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University of Pittsburgh Medical Center - May 3, 2011
University of Pittsburgh Medical Center
Standards-based platform.
University of Pittsburgh Medical Center's SingleView is a standards-based platform that provides a federated PACS to unify views of all patients' imaging reports and prior studies across UPMC facilities. When you're part of a large integrated healthcare delivery system like UPMC--which has 20 hospitals, 30 outpatient imaging centers and other facilities performing medical tests, the use of disparate medical imaging is multiplied over many times.
The SingleView system developed by UPMC allows radiologists to access reports and imaging studies residing in any of the many PACS and other imaging systems in the UPMC enterprise so that they can compare a patient's imaging when making a reading. Having this information available to about 20,000 UPMC clinicians and radiologists is reducing the number of unnecessary or redundant tests ordered for patients, helping the patients avoid unnecessary exposure to radiation. It's also reducing the number of disputes with payers regarding unneeded or redundant testing, said UPMC officials.
This article originally appeared Health Industry Washington Watch
9 Ways Health IT Improves Patient Care - May 3, 2011
9 Ways Health IT Improves Patient Care
HITECH allocating $20 billion to push the
adoption of health IT nationwide.
Marianne Kolbasuck McGee 11/09/2010 The HITECH legislation of the American Recovery and Reinvestment Act is allocating more than $20 billion to push for the adoption of health IT nationwide, including e-health records and e-prescription systems. Health IT can boost patient's quality of care by reducing medical errors, improving clinical decision making and helping to eliminate redundant and unnecessary tests and costs. Health IT, including automated systems that check for adverse drug interactions, allergies, and confirm patient IDs, can help patients avoid being victim to medication and other errors. Meanwhile, as more aging and chronically ill patients are cared for at home, health IT deployments can help keep those individuals out of the hospital, while mobile apps and other tech deployments aid in wellness programs to keep the healthy active. Here are a few examples of health IT helping to bring those benefits.
This article originally appeared in InformationWeek Healthcare
HHS Secretary Kathleen Sebelius. - May 3, 2011
HHS Secretary Kathleen Sebelius.
"2 of 5 physician practices plan to meet
meaningful use criteria by 2015."
Complying with meaningful use rules can earn bonus money for your practice from Medicaid or Medicare -- but it also can shake up the way your office operates and the way you interact with patients.
As hospitals and practices prepare for attestation of having met the requirements, many convened at the 2011 Healthcare Information and Management Systems Society annual conference in February in Orlando, Fla., to learn what they can expect after going electronic.
Meeting meaningful use will involve more than receiving incentive pay up to $44,000 from Medicare or nearly $64,000 from Medicaid for using an EMR. It means a lot of work -- and adjustment by you and your staff.
Those changes are expected to trickle down even to those who have no plans to seek the incentives, said Natalie Berger, PhD, chair of the HIMSS Ambulatory Information Systems Committee. So physicians need to prepare. "Right now it's only Medicaid and Medicare providers ... getting those reimbursements. But eventually [private] payers are going to follow those guidelines. And then I think patients are going to demand it. It's no longer going to be OK to go to a doctor's office that doesn't have your records or doesn't know you are allergic to those medications."
Some of the changes EMRs bring will be for the better, some for the worse, depending on how the change is managed. Much of the 2011 HIMSS conference focused on those changes, and how physician practices and hospitals could prepare for them. Many discussions revolved around five basic themes: patient engagement; reporting; collaboration; efficiencies; and security and privacy.
This article originally appeared in amednews.com / American Medical News
Physician Practices Embrace Tablets - May 3, 2011
Physician Practices Embrace Tablets
Several times a day, Frank Adams, a solo pulmonologist in New York City, uses his Apple iPad to access his practice's EHR, to review charts and prescribe medication, and to pick up e-mail messages from his staff.
Media tablets like are quickly becoming EHR-era physicians' favorite toy. But should your practice be using them?
Several times a day, Frank Adams, a solo pulmonologist in New York City, uses his Apple iPad to access his practice's EHR, to review charts and prescribe medication, and to pick up e-mail messages from his staff. Only nine months since he purchased the device, he can't imagine his life without it: Having an iPad has improved Adams' workflow and made him more available to patients.
