Aledade CEO Dr. Farzad Mostashari, a former national health IT coordinator, speaks at the 2016 Oliver Wyman Health Innovation Summit in Chicago.

These days, the federal electronic health records incentive program known as Meaningful Use is largely seen as failure. Washington has spent more than $35 billion to date on Medicare and Medicaid incentives through Meaningful Use, yet the goals of data interoperability and care quality improvement remain elusive.

A former national health IT coordinator, Dr. Farzad Mostashari, thinks politics had a lot to do with this disappointment. As is often the case in healthcare reform, the provider lobby seems to have been successful in maintaining as much of the status quo as possible.

The culprit, in Mostashari’s view, was the Federation of American Hospitals, representing for-profit hospital companies.

“Stage 3 of Meaningful Use, which we were supposed to be in now, was supposed to be outcomes,” Mostashari said Thursday evening at the Oliver Wyman Health Innovation Summit in Chicago. “That was the plan.”

The 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act called for Meaningful Use Stage 1 to start in 2011, which did happen. It also said that Stage 2 should begin in 2013 and Stage 3 in 2015, but the Department of Health and Human Services changed each stage to three years instead of two.

A pending proposal to implement the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) would roll Meaningful Use into a new program focused on outcomes. That program is set to start in January, though care providers would be allowed to submit “test” data next year and fully participate starting in 2018.

So it could be seven full years from the time Meaningful Use debuted in 2011 until Medicare gets some tangible clinical and financial improvements from its massive investment.

Flash back to the summer of 2009, when Mostashari was new as deputy national coordinator in the Office of the National Coordinator for Health Information Technology. (He was elevated to the top spot in April 2011, a post he held until October 2013.)

“Two weeks into the job, I get a letter from Chip Kahn,” president and CEO of the Federation of American Hospitals, Mostashari recalled Thursday. While he said he has always liked Kahn on a personal level, the letter was strongly worded and all business, according to Mostashari.

“If you make this about outcomes,” Mostashari recalled Kahn writing, “we’re going to sue your ass,” he said, obviously paraphrasing.

An FAH spokesman didn’t return a call Friday seeking comment on Mostashari’s assertion. The Washington-based group also did not comment in May, when Mostashari went on a Politico podcast a and told a similar story.

(UPDATE, Monday, May 26: FAH supplied MedCity News with a copy of the letter, addressed to then-national coordinator Dr. David Blumenthal and then-Medicare chief Jonathan Blum. “We don’t think the language in the letter matches his recollection,” spokesman Sean Brown said an email.)

“If there’s one regret I have, it’s that I didn’t say, ‘So sue me,'” the former coordinator said Thursday.

Instead of outcomes-based goals, we ended up with a Meaningful Use program based on checking boxes of functionality. “I hate compliance,” said Mostashari. “Compliance can’t be what drives change.”

Instead, there should be greater emphasis on process redesign, he said. That is why in 2014, Mostashari founded Aledade. That Bethesda, Maryland-based startup helps physician practices participate in Accountable Care Organizations.

Photo: Neil Versel/MedCity News