WASHINGTON, D.C.—Rheumatology practices of all sizes are considering the most cost-efficient and effective ways to achieve Meaningful Use, standards created by the Centers for Medicare and Medicaid Services (CMS) to promote the adoption of electronic health records (EHR) systems through incentives and, starting in 2015, reimbursement penalties.
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Standardized recordkeeping, improved communication among providers, exchange of health information to improve quality of care, and better patient engagement and health outcomes are the lofty goals of the program, part of the Health Information Technology for Economic and Clinical Health Act passed in 2009. Eligible providers may receive bonuses if they switch to EHR systems and begin reporting key clinical quality-measures data and sharing records with patients.
Not everyone is on board yet, but they should be making plans to do so, said Robert Warren, MD, PhD, chief medical information officer at the Medical University of South Carolina in Charleston. Dr. Warren spoke about Meaningful Use at a session titled, “The Guide to Meaningful Use and Beyond,” at recent 2012 ACR/ARHP Annual Meeting, held here November 9–14.
Eligible Medicare providers may now access up to $44,000 paid over five years for achieving Meaningful Use Stage One, which includes implementing EHR systems, reporting certain patient data through coding, and providing patients with copies of their health records. Providers may also take advantage of up to $63,750 in Medicaid incentives, Dr. Warren added.
Meaningful Use is rolling out in three stages. Stage One started in 2012 and 2013 and focuses on incentivizing physicians to install EHR systems and begin reporting key data on patients. Stage Two launches in 2014 and involves more sharing of electronic prescribing and lab results across providers. Stage Three starts in 2016 and includes standards to offer patients more access to self-management tools and sharing data to improve public health.
Too Much Time and Money?
Some rheumatology practices may be reluctant to invest money in new technology or time in training staff to manage the new recordkeeping systems and reporting clinical quality measures, Dr. Warren said. He urged skeptical rheumatologists in the audience to explore web-based EHR systems that cost as little as $100 a month and require no purchase of new software. Web-based systems are also easier to upgrade, he said. If incentive money is not enough of a lure to urge doctors to act now, he noted that Medicare providers who do not achieve Meaningful Use standards will incur 1% reimbursement penalties starting in 2015. Penalties rise to 5% by 2019.
“Market pressure is expected to become relatively extreme as CMS plans to publish lists of Meaningful Users. There will be multiple private insurers who will only work with Meaningful Users,” Dr. Warren said. The goal of Meaningful Use is to collect structured data on patients, including information like medications, allergies, or smoking status, and to use that data to support and coordinate patient care, he noted. “Are you going to focus your practice on care improvement by implementing Meaningful Use and implementing feasible processes? You can get incentives and avoid penalties by doing one or both. Every certified electronic health record system ought to make this relatively easy.”
During Stage One, physicians are required report only three out of six clinical quality measures, such as blood-pressure measurement, tobacco-use assessment and cessation intervention, and adult weight screening and follow-up, said Dr. Warren. “Rheumatologists are feeling the pain because none of the additional clinical quality measures have specific relevance to rheumatology,” he noted. However, rheumatologists might choose to track measures that are meaningful for their practices and their patients and are easy to achieve. One example: preventive care and screening for influenza. The disease can be dangerous for people with autoimmune diseases, and CMS counts screenings for all patients six months or older toward reporting goals. Providers may report measures through either attestation or eReporting pilots.
“All CMS really wants to know now is that you got the data, not that you are showing valuable outcomes. In Stage One, it’s not about performance,” Dr. Warren said. In Meaningful Use Stage Two, standards will become more complex: Providers will have to report on nine of 64 approved measures.
Rheumatologists who have not yet adapted their practices will have a tough time getting the full $44,000 incentive for 2013 because they must achieve a 365-day reporting period, Dr. Warren said. If a practice has not yet made the switch, it may be wise to sign on next year in time for Stage Two, which will require only a 90-day reporting period in 2014, he said.
Not all practices that have installed EHRs have achieved Meaningful Use, said Craig Carson, MD, a rheumatologist at the Oklahoma Arthritis Center in Edmond, Okla., who shared his experiences. His six-provider practice handled 14,311 patient visits in 2011 and has used electronic systems since 2006.
Dr. Carson spoke highly of the benefits of electronic prescribing and clinical lab-test results recordkeeping but pointed out that the systems have their pitfalls. One is matching patient demographics to set definitions provided by the government. Another is tracking other measures that don’t seem relevant, he said. “The government’s idea of meaningful may not match what you or I see as meaningful,” he added. However, it’s important to enter data so a practice may get credit for their work, achieve incentives, and avoid future penalties, Dr. Carson stressed.
Rheumatologists must understand how their EHR system works, and, if necessary, change gradually, Dr. Carson said. “We decided to delay the e-copy [electronic summary] to patients until we could establish a portal, which is more secure,” he said. Web portals allow patients to log on to a secure site to access records rather than having them e-mailed. To send patient reminders, another Meaningful Use measure, his hospital’s technology staff created a program to send patients text messages that upload to their smartphone calendars.
Dr. Carson said his practice decided to work toward achieving Meaningful Use mainly for the incentives. “It may not be associated with meaningful care, but penalties are impactful,” he said. “You need to understand how measures are recorded by your EHR and come up with a plan.”
Susan Bernstein is a freelance medical journalist based in Atlanta.