While a few neurologists have already received $18,000 checks from the federal government, the vast majority sat on the sidelines in the first year of a huge incentive program to encourage “meaningful use” of electronic health record (EHR) technology.
In the first 11 months of 2011, only 269 neurologists — fewer than 3 percent of all neurologists practicing in the US — had qualified for the first-year financial incentives from the government's Medicare and Medicaid EHR incentive programs.
Many neurologists spent the year working to meet meaningful use criteria. But still others appear to be unaware that the Centers for Medicare & Medicaid Services (CMS) is offering up to $44,000 — or up to $63,750 for physicians who primarily treat Medicaid patients — over five years, let alone how to earn the incentives.
“I would say that if you ask 10 doctors, probably two will have heard of ‘meaningful use’ and one might know some specifics; however, few and far between will really understand how to implement it in practice,” said Gregory J. Esper, MD, medical director for the department of neurology at Emory University.
Amanda Becker, the AAN associate director for medical economics, expects that when CMS posts the year-end numbers for 2011, many more neurologists will have achieved meaningful use. That said, she agrees that fewer neurologists are biting CMS' carrot to encourage EHR use than she would have expected.
“A lot of them do not seem to realize what an opportunity they might be missing if they don't start participating to get the full incentive payment,” she said.
The limited participation does not suggest that neurologists do not value the electronic medical record systems that many of them are already using.
“Many neurologists who currently use [these systems] wonder how they practiced without EMRs,” Dr. Esper, associate chair of the AAN Medical Economics and Management Committee, said. “However, making the leap from current use of electronic medical records to the satisfaction of meaningful use requirements requires a more significant financial, human resources, and time investment than many anticipated.”
HOW MEANINGFUL USE WORKS
The meaningful use program takes its name from the CMS goal that physicians use EHR technology in three specific ways: for activities such as e-prescribing; for electronic exchange of health information to improve the quality of health care; and for submission of clinical quality and other measures.
Unlike the government's incentive programs for electronic prescribing and quality data reporting, which offer physicians a small percentage increase in their reimbursement if they comply with CMS, the EHR program offers a fixed sum if physicians meet specific criteria. (See “How Much is Meaningful Use Worth.”)
Physicians and other so-called eligible professionals, such as nurse practitioners, earn the incentive payments if they meet the meaningful use criteria for a consecutive 90-day period in the first year of participation and attest to that fact on the CMS websit. To receive incentives in subsequent years, they must meet the meaningful use criteria for the entire year. Criteria will become more stringent in 2013 and again in 2015, when the second and third stages of the program are launched.
As of the end of November 2011,10,155 physicians and other eligible professionals such as nurse practitioners earned the meaningful use incentive, and the government had paid out nearly $183 million.
Physicians who achieve the meaningful use criteria in 2012 can earn the full $44,000 incentive over the next four years; however, physicians who do not qualify until 2013 or thereafter will receive less than the maximum. (See “Meaningful Use Criteria and Objectives.”)
WHAT SUCCESS LOOKS LIKE
Steven J. Zuckerman, MD, a solo practitioner in Baton Rouge, LA, received the $18,000 incentive last year and expects to earn the entire $44,000 during the five years of the program.
He has been using an Internet-based EHR system for several years, and it is programmed to help him achieve the meaningful use incentives. A dashboard screen identifies whether he is meeting each of the criteria and, if not, what he needs to do to comply. As he enters new information during a patient visit, the system coaches him.
“If you didn't put in their medications, there is a pop-up that says, ‘You didn't put your medicines in; therefore, this won't count for meaningful use,’” he said. “So you don't really have to keep all those criteria in your head.”
HOW MUCH IS MEANINGF...Image Tools
As he pursued status as a meaningful user in CMS' eyes, he learned that the criteria are not quite as daunting as they first seem. For example, neurologists do not have to comply with requirements — such as recording weight, height and other vital signs for at least 50 percent of patients — that do not apply to neurologic practice.
“You can just attest to the fact it's not within the scope of your neurology practice to obtain those pieces of information,” he said.
The biggest challenge for him was providing patients with a clinical summary of their visit. Eventually, his EHR vendor provided a password for each patient, which allows them to access the summary on the company's website.
