Six Myths of Meaningful Use
Meaningful Use is one of the most talked about components of the Health Information Technology Economic and Clinical Health (HITECH) Act. Unfortunately it’s also one riddled with myths, rumors and misunderstandings.
Essentially, Meaningful Use (MU) is an incentive program established by HITECH and the American Reinvestment and Recovery Act (ARRA). MU provides financial incentives to Medicare and Medicaid providers who have implemented an Electronic Health Records (EHR) system and demonstrated its use in a meaningful way to improve patient outcomes.
It is a complicated program of which the final implementation is being sorted out by the U.S. Department of Health and Human Services and Centers for Medicare and Medicaid Services (CMS).
Here are some of the most common myths:
1. I still have plenty of time.
Although the deadline for participating providers and hospitals to demonstrate meaningful use isn’t until Dec. 31, 2015, adoption of an EHR system is a lengthy process. The set up alone includes system training and practice integration. Depending upon the practice staff’s level of comfort with new technology, the learning curve can be long.
If the practice intends to take advantage of the incentive programs, time is running out. Medicare eligible providers have until Dec. 31, 2012 to attest to MU in order to be eligible for the maximum incentive payouts. Each year thereafter, the bonus amount decreases. If a provider does not attest by the end of 2015, penalties will be levied on Medicare and Medicaid payments..
2. Once EHR is set up, MU will be established.
Meaningful Use is not always instantly achieved upon implementation of an EHR system. In fact, it can take months to receive MU designation. Because MU criteria requires quantity and quality metrics, several patient visits need to be included in attestation documents. In addition the EHR must be in use for 90-continuous days in order to qualify for CMS incentives.
3. Your EHR vendor will provide your MU certification
The vendor’s main responsibility is providing the technologies making it possible to achieve MU. Some companies will make attestation easier through a variety of support programs, like DrFirst’s AttestEasy. Ultimately the burden of proving MU falls on the healthcare provider.
4. Meaningful Use is a project for your IT provider.
Although the initial set up and networking project will most likely fall with a computer expert, proving MU is the responsibility of the clinical and administrative team within the practice or hospital. Training may be offered by the IT provider, but after the initial set up phase, the IT provider role is complete, except for troubleshooting technical issues. Some offices may appoint an IT project manager to spearhead the program..
5. Meaningful Use only involves Medicare/Medicaid patients.
Although CMS offers the incentive program, EHR and attesting to MU in the practice covers all patient outcomes regardless of payer. When proving MU, data for every patient encounter entered into the EHR is taken into account for attestation.
6. We only need to prove five of the 25 set objectives in order to attest to MU.
That is partially true. All eligible providers must meet 15 core requirements of MU established to help realize the clinical and financial returns, including improved care coordination, e-prescribing and patient engagement. Providers then must choose at least five of ten additional measures which to attest.
There are instances where the criteria will not meet the practice’s workflow. If a particular objective is not relevant to the practice, the provider can attest to that and will not be required to meet the objective.
The Attestation process may seem daunting, but with time and experience, EHR and MU will make healthcare more efficient for both the provider and the patient.
What rumors have you heard? Are there any that are preventing you from implementing your EHR?
It is an inevitability that many attempting to delay. Electronic health records (EHR) are not going away. The deadline to take full advantage of the financial incentives available from the Centers for Medicare and Medicaid Services (CMS) for incorporation and proving Meaningful Use (MU) is approaching.
It’s not too late to identify the right system for your practice. It’s important to note, however, that you must prove MU in 2011 or 2012 in order to receive the maximum payout of up to $44,000. Those providers practicing in under-served or rural areas are eligible for up to $48,400 in Medicare reimbursements.
The following table shows the reduction in Medicare reimbursements by delaying adoption of EHR and proof of meaningful use.
Some providers may find it more beneficial to take advantage of the Medicaid bonus program based upon payer mix. Although participants have until 2016 to prove Meaningful Use and can receive up to $63,750 in incentives, the process is more complex. In order to participate in this program, a provider must prove that at least 30 percent of the practice’s patients receive Medicaid benefits. There are several calculators available to help providers choose the program best suited to the practice.
