GAO Calls For Significant Strategy Changes To The CMS EHR Incentive Program

The GAO recently took a swipe at the government’s Meaningful Use EHR Incentive Program, saying it lacked strategy and called for action to establish a strategy in order to achieve its goals, especially those aimed at improving care.

Specifically, GAO called for establishing a strategy to better ensure the reliability of clinical quality measures, known as CQM, and collected using EHRs and develop and use outcome oriented performance measures to monitor progress toward goals

Controversy has swirled around clinical quality reporting, with many providers struggling to do as required under meaningful use Stage 2.

As Pamela McNutt, senior vice president and CIO of Methodist Health System in Dallas, told Healthcare IT News in an interview last month, “This notion that we’re going to extract every piece of data that we need to do clinical quality reporting solely from the electronic medical record is folly.”

John Halamka, MD, CIO at Beth Israel Deaconess Medical Center in Boston, elaborated on the topic in a recent blog.

“The clinical quality measures are certainly one of the problem spots, using standards that are not yet mature, and requiring computing of numerators and denominators that are not based on data collected as part of the clinical care workflow,” wrote Halamka, who serves as vice chair of the federal Health IT Standards Committee, back in his November 2013 blog.

The GAO found that “the lack of a comprehensive strategy limits HHS’s ability to ensure the department can reliably use the clinical quality measures collected in certified EHRs for quality measurement activities.”

“Reliability issues persist,” GAO added. “Although CMS and HHS’s Office of the National Coordinator for Health Information Technology have made efforts to address concerns. For example, different providers may report CQMs based on and tested to different requirements depending on whether their EHRs have incorporated technical updates. Without a comprehensive strategy, efforts to address reliability issues (in accordance with the internal control standard requiring relevant and reliable information) and improve quality and efficiency may be limited.”

As required by the HITECH Act that established the programs, the GAO did the following:

• Assessed the extent of current and expected participation in the EHR programs;
• examined information reported by providers and others to measure meaningful use in the EHR programs;
• evaluated HHS efforts to ensure that EHR data can be reliably used to measure quality of care;
• evaluated HHS efforts to assess the effect of the EHR programs on program goals related to adoption and meaningful use of EHRs and improved outcomes;
• GAO analyzed data from CMS and other sources; reviewed applicable statutes, regulations and guidance, and interviewed officials from HHS and stakeholder groups.

GAO found that programs increased substantially from their first year in 2011 to 2012. For hospitals, participation increased from 45 percent of those eligible for 2011 to 64 percent of those eligible for 2012. For physicians, participation increased from 21 percent of those eligible for 2011 to 48 percent of those eligible for 2012.

The report concludes: “Although HHS expects that the use of EHRs can help achieve improved outcomes and support other efforts that are also intended to improve care, that result is not yet assured. CMS and ONC may lack critical information necessary to establish program priorities and subsequently make program adjustments based on progress toward outcomes.”

Access the full report here.(pdf.)

Article written by Bernie Monegain