When Dr. Zuckerman first began using EHR system several years ago, he did find that it reduced productivity for about six months while he was learning to use the technology. But with that experience already out of the way, he found that achieving meaningful use and earning the first year incentive is something any physician can accomplish.
“If they got through medical school and neurology residency, they certainly have the wherewithal to do this,” he said.
MOVING TOWARD IMPLEMENTATION
The meaningful use program may gain traction with solo practitioners like Dr. Zuckerman more quickly than with physicians that work in academic medical centers, Dr. Esper said. Many neurologists in academic settings are experiencing what his colleagues at Emory have seen: lots of administrative communication about the use of EMRs without specific reference to meaningful use. The communication seems disconnected from their day-to-day practice, he said.
For one thing, academic physicians have no financial outlay for EHR technology and their institutions may or may not choose to share part of the financial incentive with their physicians. However, adopting EHR technology does require big changes to work flow processes and will probably decrease productivity for a few to several months.
At Emory, the meaningful use incentive program triggered the development of Project Falcon, a major initiative designed to take advantage of new electronic tools and create the ideal patient experience throughout the medical center's clinics. That means providing the highest quality of care and safety, making sure patients understand their diagnosis, their care plan and their medication regimens when they leave the clinic so they can follow physicians' orders correctly.
Groups of clinicians, information technology staff members and trainers are systematically working their way through each clinic.
“We are teaming up with sections one by one to enact standard operating procedures that maximize use of the EMR to make sure that all the (care) processes are aligned, not only to provide the ideal patient experience, but also to achieve meaningful use,” Dr. Esper said.
MEANINGFUL USE CRITERIA AND OBJECTIVES
* Computerized physician order entry (at least 1 medication ordered for more than 30% of patients)
* Drug/drug and drug-allergy checking
* At least 40% of medication orders are generated and transmitted electronically
* At least 80% of patients have an updated problem/diagnosis list
* At least 80% of patients have active medication lists
* At least 80% of patients have active medication allergy lists
* At least 50% of patients have vital signs recorded (height, weight etc.)
* At least 50% of patients have demographics (race, gender, ethnicity, date of birth) recorded
* At least 50% of patients have smoking status recorded
* Report quality measures to CMS
* Implement at least one rule relating to clinical decision support and track compliance
* Provide at least 50% of patients with clinical summary of visit within 3 working days
* Provide at least 50% of patients with electronic summary of health information within 3 working days
* Electronically share medical information with at least one other provider
* Conduct or review a security risk analysis and implement security updates as necessary
FIVE OF TEN OBJECTIVES TO BE MET
* At least 40% of patients must have test results included
* At least 50% of patients must have medications reconciled in system
* Drug formulary must be checked at least once
* Generate at least one list of patient conditions and use it in quality improvement
* Provide greater than 10% of Health Information Exchange (HIE) to appropriate providers within 4 working days
* Provide at least 20% of patients with reminders for preventive/follow-up care
* Provide at least a summary care record for at least 50% of patient transactions
* Perform at least one test on submitting electronic data to immunization registries
* Provide at least one test of submitting electronic surveillance data to public health agencies
* Provide greater than 10% of patients with relevant educational resources
Source: Bryan Soronson, Chair, Business and Research Administrators in Neurology Society
MEANINGFUL USE: HOW TO GET STARTED
* Details about the meaningful use incentive program are available on the AAN website at http://bit.ly/x8p23D
* These AAN webinars are scheduled to help Academy members achieve meaningful use:
* EHR Implementation: What You Need to Know from A-Z, Feb. 7
* Incentive Programs and Penalties: What Do They Mean for My Practice?, April 12
* Ready, Set, Payment: Using Certified EHRs for Meaningful Use Payments, May 16
* A special presentation, “The $44,000 Question: Are You Ready to Make the Most Out Of Your EHR?” will be held April 23 at the Academy's 2012 annual meeting in New Orleans.
* Additionally, the government operates Regional Extension Centers in each state to help physicians adopt EHR technology and achieve meaningful use. Check out the website for the Office of the National Coordinator for Health Information Technology at http://bit.ly/sB1Yus to find the center nearest you.