Rather than requiring all eligible providers and hospitals fill out what is generally the same checklist for Meaningful Use, organizations which prove they are achieving outcomes far beyond the norm could qualify right off the bat, suggested National Coordinator for Healthcare IT David Blumenthal, M.D., at the October HIT Policy Committee meeting.
While the former category of providers might be thought of as “vanilla Meaningful Users,” he said, “another group might say, ‘If I’ve accomplished performance outcomes which are three standard deviations better than other institutions, related to 10 outcomes criteria using health information technology, maybe I should be exempt from the task of checking boxes, because I’m there; I’ve risen above the criteria you put in the regulation.”
Blumenthal went on to talk about how the Policy Committee might consider offering different “tracks” to Meaningful Use for different “classes” of providers.
But he quickly made clear the idea was just that at this point. “We haven’t run this by our council yet, so we don’t know if it’s consistent with the law, but you (the Policy Committee) are not bound by what our general council thinks.” As if to emphasize, he added, “I’m just posing this as something to think about. Offering more flexibility with greater monitoring might be a chore, but could also be, if constructed correctly, not more complicated.”
Neal Calman, M.D., president and CEO of The Institute for Family Health and a committee Member, however, said it certainly sounded like a chore. “I like the idea, but would we have to go through the same process for this that we are going through for the set of criteria we’re struggling with for Stage 2 Meaningful Use measures? Are we saying we have the capability to determine three alternative sets of criteria for 2013?”
Paul Egerman, a software entrepreneur and committee member, also raised concerns about establishing classes of institutions, cautioning that organizations with less money should not be placed at a disadvantage by any new programs. “It’s important that there is no economic aspect to these classes, that poorer institutions can participate in the same way.”
Blumenthal’s informal proposal could constitute a way to address concerns around the Meaningful Use program. “There is a general sense that if we were to keep adding on to the approach we took in Stage 1 — to keep adding functionalities, and requirements around functionalities — it would lead to a proliferation of specific metrics that would be in danger of collapsing of its own weight. We would then lose credibility in the community because it would look like we are micromanaging.”
As the committee looks more at quality measures, Blumenthal noted other areas of Health and Human Services were also examining that issue, and those areas would likely take the lead. “I think that as we focus on outcomes, we have to step back and say we are committed in principle to outcomes, but can’t specify unilaterally which we will evaluate — that will depend on work done elsewhere.”