On the broader question, hospital leaders gave the government roughly as many B's as C's, although there were enough D's and a few F's to drop the broader government's GPA into the C range. Their peers, leaders in medical groups, were far stingier—giving the government marks on both questions roughly half a letter grade lower than their hospital counterparts.
Across the board, hospital executives and medical group leaders cut the government a bit more slack for “originality” in crafting the electronic health-record programs under the stimulus law enacted in 2009.
Both groups gave lower grades to the CMS and the ONC in fashioning and setting the height of the hoops providers must jump through to achieve meaningful use of an EHR and get paid under the Medicare portion of the program.
Group practice leaders were particularly tough on the CMS and the ONC in that regard, with 86% of those surveyed dishing out grades of C or lower, yielding a GPA of 1.67, well into C-minus territory.
Anthony Molchany, CEO of Orthopaedic Specialists, a 20-physician, multispecialty group practice in Bryn Mawr, Pa., gave the government a B for coming up with an IT incentive program, but the CMS and ONC merited only a C for implementing it so far.
“I like the concept and the intent, but when you come down to the practice level, it's a little difficult,” Molchany says.
“I think the healthcare industry, by far, especially on the physicians' side, has been behind the eight ball for years and years in the development of electronic interventions in healthcare,” Molchany says. “I applaud the concept of Congress and the White House—I think it was even George Bush who said we need to develop a system to move to EHRs.” Providing federal funds, he says, creates “a great incentive” to buy a system.
“Now, when you step down to the actual implementation and the concepts of those things, and you get into CMS, the rules and regulations that they often design are far-fetched. There is not enough thought process—it's probably CMS at this level—to reach out to multispecialty groups and practitioners and bring people to the table at forums and say, ‘Let's make this work.' ”
Charles Tveit, chief operating officer for Lake District Hospital, Lakeview, Ore., a 24-bed critical-access hospital, gave the government a C and the CMS/ONC a B.
“There are a lot of people putting a lot of thought into what's going on,” Tveit says. “I'm impressed with some of the criteria they came up with for meaningful use. I think many of them are very rational. Their questioning process, of what's doable or not, is very good.”
Congress mandated that one of the meaningful-use criteria be electronic prescribing, but according to Tveit, a one-size-fits-all approach doesn't fit a healthcare system as large and varied as we have in America.
“Our little town has one pharmacy,” Tveit says. “Do we need to be connecting to him when he can barely handle the electronic process?”