Providers, Advocates at Odds Over Meaningful Use Health Record Access Rules

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By Alex Ruoff

May 26 — Physicians and patient advocates are divided over whether federal regulators should ease meaningful use program requirements for giving patients online access to their health records.

The nearly 200 publicly available comments on a Centers for Medicare & Medicaid Services proposed rule (80 Fed. Reg. 20,346, April 10, 2015) that would step ease the meaningful use program's view, download and transmit (VDT) requirement and make other changes to the program were largely split between health-care providers who believe the program is already too challenging and those who want to expand patient access to health data.

Stage 2 of the meaningful use program requires providers and hospitals to get 5 percent of their patients to download a copy of their health record through a patient portal. The proposed rule would drop that requirement to 1 percent.

“Reducing it to 1 percent takes any of the onus or the encouragement factor off the physician,” Nick Dawson, president of the Society for Participatory Medicine and executive director of innovation for Johns Hopkins at Sibley Memorial Hospital in Washington, told Bloomberg BNA May 26. “It effectively allows the denominator to be zero; you can get by with one or two people.”

The CMS's proposed rule, published April 10, would also shorten the 2015 reporting period for hospitals and providers in the meaningful use program from a full year to 90 days and make other changes aimed at removing “duplicate or redundant” requirements.

The American Medical Association said it supported nearly every provision of the proposed rule, including a reduced VDT requirement, and asked the CMS to quickly finalize the proposed rule in a May 20 comment letter.

Comments on the proposed rule are due June 15. The CMS isn't scheduled to publish the final Stage 3 meaningful use rule until April 2018, according to the agency's regulatory agenda, released May 21.

Reducing Requirements

Some health-care providers said they oppose many of the meaningful use program's “patient engagement” requirements because they make providers responsible for the actions of their patients. Providers said they shouldn't face the meaningful use program's Medicare reimbursement penalties for failing to convince their patients to take advantage of new technologies.

The meaningful use program has several requirements designed to get patients more involved in their own care. This includes the VDT requirement and a requirement that providers and hospitals exchange a secure e-mail with at least 5 percent of their patients.

Michal Savcenko, a cardiac surgeon practicing in Plano, Texas, said many patients won't send an e-mail to their health-care provider because they find the messaging tools in their patient portal “unnecessary and useless.”

“The physician should not be penalized for that,” he said in his comments.

While providers can offer a patient portal, they have little or no control over whether their patients use it to download their health records, Richard Augspurger, a urologist who practices in Denver, said in his comments.

Providers who fail to successfully meet the meaningful use program's requirements face a 1 percent reduction in Medicare reimbursements each year they're out of compliance with the program.

Patient Engagement

However, some providers and patient advocates warned that lowering the VDT requirement would be a disservice to patients, who largely find the e-mail and record-access functions of their patient portals to be useful.

“For both quality and safety, patients need real-time full access to all the information in their medical record,” Peter Elias, a physician who practices in Auburn, Maine, and a member of the Society for Participatory Medicine, said in comments to the CMS. “Reducing the requirement from 5 percent to 1 patient is governmental malpractice and patient abuse.”

Dawson told Bloomberg BNA that many physicians see the patient portal as a time saver. He said some providers prefer to follow up with their patients and give their patients “normal” test results, those that don't indicate a major medical condition, via a patient portal rather than over the phone or in person.

“Instead of ‘take two and call me in the morning,' it's ‘take two and log on to your patient portal in the morning,'” Dawson said.

Dawson said patients want to be able to easily look up their basic health information, such as immunization records.

“There is clear value to both providers and patients in accessing their records and communicating with one another via online portals,” Dawson said.

To contact the reporter on this story: Alex Ruoff in Washington at aruoff@bna.com

To contact the editor responsible for this story: Kendra Casey Plank at kcasey@bna.com