"If I get an emergency phone call at home or on the road I can call up a patients' record in a matter of seconds," he says. "Just last weekend someone called my answering service with a history of severe cough. I happened to be in the middle of Manhattan but spoke to the patient on my cell phone and decided that an antibiotic was indicated. I asked the patient if she had any drug allergies and she said she wasn't sure. I had taken the iPad with me since I was on call and quickly accessed my EHR and found that she did have a history of an allergic reaction to an antibiotic that I might have prescribed. I then e-prescribed an alternative drug."
These days, Adams is in good company. In the year since the April 2010 release of the iPad, the most popular media tablet to date, Steve Jobs and Co. have changed the way people think about personal computing. Nearly 18 percent of 1,400 physicians surveyed for Physicians Practice's 2010 Great American Physician Survey said they used tablet computers. That poll ran from March through May of last year. And adoption continued at a rapid clip after that. According to a separate survey of 2,206 physicians and other clinical workers in January and February 2011 by Physicians Practice's parent company, UBM Medica, 38.5 percent said they plan to buy an iPad or other media tablet this year.
The iPad and its emerging rival tablets belong to a category of mobile computing devices defined by their shape, size, and power. They're lighter and thinner than laptops, feature touch-screen interfaces, take up less dimensional space than a piece of notebook paper, and can be held like clipboards. iPads look like blown-up iPhones.
At a growing number of practices, physicians, and supporting staff are using media tablets in lieu of laptops to do everything from collecting data to showing patients how a disease can manifest itself in their body to retrieving medication-allergy information in the dead of the night for a panicked patient.
But before joining the tablet party, you should consider how the devices compare with those mobile computing devices your practice may already know and love — specifically, smart phones and laptops.
Tablets vs. laptops
Whether they're using them to input patient data into an electronic chart or check on medication allergies, doctors say tablets' user-friendly design often make them preferable to laptops.
Because tablets are lighter and skinnier than laptops, they're also easier to carry. The iPad, for example, weighs 1.33 pounds and measures 9.5 x 7.31 inches, so it can be slipped into a briefcase or a purse. Other tablets, like the newly released BlackBerry Playbook, sport even smaller dimensions (5.1 x 7.6 inches; 0.9 pounds) and can fit into lab coat pockets. And because they're lighter and skinnier than laptops, they're inherently less cumbersome.
Holding a tablet is similar to and easier than holding a clipboard; a physician can hold a tablet in one hand, and use his other hand to operate the touch screen. Laptops, of course, have the advantage of a physical QWERTY-style keyboard, but they're also bigger and bulkier. Carrying them around all day is a burden, and they rarely have more than a few hours of battery power.
However, the touch-screen interface of an iPad can be a problem - at least at first. Because most doctors are trained to type using a tactile keyboard, typing on a digital screen where there are no keys to push into can feel unnatural, slow down the input of information, and make you more prone to typos.
Barbara Morris, a pediatrician with 200-provider practice Community Care Physicians in Albany, N.Y., says the process of getting used to a touch-screen interface was one she had to "persevere through."
But so many other things about the iPad made it worth the effort. For example, Morris likes being able to expand images by moving just a couple of fingers outward.
Additionally, "the landscape view makes it easy to see stuff," she says. "Laptops have lightness, but not small physical size for carrying around."
Physicians who cannot bear the thought of doing without a tactile keypad do have a few options, however. They can buy a separate keyboard attachment to use in the office or at home (some models use Bluetooth radio frequencies to wirelessly connect to tablets). There is also the option of purchasing a hybrid "tablet" computer that looks and feels like a tablet when held, but comes with a slide-out or detachable keyboard.
This article originally appeared in the April 2011 issue of Physicians Practice.
Medicare MU Attestation Starts April 18 - April 6, 2011
Orlando Florida -- Attestation for the Medicare Electronic Health Record (EHR) Incentive Program begins on April 18, 2011. In order to receive your Medicare EHR incentive payment, you must attest through CMS' Medicare and Medicaid EHR Incentive Programs Registration and Attestation System. Our professional services team is offering a service that will cut through all the paperwork using CMS certified practices that will get you the maximum allowable reimbursements and your payment in as few as 30 days, say Brian McCarthy CEO of Lake Mary Florida based Sencilo HealthIT Solutions. CMS expects to issue over $2 billion in reimbursements next month in stimulus dollars for the 153,000 Physicians with the foresight to purchase certified EMRs prior to January 2011.