The following table shows the maximum disbursement schedule for providers choosing the Medicaid Meaningful Use Program.
It’s not too late to start working toward attestation in 2012. But, if you have yet to begin researching EHR systems, the time is now. It’s not a decision to be taken lightly, as the initial investment and time commitment can be substantial. It’s important to note that incentive payments are available not just when the program is incorporated, but when Meaningful Use is proven. That means systems will need to be implemented and staff trained in the new technology before Meaningful Use will ever be established.
In 2011, CMS established three phases of MU. By 2015 Medicare eligible professionals and hospitals will be required to meet MU or may be subjected to financial penalties. Financial penalties may include a reimbursement reduction of one percent the first year and up to three percent by 2017.
With uncertainty surrounding the criteria for Stage 2, CMS has recently extended Stage 1 until 2014, giving an additional year to those who have not already attested. The requirements for Stage 2 and Stage 3 have not yet been clearly defined by CMS.
Here are some key dates:
February 29, 2012: Last day to attest to Stage 1 in order to receive payment for usage in 2011.
Sometime in 2014: Medicare eligible participants must meet Stage 2 of Meaningful Use.
December 31, 2014: Last day to qualify for any type of Medicare incentives.
January 1, 2015: First day Medicare penalties may be implemented.
December 31, 2016: Last day to qualify for any type of Medicaid incentives.
Don’t get left out of receiving the thousands of dollars to help offset the cost of EHR implementation. Start the process today.
Running a prison is not inexpensive. A 2011 Financial Times article reported that states spend $50 billion a year on correctional facilities—the second largest expense the second-largest expense, right behind Medicaid. In that article, findings revealed it costs more than $44,000 per year to incarcerate a person in California—equal to spending a year, including room and board, at Harvard.
It’s important for prison officials to do everything possible to save money. One approach is to implement electronic health records and do away with the old-fashioned pen-and-paper system. Electronic health records save states money and assists in enabling better care for inmates.
First, consider the cost savings. According to a report by CIO|Insight magazine, a study of 14 medical practices found it took an average of two-and-a-half years to recoup the costs of transitioning patient health records from a paper-based to an electronic system. Once the pay-back period ended, the practices enjoyed $23,000 in annual savings, mostly from increased efficiency and reduced staff hours.
In a 2010 report, the Rhode Island Department of Corrections noted a significant savings of both time and money from its adoption of electronic health records.
For instance, when patients were transferred from one detention facility to another, at the same time someone had to physically transfer the health records. Today, prison officials log onto their computers to access a patient’s medical history, including prescribed medications, treatments and allergies or illness. In the past, medical personnel would attach sticky notes to a paper file, inevitably misread or lost in the chain of hands. Today, medical personnel simply update the patient information in the prison computer system.
Rhode Island’s experience proves that switching to electronic health records can save prisons not only significant money annually, but also improve the medical care provided to inmates.
In a recent story, the website Corrections.com, praised the Obama administration’s decision to invest $10 billion over a five-year period — ending in 2013 – to move U.S. healthcare to an electronic-based system, citing the positive impact electronic systems could have on U.S. prisons.
The story pointed to a study published in 2005 by the RAND Health Corporation.. The study found that electronic health records could result in savings by reducing redundant health care, making patient treatment more efficient, boosting patient safety and keeping patients healthier longer.
Consider how this would work in a prison system. With electronic health records, prison physicians would reduce the potential of prescribing errors and would make it more difficult for patients to abuse addictive drugs. By improving inmate care, physicians could generate significant annual treatment cost savings.
The shift from paper-based prescribing and medication history methods to an electronic medication history system is of immeasurable value to not only the patient and medical staff, but to those countless individuals involved in the scramble that often occurs during a hospital admission. While the common denominator among both patients and healthcare professionals is a focus on the final positive patient outcome, that final determination relies heavily on the speed and accuracy of those first few moments when a patient is admitted to the hospital.
According to a 2007 study by the Department of Health and Human Services, it is estimated that deaths as a result of paper-based medication errors reach nearly 7,000 annually. Transitioning to an electronic medication history system has the potential to prevent 2 million missteps and resulting adverse drug events a year, as well as a total annual savings of over $20 billion.
