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Recent News Articles

Recent News Articles

Meaningful Use Mondays — Registering for EHR Incentive Money

Meaningful Use — Doctors Have No Choice

Physicians Already Seeing Early Impact of Healthcare Reform — Are You Prepared?

Meaningful Use — The Rules Explained At Last

Health Credit Cards: Proceed with Caution

Scanning Paper Charts in an EMR Office

Meaningful Use Incentives Jeopardized by GOP Bill

By Dan Bowman | Source: feircehealthit.com

January 28, 2011
Despite news Thursday that support for H.R. 408 —the Republican-sponsored House bill aimed at cutting $2.5 trillion in federal spending over the next decade--could mean the repeal of the Meaningful Use incentive program allotted in the American Recovery and Reinvestment Act of 2009, some people, including Justin Barnes, former leader of the HIMSS Electronic Health Records Association, have said they aren't worried.

Barnes, who now serves as vice president of marketing, corporate development and government affairs at Greenway Medical Technologies, calls the bill more of a "message bill" than anything else.

"I have zero concern about it taking away the incentives," he told Health Data Management. "It is a campaign promise."

Geoff Gerhardt, a senior staff member of the House Ways and Means Committee, didn't think it would amount to much, either. "I do think there may be a legislative attempt in the House to try to change some of the funding; however, I am confident that it's not going to succeed at the end of the day," Gerhardt said.

The bill, according to HDM, would repeal some ARRA provisions specific to Meaningful Use. Specifically, Section 302 of the bill states: "Effective on the date of the enactment of this Act, subtitles B and C of Title II and Titles III through VII of Division B of the American Recovery and Reinvestment Act of 2009 [Public Law 111-5] are repealed, and the provisions of law amended or repealed by such provisions of Division B are restored or revived as if such provisions of Division B had not been enacted."

Meaningful Use falls under Title IV of Division B, which means those incentive dollars would disappear if the bill became law, according to HDM.

Meanwhile, confusion abounds over the future of the Healthcare Information Technology for Economic and Clinical Health (HITECH) Act, should the bill be successful. HITECH falls under Division A, Title XIII of H.R. 408, meaning, for the most part, it steers clear of the chopping block.

However, Section 301 of the bill puts "un-obligated balances of the discretionary appropriations made available by Division A" of the stimulus law in jeopardy. In other words, if any of the $2 billion in discretionary spending money allotted to the Office of the National Coordinator for Health IT from HITECH goes unspent, it could be taken back, as well.

All of that has HIMSS Vice President for government relations Dave Roberts just a little on edge, reports Healthcare IT News.

"We're trying to tell people that this process is going on. This is only one body [of Congress]. Don't let this be a concern," he said. But "if this is a new way of thinking, that could be concerning. So I think that while this particular bill may not pass, it's something that has to be watched closely."

Patti Dodgren, CEO of Hielix--which helps to facilitate electronic health information exchanges across the U.S., shares Roberts' view.

"Just the suggestion of repealing HITECH stimulus funds for physicians...is short-sighted at best, and threatens the very progress that is already beginning to be realized within the industry to move our healthcare system into the 20th [yes, 20th] Century," Dodgen told FierceHealthIT. "All this bill serves to do is strengthen the cynics of health IT. We work with thousands of physicians and state government healthcare officials who have worked tirelessly over the past months to achieve the benefits that healthcare IT promises, and this bill is a disservice to them and to the healthcare industry"

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Meaningful Use Mondays — Registering for EHR Incentive Money

By Lynn Scheps, Vice President, Government Affairs at SRSsoft
Source: emrandhipaa.com

January 3, 2011
Registration for participation in the EHR incentives program begins today. It is done online (no paper registration, appropriately enough!) by using the registration link that should now appear on the CMS Registration and Attestation page. That page details all the information needed, so I will just remind providers who plan to participate under the Medicare program that they will have to be enrolled in PECOS (Provider Enrollment, Chain and Ownership System) — although not necessarily before they register.

While it is a good idea to begin familiarizing yourself with the registration process and requirements, there is no need to feel rushed. Registration does not have to be done immediately-it can even be done at the same time as attestation-and the earliest date that providers can attest to demonstrating meaningful use is April 1, 2011. Providers have until as late as October 1, 2012 to begin reporting on meaningful use and still earn the maximum reimbursement under Medicare — although it is clearly not advisable to wait until the last minute to start-and they can begin even later under the Medicaid provisions. (To be discussed in future posts.) The important determination eligible providers have to make upon registration is whether they will participate under Medicare or Medicaid, because once they receive their first incentive payment, they will only be able to switch programs one time. The next two Meaningful Use Monday posts will provide information to help providers make this decision.

