January, 2013

Meaningful Abuse

By Michael J. Katin, MD

Note: although this could be construed as The Meaning of Life, Part II, i.e., the completion of The Meaning of Life, Part I , from May, 2005, this is not it.
Maybe later this year.


In the expression, "Meaningful Use," for what is the "use" to be "meaningful ?"
1. Meaningful use of physicians' skills?
2. Meaningful use of patients' time?
3. Meaningful use of office space?
4. Meaningful use of physicians' time?
5. Meaningful use of valuable but diminishing medical care resources?
6. None of the above.

In fact, the answer is #6, "None of the above." This should be logical, since, obviously, physicians' skills, patients' and physicians' time, office space, and medical care resources are fairly limitless and do not require supervision. The logical answer would probably be "Meaningful use of the legislation produced by hard-working twenty- and thirty-something administration and congressional staffers" since we need to respect the enormous amount of time they put into producing a document so prodigious and arcane that we may never decipher it entirely. Or, is it that upcoming legislative time and effort should be meaningfully used to address only the most critical issues, such as the dangers of vaccination the use of steroids in baseball and unidentified flying objects? Wrong!!! The goal of "meaningful use" is "meaningful use of electronic medical records ."

What has transpired so far?

Clinical staging was one of the breakthroughs in making sense out of the prognosis and optimal treatment of cancer. "Stage I" usually indicates a condition that is treatable and potentially curable, possibly by several different approaches. Stage II tumors usually are larger and have greater access to pathways to allow them to spread and contaminate the rest of the organism. These can also be cured but may require a more aggressive approach. By the time a tumor gets to Stage III or IV, the prognosis is worse and treatment may only control but not eliminate the problem.

It is, therefore, to be noted that as of January 1, 2013, the disorder known as "Meaningful Use" advances to Stage 2, on its way to Stage 3, which will then rapidly lead to death of the private practice of medicine. Actually, it's slightly more complicated. Physicians who are already participating in Stage 1 can actually take until the beginning of 2014 to reach Stage 2, based on a postponement granted as of August, 2012, whereas those who just started Stage 1 will be allowed two years to progress to Stage 2. This may be about the same time as for most squamous cell carcinomas to progress. In fact, physicians in rectangular states whose last names start with H or beyond will not need to participate until 2016, and physicians of Mayan descent have not needed to do anything since December 21, 2012. Following so far? No need to understand it: our government has produced multiple documents telling us how to do this while at the same time making sure that there's no way that any of us will be able to achieve what's being requested.

To make things more complicated, is there a difference between meaning and purpose? Granted, we have to do what CMS want us to do, but it may help to understand the mission if we go over the definitions of the terms:

  • Meaningful: Having meaning
  • Useful Having use
  • Purpose a marine mammal, often confused with a dolphin
  • Goals: targets to be achieved
  • Objectives: short-term measures to determine if one has achieved goals

This may help interpretation of meaningful use regulations, as well as appreciation of the mindset used to produce them. According to the HealthIT.gov website ,"meaningful use" is "the use of certified EHR technology to achieve health and efficiency goals." As a result, every patient seen by an orthopedist, allergist, podiatrist, otolaryngologist, or, even, radiation oncologist will have a BMI and blood pressure measured. Whereas it is reasonable to check some of these parameters to get a gestalt for the entire patient, it is hard to explain why it is beneficial to the patient to have six different specialists find out he's overweight. If the patient can't figure that out by having to buy larger and larger size pants , it's not likely that having the ophthalmologist tell him or her will make a difference. Maybe after the sixth specialist has questioned a patient about smoking cessation the patient may start making up different answers just to keep from getting bored.

So, getting back to basics, what is the ultimate purpose of this? For that matter, what is the purpose of anything? Is there meaning in the universe? Is it possible that in the future we will finally be able to determine the prime mover and the ultimate authority for all things? Will we then be able to understand Meaningful Use for EHR/EMR? Obviously, I'm grasping at straws at this point. I seriously doubt any of this was discussed in the closed-door sessions that generated the Affordable Care Act. Rather than get too far afield philosophically, should we resolve to make the government's plan work to the benefit of our patients and to us, for a more secure future?

Maybe, but before you implement everything, check with the one person who may be able to figure it all out.

In the meantime, don't forget to ask the exercise history .