This year, 2011 is a gimme year, the doctor only has to use the EMR for 90 days in order to submit for payment, next year is a whole nother story. In CY2012 the doctor will have to use the EMR for the full 365 days before submitting, even if it is their first year of using the EMR software. What that means is the office will have to order a certified EMR prior to June 30, 2011 in order to meet the deadline, since it typically takes 4 to 5 months to order, install and train a small doctors office.
Today you can preview selected screenshots of the Attestation System to help you understand what the attestation process will involve. Please note that these screenshots are only examples--the final appearance and language may incorporate additional changes. Keep in mind not completing the forms correctly may make you un-eligible for future stimulus payments. Last year 90% of the eligible hospitals failed to readiness assessments for eligibility, misunderstanding of how to apply correctly was at the top of the list.
CMS will release additional information about the Medicare attestation process soon, including their 108 page User Guides that provide step-by-step instructions for completing attestation, and educational webinars that describe the attestation process in depth which can take up to 8 hours to complete.
Here is more information to help you prepare for Medicare attestation:
You need to understand the required meaningful use criteria to successfully attest. Meaningful use requirements for eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) participating in the Medicare EHR Incentive Program are different:
EP Meaningful Use Criteria - Must report on 15 core measures, 5 of 10 menu measures, and 6 clinical quality measures, consisting of 3 required core measures and 3 additional measures.
Go to the Stage 1 EHR Meaningful Use Specification Sheets for EPs for information on core and menu measures for EPs.
Go to the Clinical Quality Measures page for information on the required clinical quality measures for EPs.
Eligible Hospital and CAH Meaningful Use Criteria - Must report on 14 core measures, 5 of 10 menu measures, and 15 clinical quality measures.
Go to the Stage 1 EHR Meaningful Use Specification Sheets for Eligible Hospitals and CAHs for information on core and menu measures for eligible hospitals and CAHs.
Go to the Clinical Quality Measures page for information on the required clinical quality measures for eligible hospitals and CAHs.
You should also make sure that you begin your 90-day reporting period in time to attest and receive a Medicare payment in 2011. The last day to begin your 90-day reporting period for 2011 incentive payments is:
* July 3, 2011, for eligible hospitals and CAHs, and
* October 1, 2011, for EPs.
Under the Medicaid EHR Incentive Programs, the date when participants can begin attestation for adopting, implementing, upgrading, or demonstrating meaningful use of certified EHR technology varies by state. Go to the Medicaid State EHR Incentive Program web tool for more information about your state's participation in the Medicaid EHR Incentive Program.
Want more information about the EHR Incentive Programs? Make sure to visit the Sencilo HealthIT EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs. Call us to schedule an appointment (877) 904-4EHR x1910 or e-mail us at CMS@sencilo.com.
How Some EMRs Are Increasing Reimbursements Through Better Documentation With Fewer Denials - April 6, 2011
Orlando Florida -- The past year has been an exciting time for healthcare professionals, bringing more changes, opportunities and challenges than ever before. The Health Information Technology for Economic and Clinical Health (HITECH) Act, which is a portion of the American Recovery and Reinvestment Act of 2009, designated over $19 billion towards incentive programs for healthcare professionals that adopt electronic medical records (EMRs) before 2015. Even though the law did not lead to the creation of EMRs, it certainly caught the attention of healthcare providers across the nation.
From improved patient care to higher reimbursement, physicians hold high expectations for EMRs and rightfully expect a return on investment. However, many investors forget that EMRs are tools, not solutions. In the February 2010 edition of the American Academy of Professional Coders (AAPC) Coding Edge magazine, the author states, EMR vendors are saying, If you buy our EMR you can code higher and make more money! but that is not necessarily true, until now! The goal of the EMR is to improve the efficiency of the physician in documenting services and ensuring all work performed is capture in the record (AAPC, p. 29). EMRs can help with reimbursement, but they will not prevent a physician from receiving denials in the future. They can improve coding and documentation, but physicians must still take the time to document services to meet medical necessity standards.
EMRs like Allscripts MyWay and Clear Practice Nimble both for $350/month/doctor are more affordable than ever, and they certainly bring many positive outcomes to the table. Yet, physicians and coders should have a realistic expectation of what EMRs can and cannot do. Major culture change is coming to the healthcare industry, and EMRs are literally changing how healthcare professionals do business. Everyone, from the physician to the receptionist, must adapt to the challenges of EMRs and take on new roles in their professions.
