Why some docs will 'just say no' to MU

'This disruptive need to fulfill meaningful use criteria interfered with my ability to care for my patients'

August 8, 2014

Thousands of eligible providers are working diligently toward EHR incentive payments, but some practices are choosing a different route: abandoning meaningful use altogether in favor of their own solutions, and finding ways to make up for the penalties they’ll incur down the road.

Some 6 percent of physicians, in fact, will be “abandoning meaningful use after meeting it in previous years,” according to the Medscape report on EHR use in 2014. In surveying nearly 20,000 doctors, Medscape found another 16 percent admitting that they would never be attesting to meaningful use in any capacity. 

And although those numbers may seem small now, chances are they won’t stay that way for long as MU requirements become progressively more stringent, said Art Gross, CEO of HIPAA Secure Now.

Technophobia isn't the issue

Providers pushing back against the MU system aren't your typical renegades. They don't have an overall disdain for regulatory expectations and they aren’t opposed to the technologies and ideals fueling MU requirements. What they do have is a concern that patient service may be compromised by the demands of the mandate.

"This disruptive need to fulfill meaningful use criteria interfered with my ability to care for my patients, and despite the consequences, I stopped (attesting)," said James Legan, MD, a Montana-based physician who has opted to pay MU penalties.  

Legan said the decision has opened up his practice to a whole host of opportunities that would have been overlooked otherwise.

"By not being encumbered with the process of MU, I decided to try out new technology to improve efficiency to offset the significant cost of the penalty," Legan said.

These technologies included patient portals and a Chromebook workaround that enables EHR projection and presentation, which have both contributed to "a significant improvement in workflow and patient satisfaction."

"I have had the time and freedom to do two extremely transforming paradigm shifting maneuvers in the office, which make the meaningful use incentive and penalty meaningless because, first and foremost, I was able to cater to what was best for my patient and, as a result, it has been very productive," Legan explained.

Not for everyone, but definitely for some

But while Legan has been able to find value without meaningful use by integrating individual technologies such as the Chromebook front-end and a faxing/portal solution, he admits that the penalty route may not be for everyone.

"Unfortunately, unless you are in a small office setting and call your own shots, this solution may be difficult to mimic," Legan said. "Nonetheless, I am practicing at a level I never imagined possible just a few years ago when taking the blind leap into the realm of the electronic record."

Whereas Legan’s approach may look like trailblazing at the small practice level today, Gross expects that others will follow suit in due time.

Early indicators from the Centers for Medicare & Medicaid Services suggest he could be proven right. On Wednesday, CMSrevealed the latest attestation rates for Stage 2 of meaningful use and while the 1,898 eligible professionals and 78 eligible hospitals that have attested to Stage 2 as of July’s end are up slightly since last month’s paltry numbers, they do trigger questions about when we may start to see attrition away from meaningful use.

"I don’t think we’ll see the big push in dropouts until next year or the following year," Gross said, "because it does get harder and harder."

Topics: Meaningful use, Electronic Health Record (EHR), Workforce Management, Patient portals, Medicare, Medicaid,Centers for Medicare & Medicaid Services (CMS)