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Meaningful Use — Doctors Have No Choice

By James O'Connor, MD — Source: Physician's Practice

EHR vendors, consultants, regulators, and even some CIOs have giddily promoted the EHR incentive program (“meaningful use”) for nearly a year. Countless businesses and blogs have been born to fulfill the need to ingest and digest compliance information. In-your-face marketing has been a powerful current sweeping doctors towards choosing an EHR system or meaningful use consultant.

Physicians' responses are all over the map. A surprising number of our colleagues still don't know about meaningful use. Some doctors plan to ignore it altogether. (It appears that the fewer the number of years to retirement, the greater the apathy towards meaningful use.) Some practices are optimistically and enthusiastically making plans. Others are revealing their ambivalence, wrestling with the question “should we or shouldn't we?”

I whole-heartedly support the adoption of electronic health records. I was an early adopter in my own practice and have spent a good deal of time in the industry. I am aware that the majority of my colleagues remain resistant to EHRs. Government incentives are a positive way to initiate widespread adoption. Meaningful use has its flaws, but the stimulus will fuel innovation in healthcare IT, potentially creating a powerful engine for economic recovery.

On the other hand, meaningful use places a burden on doctors with little direct return on investment. In most cases, the incentive will not cover the real cost of adoption, which includes more than just hardware and software. There is a well-documented productivity loss in the first 12 to 18 months after adoption of an EHR. It is widely reported that compliance with meaningful use will require medical practices to hire additional staff. Experts predict a shortage of staff with requisite skills. Meaningful use coincides with the planned elimination of the consult code and looming 21 percent cut in Medicare reimbursement.

Nonetheless, the pros and cons of meaningful use are not really the problem. The problem is that, once again, we physicians are subject to a mandate over which we have little control and no choice whether to comply. Is this surprising to you? Consider these facts:

OK, so technically, we do have a choice. We could stop taking Medicare and Medicaid patients, accept cash only, give up our board certification (and thus usually hospital privileges), and move to a state (or country) that doesn't impose EHR requirements. But is that really a choice? No. Our only real choice is action. Here are a few suggestions:

The final choice — watchful waiting — may seem like capitulation. But there are two reasons this may be the wisest course. First, there are many who doubt CMS' ability to deliver on the incentives. Small practices can probably wait until early- to mid-Spring 2011 to see what develops and still have enough time left in the year to choose an EHR and qualify for the 2011 incentive. Second, EHR vendors have a huge stake in this market. Vendors will have to introduce innovation into their offerings in order to distinguish themselves and win your business. The right innovation could make this pill easier to swallow.

James O'Connor is an OB/GYN, founder of MDcohort LLC, and co-chair of CCHIT's Clinical Research Group.

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Physicians Already Seeing Early Impact of Healthcare Reform -
Are You Prepared?

By Dr. Gunter Dymkova-Fuchs — Source: The Fox Group, LLC

Even though many provisions of the Patient Protection and Affordable Care Act are implemented in 2014, some are active right now. Many of these changes will affect what the covered services are for your patients, or even who will be eligible for coverage in the first place. Consequently, the practitioner will be able to potentially provide service that was not covered in the past.

Examples of coverage related changes due to heatlhcare reform:

• Young people can remain on parents' health insurance until age twenty-six;
• There can be no discrimination against children with pre-existing conditions;
• No dropping people from coverage when they get sick;
• There will be no lifetime limits on coverage;
• New plans must offer free preventive care; and
• There will be an expanded ability to appeal decisions made by the health plan

In addition to the changes in coverage for your patients, there are a number of requirements and operational impacts that providers are needing to reckon with. These changes can in some cases be far reaching, and require some fundamental reorganization for a number of solo and medical group practices.

Examples of operational changes in a medical practice due to healthcare reform:

• Physicians and other providers applying for Medicare participation will be required to have a medical Compliance Program in place. It is yet unknown if this requirement will extend to an existing Medicare participating medical group which is adding a physician or other practitioner who has not previously participated in Medicare, but it's safe to assume that that's the direction things are moving;
• States may use Recovery Audit Contractors (RAC's) for audits of state Medicaid programs. So anticipate more frequent and in-depth scrutiny. Developing and implementing effective Compliance Policies and Procedures that include internal monitoring, and risk-based coding and medical documentation, have become essential; and
• Efficient and effective medical group operations have always been sought, but as reform measures bring about the above described scrutiny, be aware of how much more critical billing practices, personnel management, and general practice operations are going to be if you are to prosper in this new environment. If you're unsure about your current status, or know that there are some rough spots, but are struggling to find solutions, consider having an independent third party review by a qualified healthcare management consultant. Someone who can properly review, evaluate, and give sound advice on necessary modifications. And someone who can help you put those changes in place.

