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Thursday, June 27, 2013

Failure has to be an option if success is to be Meaningful

Anyone familiar with one of my favorite TV shows:  MythBusters has probably heard the expression "Failure is always an option".  Co-host Adam Savage indicates that the principal behind this is that you learn from what you are doing, whether or not you succeed.

Compare that attitude with this most recent report to cross my twitter feed: Alarming Fact: Meaningful Use Dropout Rate at a Staggering 17%.

That 17% figure is staggering only if you aren't thinking about what it means.  17% of early adopters have decided to take an implementation break.  For some of them, that may be a signal that they are giving up, and for others, it might be a well considered strategy to ready themselves for the next stage. As I recall, Meaningful Use is forgiving for early adopters, allowing them to take a year off and still get the entire $44K reimbursement.  Of those 17%, I wonder how many are doing that?

We don't know because that isn't reported in the CMS attestation figures.  You'd have to ask providers what their intentions are.  There's another report that does just that, and finds that 14% of providers attesting to Stage 1 do not intend to attest for Stage 2.   Unlike the author of the first article, I don't find the conjunction of the two findings to be "even more alarming", since the second report simply confirms the results of the first, that somewhere around 15% of providers won't be moving forward (at least as far as incentive $$$ goes) into Stage 2.

Who are we losing?  The only group that this information can be readily applied to is early adopters, because those are the only providers who could have been doing MU Stage 1 for 2 years at this point.  So, my inference here would be that early adopters have a high failure rate.  The author of the first report is concerned because those are also the most experienced.  Another possible explanation here is that it was the ones who tried to be an early adopter but weren't the most experienced who dropped out.  Another possible explanation was that is was the specialty providers for whom Meaningful Use (especially Stage 1) wasn't a great fit.  There are a lot of unscary possibilities, and also some scary ones.  We need more data to evaluate.

Even so, I'm not really all that worried about the Meaningful Use program, and here is why: If failure isn't a possibility, we aren't pushing hard enough.  Failure has to be an option before success is at all meaningful.



  1. Actually, while the Medicaid MU incentive program allows you skip years and still attest to MU and receive incentive payments in subsequent years, the Medicare program requires attestation in consecutive years. So for that portion of the 17% that "dropped out" and were part of the Medicare program, they have forfeited their subsequent MU incentive payments. They, however, still should try to achieve MU in order to avoid Medicare payment reductions (as well as to improve patient care, of course).

  2. Keith,

    We agree with you that we need to keep failure as an option otherwise people won't try. I, too, see 14-17% failure a small number to worry about. I will be alarmed if this was more than 33% but this number of around 15% is high enough to raise a "yellow" flag. We need to find reasons for this failure. Failure just as an option to fail without lessons learned is not useful.

  3. We're a vendor whose only clients are specialists who most often run very small clinics (1 doctor and 1 other staff, often doctor's wife). Our MU customers barely meet the minimum receivables from medicare to even achieve the full $44k (which is ~$59k). They are concerned about the effect of making the (basically optional) Stage 2 changes at roughly the same time as the (completely mandatory) ICD-10 changes while still being on a very limited budget. I suspect our MU S2 dropout rate will be well over 17% when the reimbursement will only be $8k and they have to decide to do ICD-10 or MU S2 if they can't do both.