Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

As the industry anxiously anticipates the Proposed Rule for Stage 2 meaningful use—likely expected during HIMSS this week—many providers are still struggling to understand meaningful use Stage 1. So while we wait for the impending news story to break, let me address another question that was recently posed by a reader. 

Q: Can a physician attest and earn a Medicare EHR incentive for his second reporting year if he will be retiring in the middle of the year? 

A: To my surprise, this situation is not explicitly addressed in the regulations. One would think that a physician who works full time for part of the year would be just as eligible as one who works part time for the full year. The retiring physician, however, faces two obstacles: 1) The regulations require that an EP report for an entire calendar year after receiving a first meaningful use payment. 2) The EP must have an active enrollment record in PECOS (Medicare) to be eligible to attest—if he retires and withdraws from Medicare, he would no longer have active status. These factors suggest that a retiring physician is not eligible for an incentive (unless, of course, he times his retirement for the end of the year!)

In lieu of a definitive answer to the question, however, I offer the following food for thought: 1) Couldn’t the retiring physician simply wait until December 31 to attest and then report on the full calendar year? 2) What if he simply postpones surrendering his PECOS enrollment until the end of the year? (According to a local Medicare contractor, nothing prohibits him from doing that even though he would no longer be submitting claims.) If there are countervailing reasons not to do this that readers are aware of—and there may well be—please share your insights by commenting below. 

(Note: This is not an issue for retiring physicians in their first incentive year since they attest immediately upon the conclusion of their 90-day reporting period.)

It’s Sunday and the excitement to see old friends and hear interesting things at HIMSS 2012 is just around the corner. The #HIMSS12 hashtag is off the charts with people flying into Las Vegas and others talking about what they’re doing, seeing, hearing and expecting from HIMSS Las Vegas.

Most people on Twitter are quite excited for HIMSS (as am I), but a few have said that people won’t be missing much. I thought about it for a minute and realized that the thing I love most about HIMSS is meeting really smart people. With 37,000 people likely to attend HIMSS 2012, there are plenty of smart people to meet and connect with at HIMSS.

Justin Barnes, VP at Greenway Medical, is one of the smart people I like to talk with at HIMSS. Turns out that tonight he was sharing some of that wisdom, information and perspective on Twitter tonight. So, this EMR and Health IT Twitter roundup is the Justin Barnes edition.

Strong #MeaningfulUse progress ~ $3.1+ billion paid to 43,000+ care providers. #CMS #EHR #EMR @ONC_HealthIT @CMSGov #HealthIT #HIMSS12

— Justin Barnes (@HITAdvisor) February 20, 2012

I wish he would have broken this out into ambulatory doctors versus hospitals. $3 billion of ~$36 billion projected. I guess they’re expecting a windfall next year?

That is the billion-dollar question @theEHRGuy. There are good reasons to stay the #ICD10 course & good reasons to delay…. #HIMSS12

— Justin Barnes (@HITAdvisor) February 20, 2012

Is a billion dollars at stake in the ICD-10 delay decision? Regardless of the exact amount, it shows you the magnitude of the ICD-10 delay announcement.

Tuesday looks to be the day now when we should see the #MeaningfulUse Stage 2 proposed rule. #CMS did try to get it out on Friday. #HIMSS12

— Justin Barnes (@HITAdvisor) February 20, 2012

Someone on Twitter asked if it could be delayed past Tuesday. Neil Versel from Meaningful Healthcare IT News answered well: “Never underestimated bureaucracy.”

Good #MeaningfulUse update ~ $71M+ paid to 3,379 Nurses & Physicians Assistants under #Medicaid #EHR Program. #CMS #HIMSS12

— Justin Barnes (@HITAdvisor) February 20, 2012

That’s a little surprising to me that so many Nurses and PA’s got paid so much since they only qualify under Medicaid. I’m glad to hear it.

$412,866,000 in #EHR #MeaningfulUse incentives paid to 22,937 #Medicare Eligible Professionals. #HIMSS12 #EHRAssociation @CMSGov #EMR

— Justin Barnes (@HITAdvisor) February 20, 2012

When the number is totally written out, that’s a lot of 000′s and that’s only millions.

Looking forward to seeing many old friends and making many new friends at HIMSS this week.

If you live and love the EMR, EHR and Healthcare IT world like I do, then you’re enjoying all the big news that’s coming out right now. A part of me thinks that the big news is coming out because HIMSS is so close, but some of the news seems like it might not necessarily be timed directly to HIMSS. (To see company news coming out at HIMSS, check out our EMR, EHR and Healthcare IT News site.)

For those not keeping track, here’s a quick run down of some of the major news pieces I’ve seen that really point to larger trends in healthcare IT:

Meaningful Use Stage 2
We know that meaningful use stage 2 is imminent. It’s just a question of when we’re going to hear it. In fact, it might be announced as I’m writing this post. Neil Versel first queued us into the Meaningful Use Stage 2 Announcement prior to HIMSS, but the Twittersphere is also full of rumors about the announcement. Brian Ahier commented on my Facebook message about it:

Nothing is official until it’s released, but since Monday is a holiday it is very unlikely they will wait until next week. My understanding is that the review at the OMB is complete and the proposed rule is ready to be published…

For those who want a sneak preview on what to expect in meaningful use stage 2, check out Jennifer Dennard’s meaningful use stage 2 post.

