The successful adoption and implementation of electronic health records (EHRs) has, since 2011, been measured by the attainment of “meaningful use (MU),” a series of staged requirements established by the Centers for Medicare and Medicaid Services (CMS). During the first 4 years of the program, more than 350,000 eligible providers registered, and more than $7 billion in bonus payments has been paid out. Beginning in 2016, penalties will be assessed.

According to the results of a recent survey of orthopaedic practices by the American Association of Orthopaedic Executives (AAOE), however, neither the incentive payments nor the penalties may be sufficient to prompt some practices to begin or continue participation in the program.

For example, of 225 practices responding to the survey, just 22 reported Stage 2 participation in 2014. Nearly a quarter (56 practices) did not participate in the MU program at all in 2014. “The current requirements are causing many orthopaedic practices to step back and think about continuing to participate,” wrote Jason M. McCormick, in a white paper summarizing the survey results. Mr. McCormick is the process improvement manager for the Campbell Clinic, Nashville, Tenn.

Meaningful costs
According to survey respondents, the “per physician cost” of participating in MU frequently exceeded the maximum per physician bonus payment ($43,720). Practices reported average costs per year per physician of between $25,000 and $35,000. According to one respondent, “Not sure about total cost, but it’s more than the incentive and more than the 2 percent penalty.”

Software costs for certified EHR technology were the most expensive line item reported. “Members report expenses of up to $150,000 per provider per year to have access to the functionality that is required to successfully meet many of the measure thresholds,” wrote Mr. McCormick.

Additionally nearly a quarter of the practices responding noted that their current EHR software will have to be upgraded to enable continued participation in the MU program.

Not meaningful measures
Nearly half of respondents (102) do not plan to participate in future stages of MU, primarily because participation costs outweigh incentive payments. Respondents also expressed skepticism about the impact of MU on patient care.

“This causes extreme administrative burdens to meet requirements that have no bearing on the practice or patients,” wrote one respondent. “The amount of time necessary to meet the requirements take away valuable personal contact with the patient and have little-to-no impact upon our care … There has been no evidence that MU improves or enhances patient care, but there is significant evidence that it does cost medical practices money and allows CMS a way to recoup reimbursements should a practice not participate.”

Additional Information:

• AAOE
• Participation in MU did result in some practice improvements, according to the survey participants. Several reported a reduction in overall spending on transcription costs, as well as front-office efficiencies and more streamlined processes for patient care workflow due to the elimination of paper records. However, other practices noted that MU had reduced efficiencies for both staff and physicians.