With all of the buzz around “deflate-gate” lately, I naturally associated it with the Meaningful Use program. Didn’t you?
For those that aren’t sports fans (or don’t turn on the TV, open a paper, or log on to the internet for that matter) deflate-gate is a term used to describe the ongoing investigation of the New England Patriots. Supposedly, they used under-inflated balls during their 45-7 victory over the Indianapolis Colts in the AFC Championship game.
The theory is the Patriots released pressure from the game footballs, knowing this would increase their performance by making the footballs easier to catch – especially in rainy or snowy weather conditions.
Inverted-U model
Is it too much of a stretch to think that deflating the air out of something in tough conditions could perhaps lead to better performance? Not if you subscribe to the Inverted-U model (also known as the Yerkes-Dodson Law). According to the Inverted-U model, created by psychologists Robert Yerkes and John Dodson in the early 1900s, peak performance is achieved when people experience a moderate level of pressure. When too much or too little pressure is experienced, performance declines, sometimes severely. Despite its age, it’s a model that has stood the test of time.
The left-hand side of the graph portrays a state where people are under-challenged. In this state, people see no reason to work hard at a task. Their approach to the task might be “messy”; they’re in danger of approaching their work in a careless, unmotivated way.
The middle of the graph displays an ideal state where people are working at peak effectiveness. They’re amply motivated to work hard, but they’re not burdened and, thus, starting to struggle. This state is called “flow”, the pleasant and highly productive state in which people do their best work and in turn, provide high-quality results.
Lastly, the right-hand side of the graph shows where people start to crumble under pressure. They’re overwhelmed by the volume and scale of competing demands on their attention, and consequently their performance takes a nosedive.
So how does this relate to Meaningful Use?
The Meaningful Use (MU) program was initially designed to increase pressure and requirements over 3 stages, with hopes of achieving the ultimate goal of improved quality of care.
Three stages of MU
MU stage 1 consisted of achievable standards designed to ensure that EHRs were being used effectively. But it was not so prescriptive as to stand in the way of the primary goal, namely, wiring healthcare. Adoption rates soared and providers were starting to learn their ways around their newly purchased EHRs.
However, with stage 2, things started to go south real fast. The standards became far more aggressive and caused providers to have to divide attention between what needed to be done (for the sake of the patient and documentation) and what needed to be done for MU (including measures not so applicable to their practice). The pressure increased, and as the Inverted-U model displays, competing demands and the burden of meeting a checklist either crumbled their performance or caused providers to throw in the white flag.
With poor attestation statistics and frustration growing, many healthcare organizations decided to band together and lobby for a change.
Calendar-quarter reporting period in 2015
Earlier this month, the Flexibility in Health IT Reporting (Flex-IT) act was reintroduced to Congress with quick praise and support from industry stakeholders. The bipartisan bill requests that the reporting period for Stage 2 Meaningful Use is shortened to a calendar quarter again in 2015.
The full-year reporting period for 2015 ignited outrage especially with the low attestation numbers reported last year. CMS reports released in December confirmed that only 4 percent of physicians and less than 35 percent of hospitals achieved Stage 2 Meaningful Use requirements. CMS also announced that starting this month, 257,000 physicians will be penalized for failing to meet Meaningful Use in 2014.
AMA Blue Print
Will simply only changing the reporting period make all the difference in successfully participating in the MU program? Probably not, but it would be a short-term reprieve in hopes of much bigger changes to come.
The American Medical Association laid out what they think to be an ideal structure for the future of the program. In October 2014, the AMA released their Meaningful Use blueprint, outlining several recommendations for improving participation in the EHR Incentive program. Among the high-level recommendations, the AMA urged that policymakers take a more flexible approach towards MU participation, better align quality measure requirements including reducing the reporting burden on physicians and overlapping penalties, and restructure EHR certification to focus on key areas like interoperability.
In addition, they requested more focus towards specialists participating in MU. The AMA recommends that CMS and ONC take the opportunity with Stage 3 to make the Meaningful Use program less primary care centric by expanding options to meet the needs of specialists and requiring physicians to meet no more than ten requirements.
MU stage 3
CMS recently submitted to the Office of Management and Budget (OMB) the proposed rulemaking for Stage 3 Meaningful Use, which is scheduled to begin in 2017. The public notice provides little detail into the contents of the proposed rule. However, the notice previews that “Stage 3 will focus on improving health care outcomes and further advance interoperability.” It also indicates that CMS plans to “propose changes to the reporting period, timelines, and structure of the [EHR Incentive Program], including providing a single definition of meaningful use,” in order to “provide a flexible, yet, clearer framework to ensure future sustainability of the EHR program and reduce confusion stemming from multiple stage requirements.”
The public notice gives a glimmer of hope that CMS recognizes the immense pressure that came with MU Stage 2 and the need to make a change in order to improve participation. The proposed rule will be made available to the public during a comment period at some point this year, and hopefully soon enough to address the reporting period for 2015.
Finding Balance
So, how can we find balance in the middle of the Inverted-U model? Left to our own devices, without any regulatory programs, would we be motivated enough to perform at a high level and make forward progress? Do we need the pressure of regulatory programs and payment adjustments to continue to make strides in improved quality outcomes, interoperability, and patient engagement? If you were “king for the day,” what would you do? We would love to hear your thoughts in the comments below!
Diana Strubler, Senior Product Analyst, Health IT Standards, joined Acumen in 2010 as an EHR trainer then quickly moved into the role of certification and health IT standards subject matter expert. She has successfully led Acumen through three certifications while also guiding our company and customers through the world of Meaningful Use, ICD-10 and PQRS.
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