POCP Blog

By Michael Burger, Senior Consultant

The “carrot and stick” design of the Meaningful Use (MU) EHR incentive program was created to incent physicians to adopt EHRs (the carrot) with a threat of future penalties for not adopting (the stick). There is mounting evidence that the carrot may not be as sweet or the stick not as strong as originally envisioned. 

Analysis of the MU attestation data available from CMS reveals a steep drop-off in “year two” attestation among Stage 1 participants.  There are many hypotheses as to the reason for this drop off. 

One explanation is that the largest percentage of the total incentive was paid for Stage 1 participation; the remaining “installments” are much smaller.  And the amount of effort involved in achieving Stage 1 success is still top of mind to physicians.   

As EHR vendors debut features in newly certified versions, the amount of effort necessary to use these features to satisfy Stage 2 requirements is becoming understood by physicians. A questionable return on investment on the Stage 2 requirements creates a legitimate concern that the rate of defection from the program may accelerate.  

Meaningful Use is not entirely financially motivated though. Usability remains a recurring theme among EHR users.   

Usability concerns may topple the meaningful use “stick.” Physicians, fed up with clunky MU-required workflows, could reject the software upgrades to get their software to MU2 versions. Most physicians will plug along and make do with their older versions, a few will abandon EHRs altogether, but a sizable percentage (some say up to 30%) will switch to entirely new EHRs.  

The replacement market will be a hotbed for innovation. New, specialty-specific products that focus on usability and usefulness (and not on incentives) will emerge and gain traction.  A positive consequence of Meaningful Use is that it has popularized interoperability standards. New EHRs, even if they aren’t MU-certified, can still advantage data from incumbent systems and use it in ways that are far beyond the scope of MU.  

It will be an interesting year for the mainstream EHR vendors. Let’s use the extra year between Stage 2 and 3 to innovate.  Look out for the upstarts.  They’re coming!

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