Who is eligible for the stimulus HIT incentives?

Those defined as an “eligible professional” (EP).Under Medicare that means a doctor of medicine or osteopathy who is not hospital based can qualify for incentive payments based on an amount equal to 75 percent of allowed Medicare Part B charges.

Under Medicaid, a physician, dentist, certified nurse midwife, nurse practitioner or physician assistant in a rural health clinic or federally qualified health center is eligible if Medicaid patients are 30 percent of patient volume. For pediatricians that’s reduced to 20 percent. You cannot get incentives under both Medicare and Medicaid. More details are expected.

Can hospital-owned physician practices get paid for EHR participation?

If hospital-owned practices provide a substantial amount of their services outside the hospital, they might qualify for the stimulus funds. It is not yet clear whether incentives would flow through the hospital or through the providers.

Physicians solely hospital-based (ER doctors, anesthesiologist, pathologists, etc.) are not eligible, since the hospital incurs the EHR expense.

How will the Centers for Medicare & Medicaid Services (CMS) pay the incentive – through individual checks once a year, once a month?

Medicare and Medicaid EPs would receive a single, consolidated, annual incentive payment. Medicare EPs would be paid electronically via their Medicare contractor. Medicaid EPs would receive payment from either the state Medicaid agency or a designated intermediary (i.e., a Medicaid HMO).

Payments would be distributed on a rolling basis, as soon as you have: 1) demonstrated meaningful use for the applicable reporting period (90 consecutive days for first year or the calendar year for subsequent years); and 2) reached the threshold for maximum payment.

How can practices already using an EHR benefit?

Incentives are available to both new and early adopters of EHRs. However, all EHRs must meet certification/qualification requirements. Early adopters may need to upgrade to newer versions of their EHR products, depending on the standards rule. Federal agencies are required to develop standards on interoperability, security and more. Stay tuned for more details.

How will I know if my EHR is certified?

The independent Certification Commission for Healthcare Information Technology (CCHIT) has been certifying EHR systems since 2006. For purposes of qualifying products for stimulus incentives, CCHIT anticipates, but has not yet received, federal accreditation. Keep checking the CCHIT Web site.

Is there an Internet forum or bulletin board where I can get updates on HIT developments?

Yes. Visit here to join the Health-IT Listserv and stay current on information.

How do we file or apply so Medicare/Medicaid knows to reimburse us?
CMS will conduct outreach efforts later this year to ensure you understand all policies and requirements related to eligibility, selection of either Medicare or Medicaid, incentive payments and demonstration of meaningful use.

See March 6 ISMA Reports for details about recently announced Indiana Regional Extension Centers. These entities will educate, assist and “hold your hand” to help you obtain EHR incentive dollars. The centers are expected to be operational next month, providing technical assistance by defined geographic area.

To read more of the AMA question and answer document, visit here. For an AMA Webinar series, visit here.

*Based on Notice of Proposed Rule Making by CMS on 12/30/09 and subject to comment period. Subject to change.

ISMA e-Reports

 3/17/2010

AMA: When did you first implement the EHR system and what prompted your decision?

Dr. Wrenn: We wanted to integrate our clinical and business processes, beginning with the billing phase about 18 months ago and the clinical phase about nine months ago. Our motivations, we thought, were fairly simple. We wanted to create legible records, to increase the accessibility of the records and to replace our billing service.

AMA: What were your expectations of the EHR system?

Dr. Wrenn: Our greatest expectation was to increase the efficiency and speed of the practice, beginning with obtaining better control of our billing and reimbursements.

AMA: What did you do to prepare for the transition?

Dr. Wrenn: We focused primarily on calculating the return on investment. The office manager estimated that the transition would take about one year and that we would not realize a return on investment for at least another year. While we were able to identify much of the cost upfront, the support and increased hardware costs were unexpected. So far, we have spent approximately $250,000. We look forward to discussing our processes—through our participation in HealthLINC—with other practices implementing EHRs. Sharing best practices—approaches to setting up wireless networks, to scanning old charts and to implementing the system overall—should help us cut costs and save time in the future.

AMA: How did you select your vendor?

Dr. Wrenn: Our office manager did the search and screen, and we interviewed three companies—ultimately deciding to go with Greenway Medical.

AMA: What were your major obstacles during implementation? What was easier or harder than you expected? What would you do differently?

