AMA calls for reduced requirements, penalties for MU program

The American Medical Association (AMA) has a long list of ideas to make the Meaningful Use (MU) program better for physicians and shared its recommendations in a letter to the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC).

EHRs and other health IT have "the potential to help improve patient quality of care and drive practice efficiencies," wrote AMA Executive Vice President and CEO James Madara, MD, in a letter sent to both CMS Administrator Marilyn B. Tavenner and National Coordinator for Health IT Karen B. DeSalvo, MD, MPH, MSc. "Unfortunately, the existing MU program and many of the EHRs certified for use in meeting the program’s requirements stand in the way of these goals."

Overly rigid requirements and financial penalties will only dissuade providers who are otherwise open to IT adoption, according to the association. Without significant changes, Madara said that physicians will drop out of the program; patients will suffer because existing EHRs fail to migrate data for coordinated care; thousands of physicians will incur financial penalties that will prevent future IT purchases; and new delivery models will be jeopardized because they rely on data-driven approaches.

To prevent these outcomes, AMA is asking CMS and ONC to make the following changes for Stages 1 and 2:

1. Replace MU’s all-or-nothing approach with a 75 percent pass rate.
2. Protect physicians who meet at least half of the MU requirements from financial penalty.

For Stage 3, AMA said a 75 percent pass rate should be acceptable, since "adding flexibility, both to the threshold required to earn the MU incentives and to avoid the penalties, is the single most pressing change needed to ensure physicians can successfully participate in the MU program," Madara wrote.

"Expecting every physician to meet the same set of requirements despite varying specialties and patient populations is an ill-defined approach that is not working," the letter read. "The existing requirements are too primary care-centric, yet even some primary care physicians are still struggling with the program.”

Madara pointed out that CMS’ own data shows a 20 percent drop-out rate in the MU program, and that doesn’t include all of 2013. "We expect this to grow substantially unless the all-or-nothing approach is removed."

AMA made the following recommendations for Stage 3:

• Eliminate the division between "menu" and "core" requirements;
• Streamline and refocus the number of requirements;
• Remove any mandates that are outside the control of physicians;
• Better align quality reporting programs;
• Make MU mandates evidence-based;
• Tie those mandates to "tested and high-performing standards" and implementation guides;
• Consider the costs of implementation, which can "run into tens of thousands of dollars."

AMA is "deeply concerned with the volume and prescriptiveness of these requirements and believe they are hindering many vendors from being able to deliver high-performing systems," according to Madara’s letter. "EHRs and other health technologies can promote a future healthcare system that ensures data migration, interoperability and a more coordinated care system."