The right HCIT solutions will:
- create efficiencies, allowing doctors to spend more time with more patients;
- improve care, providing flexible solutions that don’t interfere with the doctor–patient relationship; and
- increase revenue, helping doctors earn more by reducing malpractice risk and insurance, creating additional revenue streams, and more.
We heard it loud and clear at our User Summit: increased data requirements cannot be accomplished at the expense of patient care. EHR solutions aren’t real solutions if they slow you down—they have to capture data with minimum interference while ensuring maximum productivity.
At SRS we’re working even harder to help our clients navigate government and industry demands and translate them into meaningful products that will satisfy more than MU: they’ll satisfy your patients. And they’ll satisfy you.
As predicted, the rule modifying meaningful use in 2014—now referred to as “The Flexibility Rule”—was finalized basically as proposed. Pleas for future flexibility, however, were rejected. (For a review of the details, read EMR Straight Talk’s Kudos to CMS for MU 2014 Proposed Rule).The good news is that for 2014, many providers can report Stage 1 again instead of Stage 2, and some providers can report using 2011-certified EHR technology instead of 2014 CEHRT.
Providers who exercise any of the flexible options will have to attest to the following statement: “EP was unable to fully implement 2014 Edition CEHRT for a full EHR reporting period in 2014 due to delays in 2014 CEHRT availability,” and they should be prepared to support their decision if they are audited pre- or post-attestation. Potential justifications include—for example—certification delays or implementation backlogs, software problems once the EHR was implemented or upgraded, delayed installation of required integrations/interfaces, insufficient time to make necessary workflow revisions, etc. Provider inaction or delay, financial constraints, inadequate staffing, and the contention that Stage 2 is just too darn hard—while certainly understandable—are not considered legitimate justifications under the rule.
Many of the comments submitted on the Proposed Rule had asked (“pleaded” would be a more accurate word) for flexibility beyond that which was offered. The biggest “ask” in this regard was for quarterly reporting again in 2015, as it is in 2014, rather than full calendar year reporting. CMS rejected that request outright. Undeterred by that response, numerous healthcare professional organizations subsequently submitted their recommendations on the future of meaningful use directly to the Secretary of HHS and the head of ONC—the two organizations responsible for the program. In addition, “The Flex-IT Act” (recently introduced by representatives Renee Ellmers and James Matheson) attempts to mandate a return to 3-month reporting.
While it may be tempting to dream that the bill will become law or that CMS will relent, the only safe assumption at this time is that the 2015 meaningful use reporting period will begin on January 1. Therefore, any physicians who want to pursue meaningful use incentives in 2015 will need to have a 2014-certified EHR in place by January 1 (if they are not already using one), and physicians who will be at Stage 2 next year should devote the next 2 months to preparing to support the increased requirements—installing required interfaces and integrations, implementing Direct, and developing new workflows as needed.