ONC panel wrestles with meaningful use by specialists

The Health IT Policy Committee today confronted the problem of how to craft a manageable set of requirements for the “meaningful use” of health IT across an industry where specialties and new practice variations are common – and where one policy may not fit all.

The advisory panel for the Office of the National Coordinator  has recommended to the Health and Human Services Department 25 clinical and quality measures that physicians and hospitals must meet in 2011 to be eligible for Medicare and Medicaid incentive payments under the stimulus law.

Those measures were geared for what is normally a patient’s first encounter with the health system: the primary care physician. But many specialists –  who do not treat a wide range of diseases and conditions – may not be able to comply with all the current 2011 requirements.

“Not all objectives and measures are appropriate for all eligible professionals,” said Paul Tang, vice chairman of the Committee and chief medical information officer at Palo Alto Foundation.

As a result, the committee must decide which of the 25 meaningful use measures should apply to specialists so they still can qualify for 2011 incentive payments –  and which requirements to delay introducing til 2013 and 2015.

“I don’t think it was understood that we weren’t intending to have all the measures apply to all specialists,” said Dr. David Blumenthal, the national health IT coordinator.

Tang described building a simple framework to sequence the measures, starting with a core set of process, quality and efficiency measures that could be applicable to all physicians and hospitals. Examples would be the use of computerized physician order entry; avoiding high-risk medications in the elderly; and confirming insurance eligibility electronically for a percent of patients.

From there, measures could be mapped to the provider’s patient population, Tang suggested. For example, an adult primary care measure might be to report the percentage of diabetics whose A1C results were under control. Specialists might be required to report referrals electronically from a patient’s primary care provider.

However, some said it may not be so simple to differentiate meaningful use measures between specialists and primary care providers.

“Providers play different roles with different patients,” said Dr. Neil Calman, president and chief executive officer of New York’s Institute for Family Health, and a committee member. A cardiologist or gynecologist may be the only physician that a patient visits, he said. The specialist may also provide preventive and chronic care for those patients. Likewise, other primary care physicians may offer a set of specialist services.

“This is going to be a hard line to draw, and we’ll need some flexibility at the patient and provider level at what to expect with quality reporting,” Calman said. “We run the risk of focusing on specialist measures but they are providing other care.”