ACA Without Meaningful Use = Failure

Healthcare be damned, full speed ahead for rationing. The author of this healthcare blog did not state it this way, but he should have. I have had the suspicion that patient engagement was not intended and Adrian Gropper, MD at least states this. Most physicians don't want patient engagement in the first place just like they do not want patients to have access to their electronic health records (EHRs) as I stated in my blog here.

Dr. Gropper had this to say about patient engagement, “Not surprisingly, patient engagement is an afterthought (talking about EHR).” Then he continues, “Patient engagement, from a health economics perspective, is incidental in care coordination but essential in avoiding the perception of rationing.” Ouch, the perception of rationing when rationing is planned. Many Medicare and Medicaid patients are already feeling the pinch of rationing as Accountable Care Organizations (ACO) and hospitals are attempting to make their funds stretch and grow their profits.

This statement is also worth quoting, “By paying ACO institutions instead of individual service providers, health insurance companies and Medicare provide direct economic incentives to reduce waste, lower costs and, if we’re not careful, withhold needed care. An ACO is by definition an organization or institutional construct.” Bold is my emphasis. “The book on patient engagement is yet to be written. EHRs still treat patient engagement as a liability and state health information exchanges (HIEs) are still being designed without any patient engagement at all. (Opt-in and opt-out is still as far as they go.) Both EHRs and HIEs still perceive strong privacy principles and fair information practices as obstructionist.”

At least Dr. Gropper recognizes the changing landscape and the need for stronger doctor/patient relationships. He acknowledges that patients and doctors need our Internet-age tools in a form for privacy and communications. Patient engagement is a euphemism for communication and I personally don't like the obtuse way they express this. Patient engagement is also used to describe meaningful use.

Dr. Gropper concludes by saying, “Let’s start by making sure our data can be liberated from the various EHRs via Blue Button Plus (see explanation below) and that every federally certified HIE includes provisions for a patient-accessible EHR Record Locator Service. These are the foundation of patient engagement (meaningful use) and essential to the success of the Affordable Care Act.

Blue Button Plus is a blueprint for the structured and secure transmission of personal health data on behalf of an individual consumer. It meets and builds on the view, download, and transmit requirements in Meaningful Use Stage 2 for certified EHR technology. Read more about this at this link.

Are Doctors Using Meaningful Use with Patients?

This remains to be seen and raises some red flags for patients. Granted, we will find out in 2014 and probably not before then. Here are the rules to this point on the books, but I know from experience they are not being followed in most cases.

The rules state that physicians are to engage patients in their care is part of Meaningful Use Stage 2 which becomes law in 2014, and includes specific requirements that physicians must adhere to including:

#1. Provide patients with their health information (via a web portal) on 50% of occasions and have at least 5% of these patients actually download, view or transmit that data to a third party.

#2. Provide a summary of the care record for 50% of transitions of care during referral or transfer of patient care settings.

#3. Provide patient-specific education resources identified by Certified EHR technology to more than 10% of patients with an office visit.

#4. Engage in secure messaging to communicate with patients on relevant health information.

#5. Make available all imaging results through certified EHR technology.

#6. Provide clinical summaries to more than 50% of patients within one business day.

#7. Provide patients for more than 10 percent of all unique patients with office visits

seen by the EP during the EHR reporting period with patient-specific education resources.

This is very specific and there have already been attempts to water this down and make it less effective. It is not the existence of the regulations and their incentives that are in question, but whether physicians are adapting. Many are not willing to adapt and are saying that as long as patients remain passive, they can't change. Others are still concerned about billing time and especially those working for hospitals must abide by their employer's wishes. This is not favorable for patients when hospitals call the shots.

At the same time, many physicians are beginning to realize that engaging the patient in their health care decisions will make health care more efficient and cost effective, and improve patient outcomes. What many physicians are avoiding and say they will avoid is emails (#4 above). On this, I can agree, as most of us do not have secure email available to us. Almost all email services available to us are very insecure and open to copying and other uses, especially by the government.

Outside of the passive patients who do not want education, but just to see the doctor and get his advice, patients are changing and wanting education to help them manage what may be wrong, how to keep their health, and improve it. Yes, patients are becoming more proactive and many want to be more participatory in their care. What is discouraging is only about 40% sign up for access to patient portals for secure messaging with their healthcare providers. I have to wonder if the physicians are discouraging this or if more will, once 2014 is here. This shows that there is much to be done between now and 2014.

Since legislating these changes and offering financial incentives is not obtaining the desired results, will penalties become necessary? Hopefully, training of new physicians and retraining of established physicians in communication skills and interpersonal relationships will be a good start. Those into participatory medicine believe that the message needs to be convincing for physicians to practice medicine the right way.

There is also something to be said for training patients and making them desire to be participatory in their medical care. At the very least, they should become proactive in their care and then as they gain confidence may transition to participatory medicine. Currently, many patients are afraid of what doctors can do against proactive patients. Are these patients justified in their concern? Some need to be because of the attitude of their doctor and some just don't care as they have already reported their doctor for not providing meaningful use. Until 2014, there is a lot to learn by both sides.