It’s Time To Narrow Down Stage 2

Anthony Guerra, founder/editor,

One of my biggest frustrations in past jobs was the way meetings were handled. Being very much the kind of person who needs concrete results to feel like the time invested has been well spent, I bristled at meetings whose only deliverable seemed to be the scheduling of another meeting to “revisit the topic.”

Now, to be sure, not every issue can be solved in one meeting, or even a few, but to the consternation of some who enjoy the deliberative style, there is a point at which a decision must be made (I know, it’s scary).

That decision should define some parameters, outside of which subsequent meetings should not go, if at all possible. This way, groups are able to tackle the problem at a macro level, then drill down within that playing field to deal with more granular issues.

After listening to yesterday’s HIT Policy Committee meeting, it is, unfortunately, clear that nothing has been placed out of bounds, that everything is still on the table. And when an entire industry is hanging on your every “signal” (a favorite term of committee members), and you’re gearing up for Stage 2 of a 3 Stage five-year program, having everything on the table makes for a big mess.

Not only are Stage 1 measure thresholds in play, but new measures will likely wind up in the menu set of Stage 2. In addition, the timing of the stages themselves is entirely in play, with options floated yesterday that range from no change at all to major delays in Stage 2 (see slide 12). But there’s more –  the Meaningful Use workgroup continues to toy with the idea that organizations which can show high quality may be able to “test out” of Meaningful Use reporting altogether. After more than two years, the only thing I’m sure of is we can be sure of very little.

When you think about it, such endless debate from the HIT Policy Committee isn’t that crazy at all. The group is merely an advisory body set up to kick the National Coordinator some ideas, who then passes the ones he likes over to CMS and up to HHS. With certification, ONC does have skin in the game, as that program is its alone. But with Meaningful Use, CMS will be left holding the bag when all is said and done.

This is why the clearest voice of reason in the room yesterday was Tony Trenkle, director of the CMS Office of e-Health Standards and Services, and member of the HIT Policy Committee. Trenkle knows that MU is an albatross hanging around CMS’s neck, and the more “aspirational” some of the Policy Committee’s special-interest wish-listers get, the bigger flop he’s going to have on his hands. Just read some of his comments from yesterday:

  •  “Sometimes we have tendency to view the universe as Meaningful Use-centric and, as we know, there are other things going on in the world of health IT and in general that will be revolutionary over the next few years. As we look at Stage 2, at the Affordable Care Act, at ICD-10 and major changes like that, it must be considered whether we look at (a Meaningful Use requirement) as a driver or just nice to have. We don’t want to create additional burdens”
  • “I’m concerned if we look at Meaningful Use as the center of universe and don’t think about other levers, we could miss an opportunity. We could tend to load down Meaningful Use in future stages without looking at other ways to achieve the same outcomes faster and better.”
  • Meaningful Use is not the center of universe. We can write rules for ACOs and test things at the CMS Center for Innovation. I don’t see why you can’t look across and say, ‘If it’s not in ACO, what can we do to bring some of that into ACO?”
  •  “We have to adopt a more global mindset besides Meaningful Use.”

Do you think Trenkle wants the Meaningful Use bar to go higher? Of course not.

On the first go-round, CMS took the HIT Policy Committee recommendations and, largely, ran with them. Far wiser now, and having felt the industry backlash, CMS will cast a more critical eye toward the recommendations it receives. Trenkle’s comments tell me he both wants the committee to stop piling on and go for simplicity over complexity. (Remember, CMS must also collect all the data, crunch it, and issue payments.)

But whether ONC can restrain itself or not, whether new National Coordinator Farzad Mostashari, M.D., will take a red pen to the recommendations of his overly ambitious advisory committees before passing them over to CMS and up to HHS, doesn’t really matter. Trenkle’s comments tell me he’s gotten the message on how MU is being received in the heartland, so whether or not ONC can hold back, he will. The buck stops with CMS and the results it achieves. No further deliberation on that point is necessary.


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