Each second is precious and costly during an emergency. Consider two patients with identical situations including medical histories and symptoms. The only difference? One has MedHx electronic medication history. The other does not.
Meet Alan and Zach. Both patients are 60-year-old males with a history of heart disease, blood pressure and diabetes. Both take the exact same prescription pills daily , complained of chest pressure and were unconscious upon arriving at the hospital. Each patient is accompanied by his wife.
Alan presents to a hospital emergency room that uses MedHx electronic medication history. As he is wheeled into the hospital, nurses and doctors quickly examine him. A physician’s assistant turns to Alan’s wife and says, “Our techs have just finished pulling up your husband’s medication history in our system. The doctors will look over it and move quickly to stabilize your husband and figure out what’s causing him to experience the symptoms you described.” Alan’s wife is taken to a waiting room and the doctors are able to run blood tests and administer drugs within moments of his arrival.
Zach presents to a hospital emergency room that does not use MedHx electronic medication history. As he is wheeled into the hospital, nurses and doctors quickly examine him. A physician’s assistant turns to Zach’s wife and says, “Can you tell us what medication he has taken today? Has he been seen in the past for any heart conditions, and is he being treated for any other illnesses? Is he diabetic?” Zach’s wife responds with his history of heart disease, blood pressure and diabetes, explaining that he takes two blood pressure medications, one of which is a beta blocker. Though she knows the name of the first medication, she does not remember the other or any of the dosages. The P.A. asks which pharmacy they use.
“We use two pharmacies,” she responds. “Zach manages his own meds, so I don’t know which pills he fills from which pharmacy.” The P.A. alerts the techs to call each pharmacy for Zach’s medication history as the doctors discuss how long they feel it is safe to wait before administering treatment.. Zach’s wife stands by the ER nurse’s station pulling the prescription bottles from her purse that she grabbed as the ambulance pulled up to her house. As the techs make phone calls and wait for faxes, several more patients stream into the ER. Zach’s wife is escorted to a waiting room. After several minutes, the P.A. returns to alert his wife that Zach has an allergic reaction to the administered drugs, that they’re giving him something to counteract them and that they are doing their best to stabilize him.
When techs pulled up Alan’s information, the doctors had immediate access to a 24 month history of his medications, dosages, prescribing doctors and dates the prescriptions were filled. When an ER nurse is asked, “is it always this crowded?” the answer is often, “It’s usually worse.” Hospitals that put an electronic medication history system in place streamline their processes and increase their rate of positive patient outcomes. Time is saved and aggravation avoided and, most importantly, lives are saved.
In 2011, Medicaid began reimbursing for the implementation of Electronic Health Records (EHR). Many providers have been hesitant at installing complete systems and overhauling their entire practices, but there are ways to take advantage of the incentives and the benefits provided by EHR.
Providers who can prove adoption, implementation, upgrading, or Meaningful Use of certified EHR technology may be eligible for up to $63,750 in Medicaid reimbursements if their state has chosen to participate in the Medicaid EHR Incentive Program as part of the American Recovery and Reinvestment Act (ARRA).
As of now, only 24 states are participating, but many are scheduled to begin in the near future.
Eligible providers must be able to prove they have met Meaningful Use. Simply put, Meaningful Use means that offices are using the technology in a meaningful manner, such as e-prescribing, the exchange of health information and submission of quality clinical measures. Stage I criteria for Meaningful Use means your EHR system must include the following functionalities:
- Record Patient Demographics
- Record Vital Signs and Chart Changes
- Problem List of Current and Active Diagnoses
- Maintain Active Medication List
- Maintain Allergy List
- Record Smoking Status
- Clinical Summaries
- Electronic Copy of Health Information
- Electronic Prescribing
- Computer provider order entry (CPOE)
- Drug-drug and drug-allergy interaction checks
- Export Patient Summary (CCD/CCR)
- Clinical decision support and tracking
- Protect Privacy and Security of Patient Data
- Report to CMS/States
The systems must also be able to do at least five of the following:
- Drug Formulary Checks
- Lab Integration
- Generate Lists by Condition
- Summary-of-Care Record
- Immunization Data to Registries (Required)
- Patient Reminders
- Patient Access
- Perform Medical Reconciliation between Care Settings
The Centers for Medicare and Medicaid Services has developed a calculator to help determine if meaningful use has been met.
