The federal government will begin its incentive program for the use of electronic health record systems in less than a year, but many physician organizations say the Medicare timeline is just too aggressive and runs the risk of turning some physicians away from the technology.
In contrast, the Medicaid incentive program offers more time for physicians to gear up. Pediatricians can start using electronic health record (EHR) technology as late as 2016 and still earn the maximum payments under the program. Those pediatricians who have a volume of at least 20% Medicaid patients in their practice are eligible to receive up to $42,500 over a period of 6 years for adopting or updating certified EHR technology, and for the “meaningful use” of that technology. For those with a 30% Medicaid volume, the maximum payment is $63,750.
Under a proposed rule issued by the Centers for Medicare and Medicaid Services in December, during the first year, pediatricians only need to show that they have installed or upgraded to a certified EHR. In the following years, they must demonstrate so-called meaningful use of the technology.
The proposed rule also outlined the requirements to achieve meaningful use. The requirements are phased in with minimum standards early on. Additional criteria are added in 2013 and 2015. Under stage 1, physicians must meet 25 objectives including the use of computerized provider order entry, electronic prescribing, reporting on quality measures, and checking insurance eligibility electronically.
In a letter to Centers for Medicare and Medicaid Services officials, sent last month, a coalition of more than 95 national and state physician organizations, including the American Academy of Pediatrics, voiced their concerns about the stage 1 requirements. Although the coalition supports the phased-in approach to meaningful use, they said there is too much being asked of physicians in the first stage of the program.
One concern is that if physicians rapidly install EHR systems without addressing the many workflow changes that EHRs create, the new systems could be more dangerous in some cases than the paper systems the electronic records replace, said Dr. Joseph H. Schneider, chief medical information officer at Baylor Health Care System in Dallas, and chair of the Council on Clinical Information Technology for the American Academy of Pediatrics.
Some of the requirements in the proposed rule also seem impractical, he said. For example, CMS proposed that as one of the requirements for achieving meaningful use, at least 75% of all permissible prescriptions written must be transmitted electronically using certified EHR technology.
That requirement overlooks the fact that in many areas there are large numbers of pharmacies that still don't accept electronic prescriptions. That figure is around 30% in Texas, he said.
But pediatricians don't need to worry about getting to meaningful use as quickly as some other specialties, Dr. Schneider said. While the Medicare incentive program requires physicians to achieve meaningful use before 2013 to qualify for the full complement of incentive payments, pediatricians under the Medicaid program can achieve meaningful use as late as 2017 and still collect all of the incentive payments.
“Most pediatricians don't need to rush to the store to get their EHRs,” Dr. Schneider said.
For one, there is discussion within the health IT community about a next generation of EHRs that may be coming in the next few years. Also, the AAP will soon be releasing better tools to help pediatricians assess their readiness, as well as tools for selecting and implementing products. Local Regional Extension Centers will also be providing support to pediatricians within the next year, Dr. Schneider said.
But depending on where you practice, you might want to think about EHRs sooner rather than later, Dr. Schneider said. That's because family physicians, who are likely to qualify for incentives under Medicare, will need to adopt sooner. If there are several family physicians in your area treating children, you don't want to be the only practice still working with paper records.
Also, pediatricians working in growth areas with lots of new families coming to the community may have a competitive edge if they adopt an EHR. Families choosing a physician in a new area may want to pick a practice that has already made the conversion to electronic records, he said.
Other factors include the ability to attract new pediatricians from residency programs, as many of these physicians expect to use an EHR.
“All of these factors, and many more, have to be weighed,” Dr. Schneider commented.
“Take your time in making this important decision and get help. We're hearing more cases of the long-term horrors of choosing the wrong EHR and you don't want to be one of them.”