Documentation Becomes Code Selection
One of the key features behind EMRs is that superbills are automatically generated with the appropriate code data as physicians document the patient visit. Structured documentation tools are embedded with procedure and diagnosis codes and are designed to incorporate the documentation and coding process into one single activity. In essence, the physician becomes the coder by default. In a resent survey of MDs and DOs 75% admitted to down-coding do to their own lack of adequate documentation, the survery went on to say using a EMR like Allscripts or Clear Practice gave them the confidence to code at the right level, adding tens of thousands of dollars each year to the practice.
Templates provide the primary documentation tools and are designed with a particular clinical focus, such as chief complaints, chronic diseases, preventive exams, and vaccines. Within the templates are pre-defined notes or generic statements that frequently accompany a particular treatment plan. Other documentation tools may include pick lists, evaluation and management (E/M) tools, and pop-up messages that remind physicians of appropriate actions they should take, such as adding dosages for a drug.
On the upside, some aspects of the coding world can be automated without introducing much risk. For example, straightforward coding combinations, such as hard-coding V04.81 to a flu vaccine, are easy scenarios to automate. On the downside, very rarely is coding so simple. In the EMR world, a physician can document a patient visit perfectly, yet the claim still will not be ready to submit to an insurance company for payment.
In the past, physicians documented their work on a superbill or patient chart, and then a coder would clean up the claim to meet coding rules and payer guidelines. In the electronic world, most EMRs are designed with the intention of automating claims processing so thoroughly that when the physician completes the visit, claims will be sent directly to the payer, bypassing the coder. What many physicians (and software designers) fail to realize is that there is a technical side of coding that goes beyond mere code selection. Commercial payer rules, local coverage determinations, mitigating circumstances, government health programs and numerous other variables introduce rules, exceptions to the rules, and sometimes even exceptions to the exceptions. To date, only the Allscripts MyWay and Clear Practice Nimble EMR on the market are intelligent enough to completely automate the coding portion of claims processing.
Coding Tools
Since few EMRs can completely replace the need for front-end claims editing, many EMR vendors partner with a coding content provider to include a code scrubber with the EMR. Most code scrubbers on the market offer more or less the same features, including edits that review claims for the following:
Valid ICD-9, CPT and HCPCS codes
Add-on codes missing parent codes
Invalid use of modifiers
Missing diagnosis
HCFA rules for reporting multiple procedures
Relative Value Units
As a general rule, most claims scrubbers warn about bad coding behavior, but they very rarely warn about revenue-producing behavior, such as adding administration codes to vaccines or injections. To a limited degree, you can incorporate some of these rules into the templates, particularly for static or unchanging coding scenarios.
Practically many code scrubbers fall short when it comes to validating claims based on the following:
Commercial payer guidelines
HCPCS rules (or DME requirements)
Patient demographics and age or gender-based code selection
Provider credentialing
Referring doctor
Accident dates
Multi-level code comparisons
These rules tend to be so variable and practice-specific that it is impossible to code for them on the front-end. Therefore, physicians and coders need a way to build practice defined rules to fill in the gaps left by standard code-scrubbing engines.
Note: Allscripts Payerpath products include the ability to perform both standard and user-defined code scrubbing. The products also interface with many EMRs vendors on the market.
Code scrubbing is a critical part of claims processing, and no on should purchase an EMR without having a code scrubbing solution. Furthermore, coders are often left out of the decision-making process when it comes to purchasing an EMR. Coders should make sure they are part of the process when it comes time to evaluate an EMR for their practice, or they risk losing out on benefiting from an EMR upgrade.
Key Question: Does the EMR provide any claims scrubbing tools that allow you to set user defined filters?
Ease-of-Use
When it comes to documentation tools, the critical factor in getting physicians to use the EMR is how easy the tools are to use. EMRs are specifically designed to help physicians document better. However, many physicians may be irritated at the level of documentation an EMR can impose before they can complete the patient visit. Physicians often under document, and it is almost guaranteed that any EMR you purchase will demand physicians document more than ever before.
One factor in determining the ease-of-use of an EMR is the number of clicks or key strokes required to capture all the pertinent data within a patient visit. (Note: The number of clicks is often directly proportionate to a physicians irritation level when it comes to using an EMR.). Clicks and key strokes should be kept to a minimum at all times. Other shortcuts can be implemented into templates to assist with proper code selection or documentation. Coders and physicians should always be on the lookout for ways to streamline templates and make them as efficient as possible.
