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'Meaningful use' requirements add red-tape challenges for providers

A major focus for healthcare providers this year is gearing up for compliance with new federal mandates related to electronic healthcare records. The EHR Incentive Program, commonly referred to as “meaningful use,” will reimburse medical facilities and practices for implementing electronic health records and complying with a host of reporting requirements.

The challenge with the program, according to healthcare professionals, is the complicated compliance process for demonstrating eligibility for reimbursement-as spelled out in a 274-page federal register-and the penalties attached, in the form of decreased Medicaid or Medicare reimbursements in a few years. The incentives will only cover only part of the expenses related to the implementation to EHR and some medical offices are having to move to the adoption of electronic records ahead of their planned schedule in order to receive the full available amount.

Physicians have to choose either Medicaid or Medicare for the incentives while midlevel providers (nurse practitioners and physician assistants) can only participate if they have at least 30 percent of their visits from Medicaid patients. They must go through attestation each year of program participation in order to get the reimbursement. For Medicare, medical facilities can be reimbursed for up to $18,000 during the first attestation year (either 2011 or 2012), with a decreasing amount every year and a total of up to $44,000 over five years. Those attesting in 2013 or 2014 receive incentives for only four and three years, respectively, with a smaller total.

“We had planned to go to electronic health records but maybe not as quickly,” said Megan McDermaid, assistant clinic administrator for Kitsap Cardiology Consultants. “We’re spending several hundred-thousand dollars to get our HER with meaningful use and we have the opportunity to get some of it back.”

Meaningful use is a provision in the Health Information Technology for Economic and Clinical Health Act, part of President Obama’s economic stimulus package in 2009. The provision authorized incentives for Medicaid and Medicare providers for using electronic health records in “meaningful ways” that lead to a significant improvement in quality and efficiency of healthcare. The idea behind the act was to reduce health disparities, improve coordination of care and get patients more involved in their care, among other things.

Phase one of this process includes 15 mandatory requirements, plus five additional ones they can choose from a set menu. One core requirement has five parts, which brings the total categories to 25. There will be two other stages.

“It’s additional administrative work that involves a number of people and takes time every month to review the information, look at areas where individual providers may not be meeting the requirements, and working with them and their staff to help them make sure they’re using electronic records properly,” said Gary Kriedberg, director of operations for Harrison Health Partners.

Providers don’t have to participate in the incentive program; however, those choosing not to participate in the EHR reporting requirements will be assessed penalties in the form of reduced Medicaid or Medicare reimbursements. Some physicians who are within five to 10 years of retirement are choosing to be out of compliance instead of investing the large amount of money into an electronic records system.

Of 302 executives surveyed earlier this year at a Healthcare Information and Management Systems Society conference, one third said meaningful use was their single most-important priority for the IT department this year. Last year, Becker’s Hospital Review quoted an InformationWeek survey that found about 62 percent of providers who had or were planning to implement EHR were estimated to spend one-fifth of their IT budget on projects related to meaningful use.

“Part of meaningful use is that you have to meet these certain criteria and there’s no easy way to track it unless you’re writing it in, so you have to write a form and then translate it into checkboxes in the computer. You have to structure it in the background for those specific measurements,” said Brandi Diaz, IT manager and EHR lead at Kitsap Cardiology.

She said from a patient perspective, there are several potential benefits. For example, e-prescribing is another separate requirement of EHR, which helps eliminate prescription errors. Patients will also receive a visit summary that includes lab information. Practitioners will also be able to share patient data through information exchange systems. But for physicians, it’s additional time to complete all the electronic paperwork and a new learning curve that could take time away from patient care.

“They’re trying to learn something new while taking care of patients,” McDermaid said. “And they still prefer face-to-face contact with other providers or getting on the phone to discuss a case.”

One component of the EHR system is the transmission of clinical quality data to agencies, including clinical outcomes, and a comparison to national guidelines developed by clinical organizations based on best practices.

“Without meaningful use, we wouldn’t have to (track it) but when you look at core measures, it really is good medicine and a good way to practice,” Kriedberg said. “To a degree, it’s about standardizing and they’re evidence-based measures reviewed nationally.”

Some physicians have expressed concerns due to the patients’ feelings about the physician constantly recording information during an exam, he said. “One of the challenges it the concern about how intrusive computers may be in the exam room,” he said. “There’s a big cultural shift going on and as we move more and more to paperless ways of communicating lab results and things like that, the older population may also have more trouble.”

Kriedberg said this kind of technology would continue to change how healthcare is delivered. Harrison Medical Center, for example, plans to launch an online patient portal that will allow patients to schedule appointments, check lab results and other things.

“There’s a lot coming down the road that will continue to change the historical relationship between the provider of care, the patient and the system,” he said.

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