"For 2011, provide aggregate numerator and denominator through attestation as discussed in section II(A)(3) of the final rule For 2012, electronically submit the measures as discussed in section II(A)(3) of the final rule"

In a classic Ten Commandments moment, the Department of Health and Human Services released its final version of the rules regarding the “Meaningful Use” of healthcare information technology (HIT).  Meaningful use entered our vocabulary in early 2009 as part of a $20+ billion gift from doctors, hospitals and the taxpayers to the needy folks at Cerner, GE, Siemens, Allscripts, Epic and other purveyors of complex, expensive and difficult-to-use and potentially even dangerous medical software products.  Dr. Scot Silverstein has written some excellent posts here, here and here about the problems increasingly caused by the HHS/HIT-Industrial Complex, and anyone interested in the greater good of economic efficiency and patient care should spend some time reviewing his articles and websites.

As our non-medical readers may or may not know, in 2009 President Obama and the Democratic Party majority in Congress passed “economic stimulus” legislation that called for doctors and hospitals to suddenly rapidly massive numbers of complex and expensive electronic medical records and computerized ordering systems.  The law created a “play-or-be-punished” program.  Doctors and hospitals who handed their own money over to Cerner, GE, Allscripts, Epic and a few other large vendors early on (i.e., before 2014), would be eligible to receive federal rebates.  (These rebates consist of money that our Federal government has presumably borrowed from China for this purpose.)  On the other hand, if these same providers persisted in not handing their money over to the HIT industry after 2015, Medicare would cut their payments for delivering actual patient care by 1% each year (1% in the first year, 2% in the second year, and so on), until they did.

This may not seem like much as financial penalties go, but that’s how it’s supposed to look to the average person.  As explained here in a previous post, these sorts of reductions in gross income turn out to be twice as big in terms of their reduction in net provider income.  In other words, a 5% reduction in gross Medicare payments actually traslates into a 10% reduction in take-home pay.

Yes, your doctor could be providing top quality care, making diagnoses everyone else has missed, be saving millions in healthcare costs and finding the cure for cancer.  But if she is not using a governement-sactioned piece of software in a certain sort of way, then *thwack!*, off with her mortgage payments!

This is basically the idea behind “meaningful use”.  If your doctor shows that she bought the software and is using it in a way that is meaningful to Congress, HHS and Medicare, then they will let her keep her house.  Those requirements were what was published today.

Of course, there is absolutely no requirement whatsoever that this hardware and software actually benefit patients or providers.  This is how you can tell that it is an initiative that revolves around the needs of the government rather than the medical needs of real people.  This makes it a Hellthcare program rather than a healthcare program.  As a rational justification for transferring of untold billions of healthcare dollars to HIT vendors and the bureaucrats who will administer the program, it is something of a ruse.

Since they were just released today, no one has actually had time to read these requirements.  But it is possible to make some immediate observations about them:

• The rules are 864 pages long.  This alone says pretty much all one needs to know about the program.  Meeting these requirements is going to be complex, painful and expensive for everyone involved in the healthcare system. But that’s not all.  What HHS released today only describes:
  

  “the initial criteria EPs, eligible hospitals, and CAHs must meet in order to qualify for an incentive payment; calculation of the incentive payment amounts; payment adjustments under Medicare for covered professional services and inpatient hospital services provided by EPs, eligible hospitals and CAHs failing to demonstrate meaningful use of certified EHR technology; and other program participation requirements. Also, the Office of the National Coordinator for Health Information Technology (ONC) will be issuing a closely related final rule that specifies the Secretary’s adoption of an initial set of standards, implementation, specifications, and certification criteria for electronic health records. ONC has also issued a separate final rule on the establishment of certification programs for health information technology.”

  In other words, this 864 pages is just the tip of the iceberg.  The rules for Stage 2 and Stage 3 of this program haven’t even been written yet.  (An EP is an “eligible provider”, by the way.)

• The list of acronyms alone in this document is three full pages.  If you were wondering why your doctor didn’t have time to review your test results today, trying to memorize these is probably one of the reasons.

• The HHS estimates that the time required for each physician to meet the Stage 1 eligibility requirements will be a mere 9 hours and 2 minutes.  It’s nice to know that it can happen so quickly.  Of course, that doesn’t take into account any of the weeks, months and (literally) years that the average provider has to spend learning, unlearning and wasting time on less efficient workflow after the typical EMR system is deployed.  Not to mention the cost of the scribes that many are having to hire to keep these things from overwhelming their ability to care for patients entirely.

The bottom line is that this new ruling is just the tip of a federally mandated HIT iceberg that will end up costing providers, patients, businesses and taxpayers hundreds of billions of dollars in new healthcare administrative overhead costs.  These costs, along with the cost of ongoing hardware and software maintenance and the loss of clinical efficiency that most providers incur when using these buggy, complex and poorly designed systems, will dwarf the initial $20 billion subsidy that is being handed to the IT vendors between now and 2015.

There is nothing “final” about these long awaited rules on “meaningful use”.  There are going to be thousands of new commandments to come.

Someone “in charge” might want to ask how these sorts of massive investments in HIT have worked out for the British NHS, or for the military’s AHLTA system.  (Spoiler alert: not too well.  Over the weekend I had my ear chewed off for over an hour by one of the Navy’s exasperated AHLTA-using doctors.  He’s a dermatologist.  It seems that there’s not really any practical way to “draw a picture showing where the skin lesions are using the damned thing…”  This is one of those things that comes in very handy when you’re seeng a patient with skin problems.  If only the government would sanction a technology like, er, pen and paper, or even clay tablets, that would allow us to do this!)

Someday our children will ask,

“Daddy, did doctors ever really spend their time actually looking at, listening to and taking care of patients instead of just doing stuff with the computer?”

And we’ll look at them wistfully, smile and say,

“Yes dear.  But that was a long, long time ago.  Before pay-for-performance.  Before the Independent Payment Review Board.  And before Meaningful Use.”