Note: Most practices will be responsible for creating their own templates and any special programming within the EMR. Do not expect a lot of assistance from the EMR vendor. Conversely, White Plume customers are provided with trained forms designers and programmers that create any electronic encounter forms for the practice.
Key Question: Are templates too top heavy or cumbersome to be used by the physician?
Data Integrity with Notes
Within the EMR templates, as physicians enter procedure or diagnosis information, they are prompted (and sometimes forced) to select clinical information that provides supporting documentation for the services they provide. Documentation is usually organized into notes that provide standard comments typical to particular diseases or illnesses.
At first glance, pre-defined notes appear to be very convenient and a great time saver. On the down side, notes are often long, difficult to read, and do not emphasize pertinent data points. Furthermore, in the eyes of auditors, the routine, generic nature of pre-built notes can actually subvert the credibility of the medical record. In the past, the standard was, If it is not documented, it cannot be coded. With EMRs, the standard is, It is documented, but is it relevant and did the physician actually do it. (Taylor, p. 8).
In short, physicians can be stuck between a rock and a hard place when it comes to notes. On the one hand, notes are necessary for properly documenting a patient visit. On the other hand, the danger is most physicians are in a hurry, and risky or not, automated notes can appear to be good enough to busy physicians. For physicians that use pre-built notes exclusively, they may see an increase in denials by payers.
These problems can be solved in one of two ways. First, EMRs should provide physicians with a way to revise existing notes or offer a free text field in which physicians can enter their own comments. To be safe, physicians should always enter something unique to the medical record. The only downside to revised or free text notes is that EMRs cannot incorporate any clinical data that affects coding into the superbill that is automatically generated by the EMR. Therefore, someone will have to edit the claim accordingly before it is submitted to an insurance company.
Key Question: Does the documentation reflect medical necessity and support the medical record?
E/M Tools
Most EMRs provide an evaluation and management (E/M) tool that calculates data to pick the correct E/M level. In general, the history and exam portion of an E/M visit are easily formatted within the EMR. Some E/M tools pre-populate previous visit information or permit information to be copied and pasted into the current visit record. Physicians are still required to review any data that is pre-populated or copied, but this function can help speed along physician data entry.
However, it is very easy for physicians to skim over copied or pre-populated data when they get busy. When this occurs, conflicting data may be documented in a patient record. For example, an established patient is seen for a routine annual exam and is diagnosed with high blood pressure. In the previous visit, the patients blood pressure was normal. If the EMR copies over the previous visits HPI (where there was no indication of high blood pressure) and the physician documents high blood pressure in the medical record, then the claim will almost certainly be questioned by payers.
Key Question: Does the E/M tool meet the practices auditing and testing standards?
ICD-10
At first, talking about ICD-10 may seem like a strange topic to discuss with EMRs, but in many ways, it is the elephant in the room that no one is factoring into EMR decisions. Beginning October 1, 2013, all healthcare providers must submit ICD-10 data on claims. ICD-10 will introduce another major culture shift to the healthcare community, and physicians should know how this change will affect their EMR.
Major system upgrades will be involved with converting from ICD-9 to ICD-10, and it is extremely unlikely these upgrades will be provided at no cost to the physician. In addition, any custom-built templates or notes must be adjusted in order to accommodate the new coding structure. In one study, it was found that (Law and Porucznik):
The move to ICD 10 CM will increase documentation activities about 15 to 20 percent. This translates into a permanent increase of 3 percent to 4 percent of physician time spent on documentation for ICD-10-CM. This is a permanent increase, not just an implementation or learning curve increase. It is a physician workload increase with no expected increase in payment, due to the increased requirements for providing specific information for coding. Electronic health record systems will not be able to eliminate the extra time requirement.
There is no doubt EMRs can help store ICD-10 information much better than any paper environment. However, it is going to take time for EMR technology to adjust to the ICD-10 code set in ways that help relieve the documentation and coding burden.
Lastly, the costs involved with converting to ICD-10 may be just as expensive as implementing an EMR, particularly if the conversion requires a complete overhaul of the EMR system. No potential buyer should sign any contract until they are familiar with the EMR vendors ICD-10 implementation plan and estimated upgrade costs.