With modular systems available that can combine to form a qualified system, providers can be selective as to what technology they are adding to their practices.
Choosing Modular
DrFirst’s Rocopia-MUTM is one such modular EHR that can easily transform an office into a qualified candidate to receive incentives. Meeting all of the requirements for Meaningful Use Stage 1, this modular EHR system is fully certified and will not only qualify for attestation, but will also make for a more efficient work environment.
The low cost system, just around $7 per day, is perfect for the office that may not be ready to make the commitment to a full EHR or have the time or resources devoted to training, but want the opportunity to take advantage of the significant reimbursements available. It allows the providers to grow their Health IT systems at their own pace, lessening the disruption of the changing technologies.
The money earned through the reimbursements can then be put toward a future upgrade to a fully paperless EHR. And since DrFirst has partnered with 200 plus EMR/EHR vendors, it’s easy to find the EHR that best fits the needs of your practice.
DrFirst also provides expert assistance with AttestEasyTM. During the first 90 days of implementation, experts provide monitoring services to help ensure that the modules are being used to their abilities and will qualify for reimbursement.
It’s important to remember that Medicaid does not require providers to satisfy the Medicare requirements to receive the first year of incentive money. Providers simply have to show proof of purchase to earn their 2011 incentive money.
What are you doing to ensure you are eligible to receive the incentives that are being provided by Medicare and Medicaid?
In the healthcare community, the distinction between an Electronic Medical Record (EMR) and an Electronic Health Record (EHR) is somewhat ambiguous, and even many professionals think of the terms as synonymous.
The two systems appear similar because they both digitize patient records in a way that improves access to information.
But that’s where the similarities end. The U.S. Department of Health and Human Services describes the differences between the two systems as significant.
While EMRs help medical professionals with computerizing health records, EHRs provide capabilities beyond basic digitization. Here is a breakdown of each system in addition to key distinctions between the two.
Electronic Medical Record (EMR)
An Electronic Medical Record is a digital version of a patient’s chart at a single organization. As an improvement over paper-based health records, EMRs help clinicians:
- Assess patient trends over time
- Monitor patient demographics
- Schedule patients for preventative treatments and checkups
- Quickly benchmark results on patient tests
- Improve quality of care for all patients
- Create easy-to-access digital versions of X-rays, CT scans, MRIs, and other tests
Outside of a medical group or system, patients’ records may not be digitally exportable to care providers and specialists. In this situation, between different organizations, EMRs are similar to paper — literally speaking; organizations will need to mail records to each other.
Electronic Health Record (EHR)
Think of this as the bigger picture. An EHR is like an EMR in the sense that it digitizes patient records to improve organizational efficiency. Unlike an EMR; however, an EHR follows the entire health history of the patient for a comprehensive medical overview.
- Providers that use EHRs are able to share information even if they are not members of the same organization.
- With an EHR, health records follow the patient between specialists, organizations, lab facilities, and other patient care centers such as convalescent homes.
- Patient data can move with patients across cities and states.
- An EHR provides features for summarizing comprehensive demographic information.
- Between organizations and care providers, EHR data remains secure and confidential.
The goal of the EHR is to improve care through ease of communication and transparency between providers and other healthcare organizations.
For instance, a primary care provider can quickly communicate allergies or preexisting conditions to emergency facilities — which is especially important if the patient is unconscious or unable to speak.
Patient Access to Data
HIPAA guidelines give patients the right to access health records, but with an EMR, patients must request copies of records.
An EHR gives direct access to the patients themselves. The intent is to keep the patient involved in managing her own care.
Usually, the patient will have access to an online account where she can track changes in lab results and monitor physician instructions for at-home care. Unlike an EMR, an EHR is interactive with the patient.
The Bottom Line
While many people think of EMRs and EHRs as interchangeable, the ability to follow the entire health history of a patient for a comprehensive medical overview dramatically sets them apart.
