The Final Rule on Meaningful Use has erased any lingering doubts about the government’s lack of interest in the participation of specialists. As HIT Policy Committee member Gayle Harrell pointed out during the July 21 committee meeting, CMS has made it more—rather than less—difficult for many specialists to comply with meaningful use. Gayle is the committee member who first identified—last spring as the rules were being created—the lack of attention to the needs of specialists, and she was a primary force behind the convening of specialist panels last October to address the issue.

When I look at some of the core [meaningful use] measures, they don’t fit into what a lot of specialists do…. I don’t know a lot of surgeons who take body mass [indices], or ophthalmologists who take blood pressure or weight. These kinds of things are really requiring an additional burden on a lot of specialists.

She was clearly disappointed with the final rule, as are the specialists, who understand that meaningful use has clearly not been defined with them in mind.

In addition to the meaningful use measures, the core clinical quality measures in the final rule are all primary-care related—the basic three are blood pressure measurement, tobacco use/tobacco cessation intervention, and adult weight screening and follow-up. The alternative core measures, which can be selected from in case not all of the first set apply, are also all primary-care related—weight assessment and counseling for children and adolescents, influenza immunization for patients over 50, and childhood immunization status. In addition, the Final Rule replaced the Proposed Rule’s specialty-specific measures with a set of 38 other measures, from which physicians are expected to report on three. Many specialists will be hard-pressed to find any measures in this set, as well, that fall within the scope of their practices.

So what will specialists do? They will recognize that the government’s current definition of meaningful use is not meaningful for them; they will not sacrifice their time and productivity attempting to meet irrelevant requirements; and they certainly will not add non-billable, primary-care functions to their patient exams for the sake of compliance. Knowing that participation is voluntary, and already skeptical about the likelihood of actually receiving any incentives—based on past PQRI experience and given the lack of recourse available to them in the meaningful use rule—the vast majority of specialists will elect not to participate.

What they should do is to revive the interest they were beginning to show in electronic medical records a year-and-a-half ago, before the government got involved, and select a system that will best address the specific needs of their own practices as they themselves identify them, rather than as other stakeholders define them.