Physicians may find that it is more financially feasible to roll EMR implementation and the ICD-10 conversion together into one comprehensive upgrade. From a business standpoint, the idea of simultaneously implementing an EMR and training physicians on ICD-10 may be overwhelming. Either way, physicians must decide on a plan of attack when it comes to meeting government expectations on EMR adoption and ICD-10 integration.
Conclusion
As EMRs continue to evolve, many of the conditions that create coding obstacles and compliance risks will be minimized, but it may take time. In todays world, risks can be mitigated if clinical personnel know what to look for and how to avoid major pitfalls. No matter how technologically advanced a system may be, the need for compliant claims still exists. Successful EMR implementations occur when physicians and clinical personnel learn how to reconcile workflow demands with claims adjudication demands. For better or worse, EMRs are the future, and users must learn how to make these advanced systems work for them.
More Information
Call (877) 904-4EHR or e-mail us at: info@sencilo.com for a live demostration how you can increase you coding while decreasing the time to get paid.
Resources
Auto-Population Gone Wild: EMR documentation creates risky record keeping and frustration. Cheryl L. Toth, AAPC Coding Edge; February 2010, 26-29.
AAPC Workshop EMRs What You Need to Know NOW! James Taylor, MD. March 2010, 1-19.
How to Successfully Navigate Your EMR Implementation. Found at: http://www.aafp.org/fpm/2007/0200/p33.html
Will Meaningful Use Incentives Work? - March 25, 2011
Orlando Florida -- Will tens of billions of dollars in forthcoming incentive payments for meaningful use of electronic health records meet the HITECH Acts goal of improving care quality and patient outcomes while bringing efficiencies to the health care industry?
That is a question posed to attendees of the Institute for Health Technology Transformation’s Summer Health IT Summit in Denver, and responses were mixed.
The incentive funding is a baby step to facilitate transformation within the industry, and likely was the best that Congress could come up with to get the industry to accelerate automation, says Barry Chaiken, M.D., president and chief medical officer of DocsNetwork Ltd., a Boston-based consultancy.
But the incentives are not big enough and will compete against other incentives that perpetuate the status quo, Chaiken asserts. For instance, the EHR incentive is miniscule compared with the payment incentive to over-treat patients. Who is going to make sure a doctor does not do more CTs or extra tests? he asks. The EHR is not going to correct the wrong incentives in our environment.
Incentives, Chaiken argues, impact people’s judgment. It is not that people are bad, the incentives are wrong. Hospitals, he notes, make more money on foot and leg amputations than on keeping diabetics healthy. Consequently, it is impossible in this political environment and economy to think that problems the meaningful use incentives are designed to correct will be fixed quickly. The incentives, Chaiken adds, may support industry transformation but will not make it happen.
Chuck Christian, director of information systems and CIO at Good Samaritan Hospital in Vincennes, Ind., concurs that meaningful use is not a silver bullet but remains a valuable program. It has truly raised the rhetoric and made people talk about how we can do better. This is causing us to have these conversations as a team.
The issue of HITECHs effectiveness will rest on whether meaningful use incentives actually compel physicians to go electronic, says Brian McCarthy, the CTO of Sencilo HealthIT Solutions in Orlando Florida.
Again, other economic incentives get in the way. Most physicians, he notes, get paid by service--the more patients they see the more they get paid. But many EHR vendors have not really worked with physicians to improve workflows, and that hampers physician acceptance of the technology, he adds. If it takes a physician 30 minutes to enter documentation in an EHR but takes three minutes to do so on paper, the physician will go back to paper, McCarthy says. Health information exchanges also may unwittingly play a role in poor economics, he fears. Through local and state HIEs, doctors can get more data on patients and that will reduce costs by reducing redundant care, but also will reduce payments.
Simplifying the electronic record is important to adoption and the way to do that is to have physician input play an integral role in EHR development, says David Rosenberg, M.D., a solo family practitioner at Jupiter (Fla.) Concierge Family Practice. An electronic records system has to think like a physician and let the physician easily do 80 percent of their tasks, and we can figure out the other 20 percent, he contends.
Rosenberg uses Allscripts MyWay EHR and truly believes it helps improve care while making his job easier. But will meaningful use incentives work? We are not going to know it unless we go through a trial, he says.
The incentives authorized under HITECH will not be wasted, says Ron Kubit, president of Intuitive Technical Solutions, a Denver-based consultancy. It is just evolution, he asserts. Other industries utilize information technology and have their evolution and acceptance phases.
