Lies, Damn Lies and Politics

Six GOP Senators call for overview of Meaningful Use EHR incentive program was the tweet.  It referenced this link.  Which then referred to this report by Senators Thune, Alexander, Roberts, Burr, Coburn and Enzi.

To be clear, I'm a card carrying Liberal, and the six Republican Senators whose names are on this report voted against ARRA and HITECH.  It's already pretty clear that we'd disagree on some things.  Yet, reading through the report, I find many statements I could agree with.  There were many others which I was quite cautious about, given that the Senators compared apples to oranges.

What annoyed me most were the at least two very clear misstatements of fact.  Given what the senators (or their ghostwriters) should know, I can call nothing other than an outright lie.  If there's something I hate worse than BS in headlines, it is outright lies in reports like this one.

Lie #1: "None of the required core or menu objectives in Stage 2 requires communication with other health care providers." (page 11, paragraph 2).

In the meaningful incentive regulation:

495.6 (j)(14)(i) Objective. The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care provides a summary care record for each transition of care or referral.

495.6 (k)(1)(i) Objective. Imaging results consisting of the image itself and any explanation or other accompanying information are accessible through Certified EHR Technology.

495.6 (l)(11)(i) Objective. The eligible hospital or CAH that transitions their patient to another setting of care or provider of care or refers their patient to another provider of care provides a summary care record for each transition of care or referral.

495.6 (m)(2)(i) Objective. Imaging results consisting of the image itself and any explanation or other accompanying information are accessible through Certified EHR Technology.

495.6 (m)(6)(i) Objective. Provide structured electronic lab results to ambulatory providers.

They missed not just one, but five separate interoperability requirements that require communication with other healthcare providers (and I haven't included a single of the "communicate with public health" requirements which also have interoperability requirements).

Lie #2: Even worse, on top of this, providers will be penalized for not all reaching a common milestone (page 13, paragraph 1)

CMS has only stated that there will be penalties for providers not achieving meaningful use after 2015.  It has not required providers to achieve the same stage of meaningful use in the incentives regulation.


Not on top of the facts #1: One of the key program vulnerabilities of the current HITECH program is that providers simply self report to CMS that they have met meaningful use criteria in order to receive federal funds. This is a startling lack of program integrity.

Indeed.  But the Senators only have congress to blame for this misstep.  I quote below from HITECH Law:

(i) IN GENERAL.—A professional may satisfy the demonstration requirement of clauses (i) and (ii) of subparagraph (A) through means specified by the Secretary, which may include—
(I) an attestation;
(II) the submission of claims with appropriate coding (such as a code indicating that a patient encounter was documented using certified EHR technology);
(III) a survey response;
(IV) reporting under subparagraph (A)(iii); and
(V) other means specified by the Secretary.

Not on top of the facts #2: One of the most alarming findings in the OIG report is CMS’ response that, despite the OIG’s warning, it does not agree that more pre-payment review of eligibility is necessary since it could delay incentive payments.


A true statement, but not the most current appreciation of the state of affairs regarding prepayment reviews, which CMS is conducting according to this report.

Useless section #1: Long-Term Questions on Data Security and Patient Safety Remain
Of course they do.  Yet there is not a single actionable observation or statement in this section.  FUD anyone?


Disingenuous warping of data #1 [emphasis mine]: According to the Government Accountability Office, participation for 2011, the most recent year data is available from an entity outside of the U.S. Department of Health and Human Services, shows that participation in the program is low.

Really? You want to rely on two year old data to assess where the program is now?  With that kind of speed in analysis, it really could take us 10 to 15 years to get there.  While I appreciate the Senators' caution, I'll cite their own words back at them: "... with the Medicare program facing insolvency it is unacceptable for CMS to wait for two years on this potential threat" (page 16).

The Real Shame

There are so many other problems in the report that it's easy to ignore everything else it has to say.   Yet some of the critiques are worth discussion.  And that is the real loss, but only if the Senators had truly wanted to have a dialogue as claimed.  Unfortunately, circumstantial evidence seems to indicate otherwise.