1. Act now to take advantage of the carrots and avoid the stick. The Medicare and Medicaid EHR incentive programs will provide incentive payments to eligible professionals, eligible hospitals and critical access hospitals as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology. The Medicare incentives will be available for physicians demonstrating meaningful use in calendar years 2011-2015. The program is well underway and a number of medical groups are expected to receive checks in the coming months.
The best strategy for any medical group is to begin adoption of an EHR system as soon as possible and take advantage of the "carrots," the incentive payments. Starting in 2013, the Medicare incentives start to phase out, with incentives completely ending in 2015, and physicians who cannot demonstrate meaningful use will face a series of "sticks," or escalating penalties.
Under the program, eligible professionals (physicians not directly employed by hospitals) are eligible for up to $44,000 in payments over five years through Medicare, or up to $63,750 over six years through Medicaid. You may choose either federal program; you can't collect through both.
2. Just having a "certified" EHR system does not guarantee meaningful use. The government has now certified more than 300 ambulatory and inpatient EHR systems. The full list of products is available at the Office of the National Coordinator for Health IT (ONC) website: http://onc-chpl.force.com/ehrcert.
Certification simply means an independent evaluator has verified that the EHR system has all basic functionalities needed for meeting meaningful use in a particular area (e.g., hospital inpatient, emergency department, E-prescribing module). Once you have purchased your certified system, however, the individual physicians in the medical group must document (report and attest) that they are actually using it in a number of specific ways to qualify for the government incentive payments.
3. Orthopedic practices can collect the needed data with a few key workflow changes. Many orthopedic surgeons have expressed concern about the scope of the data collection requirements in the program. Most primary care facilities see 15-20 patients per day, many of which are follow-up visits. Many specialty practices, however, may see 40-60 patients per day, a large percentage of which are new patients.
In terms of EHR data collection, follow-up visits are relatively simple since the patient data has already been entered into the system. New patients, on the other hand, require a new record to be created in the EHR system. Under the meaningful use program, physicians will be required to select from a "menu" of patient data reporting measures. This allows a choice of some options in data entry. All physicians, however, must report three "core" measures of quality: blood pressure management, tobacco use screening and adult weight screening and follow-up.
Since orthopedic practices have generally not collected this information, this will mean a workflow change. While these three core data points can be collected by nurses or physician assistants, the orthopedist will need to document his or her evaluation of the patient. Thus orthopedists should look for EHR systems that focus on speeding up the data entry process through dictation or click minimization. In addition, physicians who are selecting a EHR system for purchase should "test drive" features such as chart review, e-prescribing, order creation and tracking to make sure they are comfortable with the data entry and retrieval process.
4. Your EHR vendor should help you with compliance. Your EHR vendor should be an effective technology partner for your practice as you seek to meet the meaningful use requirements. Your vendor should be able to counsel you and your staff on the needed workflow changes and suggest new procedures to handle the new data reporting requirements. Ideally, the vendor can work with you on test runs to make sure all the necessary data fields are being populated correctly.
In addition, your vendor should be able to suggest techniques to meet the other requirements of the incentive program. For example, one rule requires physicians to "provide patients with timely electronic access to their health information (including lab results, problem list, medication lists and allergies)."
Many orthopedic practices find that the best way to comply with the "timely access" requirement is to create an Internet-based patient portal, where the patient information can be quickly uploaded and read by the patient. Your EHR vendor should be able to advise you how to create and maintain patient portals to meet this requirement.
5. Best preparation for Stage 2 meaningful use is compliance with Stage 1. The Office of the National Coordinator, the government's health information technology planning office, is currently accepting comments and planning workshops to define the Stage 2 meaningful use requirements. These additional requirements are scheduled to take effect in 2013. While it is not clear how strict the next level of requirements will be, we do know that many of them will be extensions or refinements of the Stage 1 directives. When 2013 arrives, practices that are fully compliant with Stage 1 requirements will be in a good position to meet the Stage 2 rules.
It is important to understand that there are many solid reasons for adopting EHR systems beyond the government's financial incentives. A business that is run on paper is highly inefficient. When specialists have access to digital patient charts created by referring physicians, they can make clinical decisions faster and more accurately. When fully in use, an effective EHR can lead to substantial cost savings for specialists. In many cases, employees that were formerly assigned to paper document management can be reassigned. Transcription costs can be reduced or even eliminated.
There will be no turning back of the clock. The era of EHRs has arrived, and every practice will need to adapt accordingly. Practices that get started early and use their EHR vendor as a technology partner will find themselves in a good position for the additional requirements to be faced in the coming years.
Learn more about ChartLogic, a national provider of EHR systems to orthopedic practices.
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