Like so many policy changes, healthcare reform in this country is less than what some hoped for, but more than what others envisioned. That being said, it no doubt is going to play a significant role in physician practices. And the requirement for an effective compliance program formally transitioning from voluntary to mandatory should certainly be a catalyst for taking these changes seriously. Like with most things in business, being proactive is typically easier and more profitable than the alternative.

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Meaningful Use: The Rules Explained At Last

By Bob Redling, Bob Keaveney, and contributing editors at Physicians Practice

THE BASICS

The EHR incentive program was created by the Health Information Technology for Economic and Clinical Health Act (HITECH Act), part of the federal stimulus package signed by President Obama in 2009. The legislation provides incentives to each physician (and certain other providers) who meet HITECH's requirements.

There are separate programs for Medicare or the Medicaid participants; you must participate in one of these programs to be eligible for the incentive. If you participate in both, you may choose to participate in either incentive program - but not both. You may switch between incentive programs after you start, but only once.

Medicare offers physicians a bonus of up to $44,000 paid over a five-year period starting in 2011.The payments are tied to 75 percent of the physician's annual allowed Medicare Part B charges that year. If you start in 2011 or 2012, you can capture the maximum $18,000 bonus in your first year of participation by billing at least $24,000 in Medicare allowed charges.

Participation in the bonus program ends in 2015, so waiting until 2013 to begin drops your cumulative take to $39,000, and to $24,000 if you start in 2014. After that, physicians who still aren't using EHRs will begin to see their Medicare payments reduced; the penalties will go as high as 5 percent in 2019.

The Medicaid bonuses are geared to patient volume and there's no penalty for not participating. At least 30 percent or more of your patient volume must be Medicaid beneficiaries (but only 20 percent for pediatricians) measured over any continuous 90-day period in the program's first calendar year. Eligible professionals for Medicaid bonuses include nurse practitioners, certified nurse-midwives, and some physician assistants such as those working in rural health clinics or provider shortage areas.

For both programs, CMS will make bonus payments to each eligible professional in your practice. In other words, a group of three internists could receive $132,000 in total if each successfully participates in the Medicare program.

For practices more likely to refer patients to health credit cards, mostly dermatology, plastic surgery, ophthalmology and other specialties that offer noncovered procedures, it's essential to be clear with patients that they are signing up for a credit card with an outside company and not, as many patients claim they were misled to believe, a payment plan with the practice.

And although new credit card regulations that became effective last month limit the size of late fees and restrict interest rate increases on balances--another area of patient contention--the regulations continue to permit "teaser" or promotional rates, Gail Hillebrand, a senior attorney at Consumers Union, told the Washington Post.

While it's not the practices' responsibility to sit with patients and go over all of a card's terms and conditions, they should encourage their customers to read the information thoroughly before signing, says Maria K. Todd, MHA, PhD, CEO of global health provider network Mercury Healthcare.

THE RULES

The legislation sets four objectives for physicians to get the stimulus money. You must:

• Use certified EHR technology in a meaningful way;
• Utilize electronic prescribing;
• Use a system that electronically exchanges health information to improve the quality of care; and
• Submit information about clinical quality and other measures.

That first bullet concerning the "meaningful use" of an EHR raises questions about what qualifies as meaningful. In response, CMS recently issued final meaningful use rules: 15 mandatory requirements for providers (and 14 for hospitals), as well as a menu of 10 additional requirements, from which providers must select five. You must attest in writing to using your EHR to those capabilities for at least a 90-day period if you start during 2011 and for a full year if you start in 2012 or later. CMS plans to raise the bar further by adding more criteria in subsequent years of the bonus program.

What are the meaningful use criteria? Here is the full list as compiled by David Blumenthal, MD, director of the Office of the National Coordinator for Health Information Technology (ONC) and Marilyn Tavenner, RN, principal deputy administrator of the CMS, in the New England Journal of Medicine. Note: We've modified the list slightly from the version in the New England Journal, in order to make it more user-friendly. The list as originally compiled can be found here.

