Medical Practice Trends.com » Reimbursement

CMS Meaningful Use Rules, Part 2

Peter Polack — Thu, 22 Jul 2010 14:06:30 +0000

In part 1, we introduced the different stages of meaningful use criteria as defined by CMS in their final rules, released July 13, 2010. Many practices and hospitals breathed a collective sigh of relief on the one hand, as several criteria had thresholds that were less onerous than were originally proposed. It seems that CMS has been listening.

Thresholds for CPOE and e-Prescribing

For example, as we mentioned earlier, the threshold for meeting criteria for CPOE (computerized physician order entry) is now set at 30%. This means that only 30% of unique patients (not total patient visits) need to have at least one order entered into the electronic medical record system to meet those goals.

Another example is electronically transmitted prescriptions or e-Prescribing. Originally set at 75% of “permissible prescriptions”, this has been dropped to “at least 40%”. This was due in part to objections that (1) some pharmacies are not quite ready to accept e-Prescribing and (2) some patients insist on getting a paper prescription.

Structured Data vs Unstructured Data

Along the subject of prescriptions, an active medication list must be maintained on patients (with the default threshold of at least 80% of unique patients) in the form of “structured data”. Structured data refers to data that can be identified by the EMR system. In other words,

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Post tags: ARRA, EHR, electronic medical record, EMR, meaningful use

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CMS Releases EHR Adoption Rules, Part 1

Peter Polack — Wed, 14 Jul 2010 14:00:36 +0000

On Tuesday July 13, CMS released the final rule for adopting a certified electronic health record (EHR) system.

After listing about 60 acronyms and abbreviations (and it’s impossible to remember them when reading the subsequent text), what follows is approximately 800 pages of proposals, related comments, and final rulings.

All this is to spell out the meaning of meaningful use (which we first touched on in October ), how to be considered an EP (eligible professional) and when said EP can expect to first receive any kind of incentive payment – for the early adopters, the first “payment year” is calendar year (CY) 2011.

When you actually receive the payment could be the end of the following calendar year). Hospitals will typically be incentivized on a fiscal year (FY) basis.

We’ll attempt to digest this compelling tome, one 100-page piece at a time (or so). Keep in mind, though, that this is only what CMS considers “Stage 1″ of the meaningful use criteria. Stage 2 criteria are expected by the end of 2011 and Stage 3 criteria by the end of 2013. The idea is to have an “initial graduated approach to arriving at the ultimate goal”: total enlightenment of EMR, I suppose.

As we previously mentioned, a meaningful user is one who:

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Post tags: ARRA, CMS, EHR, HITECH, meaningful use, medicare, Stage 1 criteria, Stage 2 criteria, Stage 3 criteria

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ePrescribing and PQRI: Are You Leaving Money on the Table?

Peter Polack — Mon, 15 Mar 2010 14:30:21 +0000

As the time approaches when potential financial incentives for the widespread use of electronic medical records (EMR) finally kick in, there is increasing excitement and anxiety among medical practices. Unfortunately, there is also a lot of confusion.

What is the difference between the financial incentives from the Stimulus Bill and bonuses from ePrescribing or those from PQRI (Physicians Quality Reporting Initiative)?

And what do you need to do to qualify for and then claim these incentives and/or bonuses?

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Post tags: ARRA, ePrescribing, eRx, HITECH, meaningful use of emr, pqri, PQRI Toolset, Protodrone

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Study: Current EMRs not good for care coordination

Frank Polack — Thu, 07 Jan 2010 20:15:17 +0000

One of the goals of meaningful use and all the related federal spending of health IT is for EMRs to improve care coordination. But the current reimbursement system that’s heavy on fee-for-service encourages software developers and users alike to focus on documentation of billable events rather than coordination of care, a new study finds.

What Exactly IS Socialized Medicine?

Peter Polack — Sat, 19 Jul 2008 03:40:28 +0000

Every so often, a visitor from afar (usually from Canada or Great Britain) will comment on the plight of the American health care system and the advantages of their “nationalized” health service. Yes, we certainly have our share of troubles here in the US. And if the current news is any indication, the upcoming election is shaping up to bring more uncertainties for the medical profession – regardless of which political party we are talking about.

A recent blog on ZDNet mentions a survey of Dutch citizens who are generally happy with their form of health care, which is primarily a government-sponsored system with some private carriers (similar to the system implemented in Massachusetts). All people are required to carry insurance, in some cases with government subsidies, relieving employers of the burden of

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Post tags: British health care system, Dutch health care system, health care costs, Medicare advantage plan, socialized medicine

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Dirty Tactics of Those Medicare Advantage Plans

Peter Polack — Thu, 10 Jul 2008 15:42:24 +0000

Once again we were saved from another Medicare cut at the last minute. This is really getting old. The only consolation is that for once it is getting more press coverage than in the past, mostly with the (correct) slant that these cuts will ultimately hurt Medicare beneficiaries. Several Republican senators changed their votes from their previous positions on HR 6331 to yes after receiving a lot of flack from their constituents, many of them physicians.

Someone (a Fox News follower) said, “There must have been a reason that those senators voted against it.” Well, yes, apparently there was.

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Post tags: HR 6331, medicare, medicare advantage, privatized health care, socialized medicine

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Pay for Performance, or Performance for Pay?

Peter Polack — Fri, 18 Jan 2008 02:35:14 +0000

The new federal pay-for-performance pilot program may prove to be short-lived.On December 20, 2006, President Bush signed into law the Tax Relief and Health Care Act of 2006 (TRHCA). A broad tax reform omnibus that also included a number of key health care measures, the bill authorized the establishment of a pay-for-performance program known as the Physician Quality Reporting Initiative (PQRI). According to the website of the Centers for Medicare & Medicaid Services, PQRI establishes a financial incentive of up to 1.5% of the total allowed charges for covered Medicare physician fee schedule services for eligible professionals whose performance meets a designated set of quality measures.

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Post tags: healthcare, Insurance, performance, Reimbursement

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Where Does All the Healthcare Money Go?

Peter Polack — Fri, 18 Jan 2008 02:12:11 +0000

Why is the cost of healthcare going up when doctors’ reimbursement keeps going down?If doctors are getting paid less and less by managed care insurance companies, why is the cost of healthcare rising exponentially in the country? Just look at the stock returns of these same insurance companies. And while physicians on average have seen about a 95% decrease in reimbursement in the last ten years, compare this to the compensation of the CEOs of these companies: $358 million for one CEO of a health insurance company.

If you add the total compensation of the top ten insurance company CEOs, this equals 1/900 of the total healthcare expenditure of the United States. In other words, 1/900 of all the money spent on healthcare in the US goes to ten people.

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Post tags: compensation, costs, healthcare, Reimbursement

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