ARRA Articles - Medical Practice Trends

Will High Court Kill Healthcare Reform?

December 21, 2011 By Peter Polack Leave a Comment

Although most people like to think that the Supreme Court is above playing politics, some healthcare experts see signs that it might be leaning towards trying to gut the national healthcare reform law. An article on UPI.com says that the high court, dominated by a 5-4 conservative majority, has shown evidence of prejudicial behavior.

While some on the right have called for Justice Kagan to recuse herself – because she was “the Obama administration’s top courtroom lawyer when the Patient Protection and Affordable Care Act was rammed through Congress over bitter Republican opposition” – the left are calling for Justices Thomas and Scalia to withdraw from the case before they were wined and dined by the law firm that will argue the case before the Supreme Court.

Others say that there is a high likelihood that the Court will opt to punt on the controversial case by claiming that federal law bars court challenges such as this one that are brought by the states.

How to Qualify for Meaningful Use Incentives – Part 2

May 26, 2011 By Peter Polack Leave a Comment

In part 1, we discussed some of the nuances of registering for Meaningful Use (MU) reporting and why most practices would be better off waiting until 2012 – such as still being able to qualify for E-Prescribing incentives. In part 2, we give you an action plan for getting your practice ready for MU.

How is the MU Reporting Actually Done?

For 2011, practices could merely report they are using EHR in a Meaningful Use without actually sending anything to CMS – this is known as attestation. For 2012, attestation alone is insufficient. CMS will require practices to report on their meaningful use criteria, which for most practices will be a total of 20 (all 15 Core Set and 5 out of the 10 Menu Set items). Some items in the Core Set only need to have functionality enabled (such as Exchanging Critical Information) or performed at least once (Security Risk Analysis). Others will become a daily part of a practice’s workflow (such as Smoking Status or Demographics) and must meet a certain threshold (such as 50% of the number of unique patients seen for the year), unless they are not appropriate for a physician in a particular specialty. For example, an ophthalmology practice does not routinely check vital signs so would report a denominator of zero for that criterion. For a list of the Core and Menu Set objectives see EHR Incentive Programs

Many certified EHR systems will have a means to upload the report files to CMS, either directly or using report-generating software such as Crystal Reports, while other practices may use a third party solution such as registries, the same ones that were helping physicians report PQRI. But while Stage 1 may consist of simply requiring a practice to report on a specific criterion, Stage 2 may contain additional requirements and higher thresholds.

An example of this would be providing a Clinical Summary Report for a patient: In Stage 1, you can document the patient’s preferred format but do not necessarily need to supply it to them in that format, whereas in Stage 2, you might have to comply with that request. And this can make the reporting process that much more onerous.

Advice from a Practice Ready for MU

Sandra Regenye, Director of Billing for Horizon Eye Care in NJ, has these recommendations for getting a start on Meaningful Use:

Make sure you are using a certified EHR (EMR) system (click here for a list of ONC-certified EMR systems).
Make sure you have a solid understanding of the MU requirements.
Do your homework. Don’t count on any one resource to base your plan on. Check your EMR vendor’s resources, CMS, or OMB, for example, for webinars, podcasts, and white papers.
Go through all of the measures to see which ones apply specifically to your practice. For example, vital signs would not be an appropriate measurement for an ophthalmology practice, so the denominator for reporting purposes would be zero.
Take a look at your workflow processes and see how they are potentially impacted by the collection of data for the requirements. An example would be the preferred language of the patient – when is it collected, by whom, where is the information stored, and is it a required field in your system (it should be).
Then check your EMR templates to see where this information is entered and stored. It may not be where you need it, when you need it.

Getting Ready for the Reporting Process

For this year, the first year of Meaningful Use, practices are only required to attest to the fact that they are meeting the MU requirements. Attestation means you are collecting the data in some fashion, even if you are only doing it manually, as on a spreadsheet. For 2012, practices will need to actually collect and submit the data to CMS. The attestation process officially began on April 18, 2011. CMS offers webinars and updates with specific details. Ms. Regenye says these have not been real clear, “but they are getting better.” She recommends that all practices register with Medicare now, even if they don’t have an EMR system yet.

How to Qualify for Meaningful Use Incentives – Part 1

May 12, 2011 By Peter Polack 3 Comments

Like many things in life, you can either choose to do something or wait until something happens to you. Many physicians are taking the latter approach when it comes to electronic medical records implementation and the Meaningful Use (MU) incentives from CMS. Their feeling is that it would be safer to wait until EMR systems are perfected (which they never will be), to wait until the government certifies a particular EMR system (which they never will do), and until the MU requirements are 100% unambiguous (dream on). These things may never come to pass. And after 2012, the MU incentives will start to decrease and then reimbursement penalties will kick in.

Meaningful Use: What’s the Point?

In his 2004 State of the Union address, President George W. Bush outlined his plan for the adoption of electronic health records that could be accessed by all citizens in the United States. The Department of Health and Human Services (HHS) then created a 10-year map to implement that plan, although there was no specific funding set. Then in 2009, as part of the American Recovery and Reinvestment Act of 2009, the HITECH Act (Health Information Technology in Economic and Clinical Health) allocated almost $30 billion to push the adoption of EHR through the use of financial incentives. Subsequently, rules were created that required those providers seeking incentives to prove they were using certified electronic health records technology according to a set of guidelines of quality healthcare, or in a ‘meaningful use’ manner.

Non-MU Incentives Aren’t Too Shabby Either (or Why Waiting Until 2012 May Be More Profitable)

In the case of our practice, we had transitioned our old practice management (EPM) system to a new one with an integrated EMR a few years ago, but felt it prudent to wait a bit before we attempted to implement the EMR module. That came about at the end of 2008, so now that we have about 2 ½ years of ‘live’ experience with EMR, we are turning our attention to the MU incentives. But we haven’t been idly sitting by. Using software we developed in-house, we have been qualifying for both PQRI (Physician Quality Reporting Initiative) and E-Rx (E-Prescribing) incentives since their inception, in 2007 and 2009 respectively. Those have resulted in as much as a 4% bonus of our annual Medicare fees.