There is been no pressure to automate records in the health care industry, Kubit contends. Now, that pressure is being brought to bear by the government but the industry itself will take charge of its transformation. He notes that physicians at Kaiser Permanente initially did not like the EHR when the organization automated and now rave about it. No one likes change.
HITECH has done its job to prod the industry, acknowledges Christopher Jackson, M.D., a physician informaticist and emergency physician at 30-hospital Sisters of Mercy Health System, Chesterfield, Mo. Most physicians and nurses have been doing the same things since the 1960s. We needed something to get stuff going.
The problem with HITECH, however, is anytime you get the government involved in an initiative, it is not a grassroots effort and becomes difficult to get to the next level, Jackson explains. That next level is using the data in EHRs to truly bring positive change. There is a high likelihood that providers will be able to meet meaningful use criteria but not be meaningful users of EHRs unless they really use the data. We need fluid, correct data in real time, he says. EHRs are not there yet. They do not have a nice user interface with beautiful data behind it, like a Allscripts MyWay EHR does, says McCarthy.
Jackson also worries that the government telling the industry what to do will take focus away from what industry should be doing. The first stage meaningful use criteria are reasonable, he says, but he is not sure subsequent criteria will be. How many resources will I have to utilize to do what they want rather than what I need to do, such as improve patient safety?
The biggest current impediment to HITECHs success is that physicians are skeptical they will be paid as promised, Jackson says. Affiliated physicians are extremely concerned about whether they will get incentive payments, and it gets even dicier with Sisters of Mercy-owned practices. These physicians do not know how much of their incentive funds they will actually receive because they are employees using EHRs that their employer paid for.
So, will employed physicians get $44,000 in incentives? Or $3,000? Or somewhere in between? That is a problem, Jackson says. Whose money is it? We already budgeted for an EHR and have other projects we would like to use some of that money for. Sisters of Mercy leaders say employed doctors will get incentive payments, but they are not yet saying how much, he adds. For more information email us at MUPayments@sencilo.com or call us at: (877) 904-4347
Register Now for the CMS Meaningful Use Call - March 25, 2011
Orlando Florida - The Centers for Medicare and Medicaid Services in early April will hold 90-minute educational conference calls to explain to eligible professionals and hospitals the registration process for the Medicare electronic health records meaningful use program.
Registration for the program has been open since early January and attestation--the process of demonstrating compliance with MU requirements--begins during April on a date not yet finalized.
An educational call for eligible providers on April 1 at 1:30 p.m. Eastern Time will cover eligibility for incentives, switching between the Medicare and Medicaid MU programs, reassigning payments, pre-registration, registration and helpful resources.
An educational call for hospitals on April 6 at 1:30 p.m. Eastern Time will cover both the Medicare and Medicaid MU programs. Topics include eligibility for incentives, dually eligible hospitals, pre-registration, registration and helpful resources.
Registration is required to participate in a call and only one registration is necessary if a group will sit in on the call. Registration will close one day before each call or when available space is filled.
To register for the eligible professional call on April 1 call (877) 904-4EHR or email us at CMS@sencilo.com
Why Payers Are Making Moves Toward MU Incentives and Why You Do Not Want to Miss Out - March 25, 2011
Federal incentive payments for meaningful use of electronic health records became more meaningful on Aug. 5 as four major commercial insurers announced programs that could result in additional private sector incentives.
The payers are Aetna Inc., Highmark Inc., UnitedHealth Group and WellPoint Inc. All four insurers, at minimum, will align their pay-for-performance programs with federal meaningful use criteria. In some cases, physicians who meet a payers P4P criteria and demonstrate meaningful use will receive a higher P4P payment; in other cases the payment won't rise but demonstrating meaningful use will become a criteria for getting the P4P payment.
Aetna will offer additional financial incentives for demonstrating meaningful use but whether the payments come from a separate incentive program or an increased P4P payment has not yet been determined.
UnitedHealth now will tie part of its P4P payments to demonstrating meaningful use. It is not yet clear if meeting meaningful use will result in a higher P4P payment. UnitedHealth has P4P programs in several regions across the nation. Now, it will rollout a single, uniform P4P program nationwide.
UnitedHealth also will designate on its consumer-focused physician directory the physicians who meet meaningful use criteria; the directory currently enables consumers to know if a physician meets certain criteria for quality and efficiency of care. The insurers Physician Advocate Program, which offers practice management improvement consulting services, now also will aid practices in qualifying and applying for federal meaningful use incentives.
