“There are so many competing priorities,” Muntz said, including getting ready for the nationwide switch to the ICD-10 family of diagnostic and procedural codes Oct. 1. “It's the demand and the resources to help that are not well-matched,” he said.
Many health IT developers were late in upgrading their software to the required 2014 Edition testing and certification criteria needed for Stage 2, and that's had a bottleneck effect on providers' ability to get ready for Stage 2.
Nearly 4,300 hospitals and about 335,000 physicians and other eligible professionals have been paid more than $19.2 billion under Stage 1 of the EHR incentive payment program. A number of them that have received payments for multiple years at Stage 1—the CMS hasn't responded to a request to estimate how many of them must move up to Stage 2—will be trying to meet the more stringent Stage 2 requirements this year. Failure would mean not only loss of a year's EHR incentive payment, but also incurring a 1% cut in 2014 Medicare reimbursements.
Muntz is not so much concerned about larger hospitals, because they have the staff and financial resources to get the job done. “It's the small hospitals and the eligible professionals I'm worried about,” he said.
“I've very concerned that if you pushed people too hard you're going to get a product that's installed that's not as good as you want it to be,” Muntz said. An EHR installation isn't like screwing in a light bulb. It takes a lot of advance preparation. “You can't rush that planning process. I've heard from so many CIOs, they're skipping Stage 2 because they have so many other obligations,” he said.
Muntz said he has spoken with Dr. Karen DeSalvo, Mostashari's replacement at ONC. The first two national coordinators, Drs. David Brailer and Robert Kolodner, had departmental budgets of about $60 million a year. With 85% of the estimated $22.5 billion of federal EHR incentive payment program already spent, the ONC is going to have to go back to making do with less. But Muntz said that shouldn't be a problem for DeSalvo.
“You don't need a lot of money to encourage the private sector to do things,” Muntz said.
The testing and certification of health IT systems, which is overseen by the ONC, could help improve information technology used in areas ineligible for federal EHR subsidies, such as long-term care and behavioral health. “I feel very strongly that behavioral health is the source of a lot of other ills that could be stopped if treated earlier,” he said.
Follow Joseph Conn on Twitter: @MHJConn
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