Although Stage 1 of Meaningful Use officially begins 2011 – with Stages 2 and 3 slated for 2013 (for the time being) and 2015, respectively – we decided that we would wait until 2012 before seeking the Meaningful Use (MU) incentives. The Office of the National Coordinator on Healthcare IT (ONC) announced that practices can qualify for the full MU incentives starting either in 2011 or 2012. They also ruled that practices can also get PQRI incentives concurrently with the MU incentives. So why would we wait another year? ONC also ruled that MU would disqualify ERx incentives, so this would give us another year of E-Prescribing bonuses plus another year to get our practice ready for MU. This means, however, that we have only one year to prepare for Stage 2 in 2013 instead of two, but this mostly builds on the work that needs to be done for Stage 1. (And, did I mention this means more money?)

Some Practices are Ahead of the Curve

Horizon Eye Care is an eight-doctor ophthalmology practice in Margate, New Jersey. Like our practice, they use an integrated EMR/EPM system from NextGen, but they have been using the EMR module for the past 10 years. According to Sandra Regenye, Director of Billing, they were ready to qualify for MU this year, but also decided to wait until 2012, since there was no decrease in the total incentives for waiting. And in addition to being able to collect ERx incentives for 2011 (which are excluded under MU), this is allowing their practice to perform simulations to test run the reporting process.

Ms. Regenye points out that it is the practice that must be a meaningful user of EMR, not the EMR system itself. “If you are not using your EMR in an appropriate manner, then you are not a ‘meaningful user.’ Even the best, certified EMR system cannot magically qualify you for MU incentives. There is no ‘plug-and-play’ for meaningful use. “

In part 2, we’ll map out your Meaningful Use incentives action plan.

Few Medical Devices Connect with EMR Systems

December 8, 2010 By Peter Polack 2 Comments

According to a white paper from HIMSS Analytics, fewer than a third of US hospitals report having active interfaces between medical devices and their EMR systems, according to FierceEMR blog. And the situation with individual medical practices can’t be much better. Although this might not sound like a big deal to most, the inability to interface medical devices with your EMR system can jeopardize satisfying Meaningful Use criteria and their potential financial incentives. Do you have any critical medical equipment that does not connect with your EMR system? If so, what do you plan to do about it?

Webinar: Federal EHR Incentives and the HITECH Act – Part 2

December 7, 2010 By Peter Polack 4 Comments

In this two-part webinar video, Jeff Grant, President of HCMA Inc., discusses the details of the Federal Electronic Health Records incentives as described the HITECH (Health Information Technology for Economic and Clinical Health) Act. In part 1, he defined eligibility criteria and the Meaningful Use Final Rules. In part 2, he goes on to describe the Menu Set criteria, Clinical Quality Measures and Reporting, and Meaningful Use Demonstration.

CLICK HERE to download a PDF of the slides

Check Out Our Webinar on Federal EHR Incentives

December 6, 2010 By Peter Polack 2 Comments

In our videos section we have a webinar full of great information on the HITECH Act Federal Electronic Health Records incentives. Our guest is Jeff Grant, President of HCMA Consulting Inc. Today we present part 1, where he discusses some of the definitions of eligibility criteria and the Meaningful Use Final Rules. Tomorrow, in part 2, he goes on to describe the Menu Set criteria, Clinical Quality Measures and Reporting, and how to demonstrate Meaningful Use.

Webinar: Federal EHR Incentives and the HITECH Act – Part 1

December 6, 2010 By Peter Polack 3 Comments

In this two-part webinar video, Jeff Grant, President of HCMA Inc., discusses the details of the Federal Electronic Health Records incentives as described the HITECH (Health Information Technology for Economic and Clinical Health) Act. In part 1, he defines eligibility criteria as well as the Meaningful Use Final Rules. Tomorrow, part 2.

CLICK HERE to download the PDF of the slides

Bonus Resource – Health Reform Timeline

October 5, 2010 By Peter Polack 1 Comment

From the folks at Aetna Health, here is a graphic demonstrating the timeline for health reform 2010-2020.

Click on the chart or the link below to download it.

Bonus Resource – ARRA Meaningful Use Spreadsheet

September 22, 2010 By Peter Polack Leave a Comment

From our partners at Software Advice comes this handy checklist for ARRA Meaningful Use Criteria that you can use for evaluating electronic medical records systems. Rate each system from 1 to 5 and add additional rows for your own specific criteria.

CLICK HERE to download the ARRA Meaningful Use Criteria Spreadsheet

EHR Technology Use Survey

September 8, 2010 By Peter Polack 2 Comments

Physicians Practice has released its annual Technology Survey, and it looks specifically at the effect that federal financial incentives are having on the implementation of EHR in medical practices. Some interesting tidbits:

More than half of practices surveyed stated that the stimulus funds make them more likely to buy and EMR system (big surprise)
Of those practices already using an EMR system, about half said that it took somewhere between six and twelve months to complete implementation
Two-thirds of practices with an EMR system expect to see a return on their investment
Two-thirds of practices with EMR maintained the same level of staffing, while 10% added staff, and 10% laid off staff
Two-thirds of practices surveyed said the meaningful use rules were unclear and too confusing
Over 70% of practices with EMR said it has improved their practice’s workflow efficiency
38% of practices surveyed said the economic downturn is causing them to delay health IT purchases
About 12% of practices spent about $10K per provider and almost 25% paid more than $12K per provider