CORE REQUIREMENTS

To achieve meaningful use of an EHR, providers must meet the following 15 core requirements under the objectives in Stage 1:

1	Record patient demographics
2	Record and chart changes in vital signs
3-5	Maintain active problem, medication, and allergy lists
6	Record smoking status
7,8	Give patients an electronic copy of their health information and a summary of clinical data
9	Generate and transmit permissible prescriptions electronically
10	Use computer provider order entry for medication orders
11	Implement drug-drug and drug-allergy interaction checks
12	Implement one clinical decision support rule and the ability to track compliance with that rule
13	Implement system to protect the privacy and security of patient data
14	Report ambulatory quality measure to CMS or the state
15	Implement the capability to electronically exchange key clinical information among providers and patient-authorized entities

MENU

Providers must also meet at least five criteria of the following "menu" of 10:

1	Implement drug formulary checks
2	Incorporate lab test results as structured data
3	List all patients who have a particular medical condition, for at least one condition
4	Identify and provide patient-specific educational materials
5, 6	Reconcile medications and provide summary records during encounters and transitions of care
7, 8	Show ability to provide data to public health agencies and immunization registries
9	Send patients preventive and follow-up care reminders
10	Provide patients with timely electronic access to their health information

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Health Credit Cards: Proceed with Caution

By Debra Beaulieu

Despite revenue-cycle and practice-management experts' early enthusiasm toward encouraging patients to pay for their noncovered care with healthcare credit cards--for which patients apply for right in the office, yielding practices' faster collections--experience has revealed a number of flaws in this solution.

And it's not just New York Attorney General Andrew Cuomo's current investigation in to health credit cards offered by major lenders--including GE Money, JPMorgan Chase and Citigroup--that has made such outside financing options less attractive to patients and practices. According to practice-operations expert Elizabeth Woodcock, MBA, FACMPE, CPC, of Atlanta-based consultancy Woodcock & Associates, patients' track record of defaulting on such loans has led GE's CareCredit and others to be less interested in retaining physician practices as clients. As a result, these companies "have not expanded and sometimes even retracted their business in the medical practice market," Woodcock says.

For practices more likely to refer patients to health credit cards, mostly dermatology, plastic surgery, ophthalmology and other specialties that offer noncovered procedures, it's essential to be clear with patients that they are signing up for a credit card with an outside company and not, as many patients claim they were misled to believe, a payment plan with the practice.

And although new credit card regulations that became effective last month limit the size of late fees and restrict interest rate increases on balances--another area of patient contention--the regulations continue to permit "teaser" or promotional rates, Gail Hillebrand, a senior attorney at Consumers Union, told the Washington Post.

While it's not the practices' responsibility to sit with patients and go over all of a card's terms and conditions, they should encourage their customers to read the information thoroughly before signing, says Maria K. Todd, MHA, PhD, CEO of global health provider network Mercury Healthcare.

Better yet, both experts who spoke with FiercePracticeManagement say, practices should strive to improve their systems of administering and monitoring internal payment plans for patients' large out-of-pocket costs.

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Scanning Paper Charts in an EMR Office

By John Meewes, President of National Scanning.

Discretionary scanning, hiring temporary help, and re-purposing office staff to scan patient charts has been a growing trend.

While the costs associated with these practices may at first glance seem lower, there are hidden costs and liabilities that far outweigh the expected savings.

When selecting a scanner, the first number potential buyers see is the "Pages per Minute" (ppm). This is the number of sheets that the scanner can read under optimum conditions (and usually at lower resolution and page size). The number usually not published or ignored is the daily duty cycle - often just several thousand pages per day.

In real world settings, the actual throughput is less than 1/4 of the published PPM. Jams, indexing, and software glitches all slow the process. Equipment maintenance, software installation, training, and employee turnover further add to the time spent on the scanning project.

As labor costs (which are a function of throughput) increase fourfold or more, the ROI model that may have initially shown cost savings with a "do it yourself" project may no longer support that decision.

Most importantly, though, is the liability physicians face for improperly scanned charts. Transient help is cheap, but they have no responsibility to monitor quality, ensure that records are properly filed & attached to EMR, or to ensure that misplaced records are found. We even worked with a physician who had temporary help literally throwing charts away to create the illusion of higher productivity.

Physicians are required by law to maintain a medical record for each patient which completely and accurately documents the person's evaluation and treatment. The failure to maintain a record for each patient constitutes professional misconduct. A missing chart could have serious consequences on the provider's ability to defend themselves in a malpractice claim. If you can't produce the documentation, then your version of the events will be suspect.

Reputable service bureaus have quality and auditing measures in place to ensure accurate and complete conversion of paper charts. While the upfront costs may seem higher, the peace of mind and longer term savings are worthy of consideration.

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