Meaningful use Q&A with AAFP’s Steven Waldren, MD


Steven Waldren, MD, director of the Center for Health IT at the American Academy of Family Physicians, recently spoke with PhysBizTech’s sister publication Government Health IT regarding the meaningful use stage 2 proposed rule and its relevance to physicians and their practices.

For physicians, the stage 2 proposed rule offers some changes that make it easier for healthcare providers to demonstrate the requirements, including aligning measures with other quality reporting programs.

Physicians also have more confidence in the program because they know some colleagues who have received their incentive payments, according to Waldren. The full text of the interview follows.

Q. Did you find anything unexpected in the meaningful use stage 2 proposed rule?

Waldren: In the stage 2 piece of meaningful use, I don’t think there are any big surprises in what is being requested. Probably the only surprise was the modification to stage 1 as it moves forward in the 2014 timeframe. I think they were trying to make it a little bit easier based on data they are starting to collect from stage 1 meaningful users.
For example, in stage 2 they’ve tried to decrease the administrative burden by making the denominators common across functional measures. Using those denominators is optional for those who do stage 1 moving forward.

Q. What are requirements that as a physician group you are pleased to see as part of stage 2?

Waldren: First, the consolidation of measures…the notion of not having to report separately on updated problem, medication and allergy lists because those are required for a summary of care exchange. We like that administrative simplification.

Second, the focus on interoperability and exchange we think is important. As we talk with our members, the two things they struggle with are interoperability and being able to do population management. Those are still fairly immature in the technology that’s out there today.

One of the limitations for meaningful use is that there is not a lever for those organizations that are not participating to accept the data or submit data to them. Lab companies are still outside the scope of meaningful use, and although structured lab data is a requirement for participating physicians, the labs are not really required to provide that in a structured format. That still is a challenge. For hospitals, those that provide ambulatory services, either radiology or lab, so far there is not a requirement to accept those orders electronically from their ambulatory spaces. We’d like to see additional work on those areas.

Third, we like the quality measure harmonization between meaningful use and the Physician Quality Reporting System [PQRS] and other federal quality reporting programs. That’s a big issue for the industry moving forward.

Q. Will more physicians adopt EHRs now that they know where the process is heading and with the meaningful use program in play for a couple of years now?

Waldren: I think we will see growth in the number of ambulatory users as we move forward in 2012 and 2013. In the first year in 2011, there were a lot of challenges around timing and uncertainty with stage 2, certification, and what it means related to accountable care organizations [ACOs] and other things happening.

I think we will see an uptick because of the number of doctors who have received their payment. In the early stages, that was one of the issues. The physicians have to make the capital investment, time and all the deployment, and then after that you can get paid over five years. They saw in the PQRS process that some didn’t get their checks like they were supposed to. Now, they can say I have a friend who did receive a check.

Physicians face other larger barriers around finding the capital, the right product, determining when I should do meaningful use and what does it mean, or should I do medical home or ACO, shall I wait and see if a hospital is going to buy my practice. There has been a lot of uncertainty for doctors to manage.

Q. Have you seen a reduction in that uncertainty?

Waldren: I think some of that is subsiding. The regional health IT extension centers have been able to get their feet on the ground, and ONC has national resources better aligned. We have a cohort that’s made it through to payment. You can leverage that experience for the next group. There is still uncertainty around the Affordable Care Act and the notion of ACOs and what plans are going to do.

But around meaningful use, what are the tools, what’s the process and will I get paid and how will I get paid, we’ve definitely seen a significant decrease in the confusion and uncertainty.