“We need to ensure that meaningful use Stage 2 criteria are truly meaningful, not just boxes to check that satisfy a requirement. The measures should ensure physicians are using their EHRs in ways that truly benefit patients and medical practices.”
showing how such actions improve pa- tient outcomes.” In response to TMA’s concerns about the measure, CMS said that the 5-per- cent threshold shouldn’t be difficult to achieve and that physicians have influ- ence over patient behavior. Dr. Schneider worries CMS’s intent with the measure represents a “slippery slope.”
“CMS thinks it listened because the agency reduced the requirement from 10 percent to 5 percent,” he said. “What CMS really didn’t hear in TMA’s objec- tion was that physicians don’t have con- trol over what patients do and don’t do. What will they require next? Will CMS require 20 percent of a physician’s pa- tients to lose weight in order for that physician to earn Stage 3 incentives?” In adopting the new rules, CMS
raised the bar on the measures physi- cians have to achieve to earn incentives in Stage 2, Dr. Schneider says. For ex- ample, Stage 1 required physicians to give patients their clinical summaries in three days. In Stage 2, physicians have only one day to do so.
“CMS is doing what it said it would
do. Now we need to determine whether CMS has raised the bar to a level that’s attainable for most physicians and ven- dors,” he said.
“The goal of this objective is social en- gineering — that is, achieving this ob- jective requires doctors to make patients do something,” Joseph Schneider, MD, chair of the Texas Medical Association Ad Hoc Committee on Health Informa- tion Technology, wrote CMS in a 14-page TMA letter objecting to the requirement, originally proposed to cover 10 percent
of a physician’s patients. “There is no ob- jective evidence to show that improved outcomes will be the result of physicians’ actions to change patients’ behavior in the proposed manner. Without such evi- dence, it is not reasonable for CMS to base financial incentives or penalties on a physician’s ability to socially engineer this particular patient behavior,” wrote Dr. Schneider, a Dallas pediatrician and chief medical information officer for the Baylor Health Care System. The measure is a sore spot among physicians.
Joseph Schneider, MD
Matt Murray, MD 34 TEXAS MEDICINE December 2012
Matt Murray, MD, a Fort Worth pe- diatrician and vice chair of TMA’s HIT committee, opposes “physicians being measured, incentivized, or penalized based on patient actions that are beyond reasonable control of the physician, es- pecially if there is no objective evidence
Physicians who started the EHR in- centive program in 2011 or 2012 must comply with Stage 2 criteria begin- ning in 2014. (See “Avoid 2014 Doom,” pages 36–37.) To qualify for the mean- ingful use incentives in Stage 2, physi- cians have to meet 17 core objectives and three menu objectives from a list of six. To access the Stage 2 meaningful use final rule, a table comparing Stage 1 and Stage 2 objectives, a complete list of the Stage 2 core and menu measures for physicians, and a Stage 2 timeline, visit
www.texmed.org/MUseStage2.aspx. Physicians do have a chance to
prompt CMS to adjust the rules. After CMS adopted the Stage 1 meaningful use final rules, the agency published hundreds of reinterpretations of the rules, and Dr. Schneider says it’s likely the same will occur with the Stage 2 rules.
“The biggest thing TMA and its phy-
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