Physicians adopting the CareTracker EHR of the Ingenix subsidiary of UnitedHealth will receive additional consulting support. Further, through subsidiary Optum HealthBank, UnitedHealth will offer zero percent financing on CareTracker until a physician practice receives its federal meaningful use incentive payment.
At WellPoint, physicians in a P4P program will have to demonstrate meaningful use to get a payment, but meaningful use will not increase the payment. WellPoint also will offer millions of dollars in low-interest loans to assist hospitals in rural, critical access or medically underserved areas to purchase and adopt EHRs. The loans will start in California and Georgia in 2011, and WellPoint will use results from those programs to evaluate expansion to other states.
Details on Highmarks incentive program were not available.
In a joint statement, National Coordinator for Health Information Technology David Blumenthal, M.D., and Centers for Medicare and Medicaid Services Principal Deputy Administrator Marilyn Tavenner, applauded the new initiatives of commercial payers. The public and private sectors can and must collaborate in furthering the goal of creating a 21st Century electronic health information system in the United States. For more information call (877) 904-4EHR
CMS will start incentive payments in May 2011 - March 24, 2011
The Centers for Medicare and Medicaid Services will begin to make meaningful use incentive payments to eligible physicians and hospitals as early as May 2011, according to a senior CMS official, who detailed steps the agency is taking to start up the incentive program.
CMS will open registration for the incentive program in January, said Karen Trudel, deputy director of CMS Office of E-Health Standards & Services. To begin receiving payments, healthcare providers must verify that they have demonstrated for 90 days meaningful use of certified electronic health records. To fit in 90 days of meaningful use means, that no one will be able to attest before April, she said. The first payments will go out in the middle of May, she said at a January 28 meeting of the federal advisory Health IT Standards Committee. Now that CMS has released its final rule on meaningful use, the agency is readying systems and processes that will trigger the payments. We are now engineering back into the system all the changes that occurred in the final rule, she said.
Getting it right is important because CMS will pay out billions of dollars in incentives called for in the HITECH Act over the next several years, said Trudel, who indicated the pressure is on. We are now working toward making all of this a reality and we have only a few months to do it, she said. The agency has rolled out a registration service in January so physicians and hospitals can sign up for the program. CMS must also test that its systems can handle the interactions transmitted through registration, attestation and payment.
Eligible hospitals and Medicare physicians must have a national provider identifier and be enrolled in the CMS Provider Enrollment, Chain and Ownership System (PECOS) if they are not already to participate in the EHR incentive program. Most providers also need to have an active user account in the National Plan and Provider Enumeration System (NPPES). PECOS manages, tracks and validates the enrollment of providers and suppliers in the Medicare program. NPPES is a system that assigns unique identifiers to health plans and providers in exchanging health information. CMS will use these systems records to register providers for the program and verify Medicare enrollment before making Medicare EHR incentive payments.
Certification Status
Meanwhile, the Office of the National Coordinator (ONC) is establishing a temporary EHR certification program and hopes to have multiple organizations ready to certify EHR products to eliminate bottlenecks in the process. Certification will assure that EHRs like Allscripts MyWay, can perform the functions called for in the standards and certification criteria final rule that ONC released. Several organizations have applied to be temporary certifiers and testers, and ONC hopes to evaluate and stand up quickly the certification organizations. Dr. Doug Fridsma, ONCs acting director of standards and interoperability, could not say if they would be operational by April 1, only that we are working as hard as we can to meet those timelines. Healthcare providers do not have to inform CMS which certified EHR system they are using until they submit information verifying they have met meaningful use requirements. That means providers may use a system that has not yet been certified but which they expect will qualify for certification by the time they fill out the CMS attestation module, Trudel said. Lets say if you have 90 days of meaningful use by April but does not have an EHR that is certified until March, you can still go ahead and attest, she said.
CMS will also set up a help desk to answer questions and offer basic information about the incentive program. Trudel said CMS and ONC will also make sure CMS regional offices and ONC regional extension centers, are communicating, so that if they get a question that is ours or we get a question that is theirs, we know how to reach each other. States, which administer Medicaid, are also busy readying their incentive programs for Medicaid providers. Trudel said that CMS will send by the fall a letter to state Medicaid directors with policy guidance to help states start up their programs. For more information call (877) 904-4EHR
