Between 2011 and 2012 the federal government spent over $9.2 billion for Meaningful Use (MU) incentives, which are part of a comprehensive plan to decrease the cost of healthcare as well is improve its effectiveness and quality. As of December 2012 just over half of US hospitals have attested to MU Stage I, and an additional $9 billion in incentive payments will go out as the remaining half reach this milestone.
Meaningful Use I, and later MU II, should be viewed as laying the groundwork for electronic health record interventions which may ultimately result in improved health care. For now, though, growing adoption of digital health records seems to be accompanied by higher provider charges: CMS has documented increases approaching 4%. This may be due in large part to electronic health records’ ability to quickly document more precisely and completely all types of care provided, and to generate bills at the highest possible level of reimbursement. CMS and other health insurers are actively investigating this issue.
The goals embodied by Meaningful Use, directed at population and patient health as well as reduced costs, are to be commended. Of course the challenge lies in the details as providers successfully navigate each of the envisioned Stages, including data acquisition, process management and improved outcomes.
As the breadth and depth of such information expands how will we determine and more importantly measure best practice?
To date, rating organizations have relied on the combination of administrative billing data, core measures and patient satisfaction scores. As our goals and data tracking capabilities have evolved, extended measures have been incorporated, including readmissions and 30-day mortality. Yet, Meaningful Use encompasses both patient and population health. How shall we assess an organization’s ability to manage care for a community?
The answer to this question may be close at hand. The Healthcare Effectiveness Data and Information Set (HEDIS) provides an analytic roadmap to quantifying our nationwide objectives, with broad categories including “Effectiveness of Care”, “Access/Availability of Care”, “Experience of Care”, and “Utilization and Relative Resource Use”. Such content cuts across multiple aspects of our delivery system, including inpatient and outpatient encounters, preventive care and population health.
So as we embrace the spirit of Meaningful Use and specifically the goals of reducing cost and promoting a healthy patient and population, identifying “wellness” leaders may hinge on the successful integration of traditional and evolving healthcare data sets. By doing so, we may shine a light on those attributes critical to the creation of a vibrant healthy community of tomorrow.
Michael R Udwin, MD, FACOG