SAN DIEGO – A majority of clinicians still lack a qualified electronic health records system and are therefore ineligible for meaningful use incentive payments from the government.
"As of November 2011, [EHR] penetration in office-based practices has reached about 50%. We’re a far cry from what you need to have in order to comply with meaningful use," Dr. Paresh C. Shah said at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons.
Dr. Paresh C. Shah
Although the government is providing financial incentives for meaningful use of an EHR, "along with that carrot comes a stick," Dr. Shah said. "If by 2015 you have not started to use these tools, you’re going to get whacked with a reduction in payments for Medicare-related services. Those reductions increase over time the longer you’re not using these electronic tools."
As part of the American Recovery and Reinvestment Act (ARRA) of 2009, all health care providers and hospitals must demonstrate meaningful use of a qualified HER system by 2015. According to Dr. Shah, $47 billion from the ARRA was allocated for health information technology. Of that $47 billion, $45 billion will be paid to eligible professionals and hospital in incentives. "That’s the check that the government is writing to health care providers around the country," said Dr. Shah, vice chair of surgery and chief of laparoscopic surgery at Lenox Hill Hospital, New York. "Another $2 billion was allocated to the Office of the National Coordinator to administer this process."
The goal of meaningful use, he continued, "is improved outcomes for our patients and improved process of care in the delivery of health care in the United States. The process of meaningful use begins with capturing data, understanding what we’re capturing, and having that support better processes of care, which result in improved outcomes."
A qualified EHR must have the capacity to include patient demographic and clinical health information, such as medical history and problem lists. It also must have the capacity to provide clinical decision support at the point of care, to support computerized physician order entry, to capture and query information relevant to health care quality, and to exchange electronic health information with other EHRs.
Meaningful use includes both a core set and a menu set of objectives that are specific to eligible professionals or eligible hospitals and critical access hospitals. The core set objectives for providers in stage 1, which occurred in 2011, included using electronic prescribing; checking for drug interactions and allergies; maintaining a medication list; maintaining an allergy and problem list; integrating decision support to help select appropriate medications; recording demographics, smoking status, and vital signs; being able to give clinical summaries to the patient; and protecting health information.
Stage 2 guidelines for meaningful use have just been released for public review, but they will go live in 2013 "and you’ll have to be compliant with them to get paid," Dr. Shah said. "If your practice was compliant with meaningful use in stage 1 in 2011, you would start to get $18,000 per year. The government has allocated $44,000 per provider to defray the cost of converting to an EHR system. That was based on calculations they did that estimated that would be about 80% of the true cost of conversion per provider. It’s not going to pay for the whole thing, but it will go a long way toward defraying that cost. This is money you are leaving on the table if you don’t have a certified EHR system employed."
It’s not too late to get on board with meaningful use, but "it is time to get off the rest stop on the information highway," Dr. Shah emphasized. "You have to get back on. If you are not electronically enabled in your practice, you absolutely have to be. If you’re not, you’ve already lost out on the first year of incentive reimbursement from 2011. If you don’t do it by 2015, not only will you lose any of the potential incentive reimbursement, but you’re then going to start to get penalized."
He advises clinicians to choose a certified complete EHR, to implement it and train their staff to use it, and to make sure it can do the reporting required for stage 1 and stage 2 of meaningful use. "You have to use all meaningful use measures for at least 90 consecutive days, and send the report" to the Centers for Medicare and Medicaid Services, he explained. "Once you’ve done that, and you attest that you’ve complied with meaningful use, you’ll get paid. Payments have already started. [The CMS] started making payments in the fourth quarter of 2011 to practices that were able to demonstrate compliance with stage 1."