Dr. Wrenn: Although we are realizing some of the benefits of the EHR system, the transition has been more challenging—bordering on painful—than we expected. The billing piece works fine, and the information gathering and sharing are works-in-progress. It is the provider piece that causes some problems. Although the Bloomington medical community has seen dramatic improvement in EHR adoption since 2003 (the percentage of providers using EHRs has grown from three to 42 percent), a number of physicians just cannot make the change to EHRs. Everyone wants to learn, but the lack of support is the biggest problem. We continue to invest in extra support, but we still have considerable ground to cover.

AMA: How are you using your EHR? Can you describe your workflow?

Dr. Wrenn: All of our billing runs through the new EHR, though we still submit a written billing statement. All of the obstetrical records are in the EHR and electronically sent to the labor room. Although it is helpful to have access to the records 24 hours a day, seven day a week, we are still standardizing our patient intake form so that it matches the layout of the EHR. Intake is easer now, but migrating our old data into the EHR system remains a challenge. Right now, we scan important documents and then facesheet the chart. This means, we must manually enter surgeries, labs and office diagnoses into the EHR. We have employed two part-time staff just for this task. We still take a pen tablet or a laptop and the old chart into the exam room. After the visit, we enter our data into the EHR and designate the paper chart for storage.

AMA: What have been your practice’s greatest clinical and operational achievements since implementation?

Dr. Wrenn: We are pleased with the billing piece and the increased access to the obstetrical records. Obtaining provider participation in the gynecology office charts is our last major hurdle. I am confident, however, that our providers will be running full speed within four months.

Our prescription process has also improved dramatically since the EHR implementation. Almost all of our prescriptions are “zeta faxed” to the pharmacy—eliminating illegible handwriting. It is also a great tracking mechanism. If a patient calls at night, the on-call physician can access the record and the prescription record—increasing patient safety and efficiency.

AMA: Do you feel your practice is maximizing your EHR system? In what ways?

Dr. Wrenn: Not yet. There are still shortcomings in our expectations about how data should populate in the EHR. Take lab data, for example. When we receive a “push” of  data from the hospital, we must transfer the data into the EHR. The data is then stored as a document under “labs.”  In turn, we cannot view the results in an integrated manner—in a historical chart or graph. The same is true for obstetrical records. We must scan the hospital’s obstetrical discharge information into our charts; therefore, the data does not populate our facesheet automatically. For example, when a patient gives birth, the information (e.g., date, time, etc.) from the delivery should go directly into our chart. Instead, we have to transfer that data manually, which, again, is costly and time consuming. Our vendor company is working on the challenge, but it takes time and it is costing us.

As an intermediate step, we are currently using clinical messaging—rolled out by HealthLINC in collaboration with HealthBridge, a not-for-profit HIE serving the greater Cincinnati, Ohio, tri-state area—alongside our EHR to facilitate the delivery of laboratory and radiology results and transcribed reports.

AMA: What are your future plans for health information technology in your practice?

Dr. Wrenn: We will continue to work on reaching our goals, and I am confident that we will achieve them. It is just taking longer than we anticipated. Fortunately, our hospital is extremely cooperative. Without them, we would not be as far along. Although we have considered eliminating the entire EHR system, I see the good spots. Our community will benefit greatly if we can continue to practice medicine and keep up with the costs of the EHR. But it is hard for any small practice to absorb such large costs. The cost alone often prohibits the transition. The more support provided by communities (through HIE initiatives or similar activities), state and federal governments and other stakeholders (e.g, employers, health systems, hospitals, pharmacies, pharmacy benefit managers, etc.), the more successful and timely the transition to EHRs will be.

Please send Dr. Wrenn questions or comments at hit@ama-assn.org.

AMA                            View Full Story

AMA Voice

Similar to many physicians, Dr. Souheil Haddad and his partner have been researching what an electronic medical record (EMR) system could do for their practice. As a neurosurgeon, Dr. Haddad relies on inpatient and outpatient information from area hospitals and other providers in his practice daily. To obtain instant access to this information, Dr. Haddad found a solution in clinical messaging. Since, he has realized new efficiencies in his practice, which he states lead to improved safety and quality in patient care.

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AMA Voice

AMA member Todd Rowland, MD, executive director of HealthLINC—a rapidly expanding and operational health information exchange, believes the question all physicians should ask when transitioning to health information technology (HIT) is “will I get reliable patient data?”

In South Central Indiana, where Dr. Rowland is working to set up a communitywide system in which all health care providers can document, store and exchange patient information electronically, HIT has become more common. Most experts would attest to the fact that through HIT there are many valuable options to retrieve patient data. Dr. Rowland’s most familiar with two—an electronic medical record (EMR) and clinical messaging.

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