ICD-10 Delayed
Many have wondered if ICD-10 would be delayed with most arguing that 5010, meaningful use and ICD-10 was a lot to change all at once. Two days ago I got an email from someone saying they thought ICD-10 wouldn’t be delayed. I replied that I wasn’t sure either way, but it seemed like there was movement that could make a delay quite possible. Although, I must admit that I didn’t even think the ICD-10 delay announcement would happen so quickly.

Regardless of prognostication, ICD-10 is going to be delayed. You can read my thoughts on the ICD-10 Delay on EMR Thoughts.

HIMSS Acquires mHealth Summit
Maybe this feels like bigger news since it’s so close to HIMSS and I can see how powerful this conference has become. You can read the press release on the acquisition here. This isn’t that surprising since HIMSS had partnered with the mHealth Summit last year. I think this spells really good things for the growth of the mHealth Summit. I’m not sure I’d want to be another mHealth conference, but there’s a niche for the right event.

I still have a hard time distinguishing mHealth from healthcare IT in general. There could be some differentiation, but I still believe that over time the dividing line between the two is going to be hard to see. Richard Scarfo, HIMSS’ vice president of vendor events (previously mHealth Summit director) is right to be concerned that it will be HIMSS 2.0.

Navinet Acquired by Blues Plans and Lumeris
Read more about the acquisition here. I must admit that I’m still trying to process exactly what this means. Although, one thing I’m sure it means we’re moving the tectonic ACO plates that will be necessary to change how we pay for healthcare.

Vince Kuraitis and Leonard Kish provide some interesting insight in this Google+ thread asking whether this is a shift from institution (enterprise) centered IT to patient centric IT or if it’s becoming payer centric IT. They also mention United’s restructuring of payments and Aetna’s acquisition spree as indicators of the shifting plates of healthcare reimbursement.

Aneesh Chopra as Senior Advisor to the Advisory Board Company
This isn’t as big of news, but it just came out so I thought I’d throw it in. For those that don’t know Aneesh Chopra is now former CTO of the US. Everyone just wondered what he’d do next. Brian Ahier posted that Aneesh Chopra landed at The Advisory Board Company where he worked previously for about 10 years. Looks like Aneesh and his energy and enthusiasm will still be around healthcare. I think that’s a very good thing.

Since I have HIMSS on the mind (as has probably been seen from my previous posts), I figured I’d talk about what we can expect from meaningful use at HIMSS 2012 in Las Vegas.

Meaningful Use Conversations Dominate
I think with all certainty all of us will be tired of hearing the word meaningful use after HIMSS. I might have to try and keep track of how many conversations I have where the words meaningful use aren’t used. Notice I’m counting the ones where it’s not used since I know that almost every conversation will include meaningful use.

I’m not sure that’s very healthy for the industry, but I think that’s the reality of where we’re at. While I’m sure I’ll ask plenty of questions about meaningful use as well, my favorite EHR vendors are probably going to be those that say: we meet meaningful use, we’ve abstracted meaningful use so its not an annoyance to doctors, and here’s what we’ve done to innovate our product outside of MU.

Meaningful Use Stage 2
Any day now I think that ONC/CMS is going to announce the final details for meaningful use stage 2. I imagine the regulatory process could push this so that ONC/CMS announce meaningful use stage 2 at HIMSS, but from what I’ve read I think they want to get it out before HIMSS. I hope they’re successful in making this happen.

Either way, I’ll be surprised if we don’t know about meaningful use stage 2 before/during HIMSS. So, if you want to be in the know, be prepared to talk about the final details of meaningful use stage 2. In the mean time, check out Lynn’s previous MU Monday post about meaningful use stage 2.

Federal IT Participation at HIMSS 12
Every healthcare related part of the federal government is going to be represented at HIMSS 12. HIMSS has been nice enough to provide a page listing all of HHS, CMS, ONC, AHRQ, CDC, HRSA, NIST, OCR, SSA, and VA sessions at HIMSS 2012. My only complaint with that page is that there are still a bunch of details missing on a number of the sessions. I imagine this is the government dragging their feet, but it sure makes it hard to plan.

While many of the government sessions can be dry and boring (partially attributed to what I call the government muzzle), it can be a really good place to hear the direction of the federal government when it comes to healthcare IT directly from their own mouth.

I also suggest that Farzad Mostashari’s keynote address won’t be nearly as interesting to someone familiar with healthcare IT as his ONC Townhall: Advancing Health IT into the Future session on Wed, 2/22 at 2:15 in San Polo 3503. I know I also want to work in a session on MU stage 2 and the future of EHR certification from the federal perspective as well.

“Meaningful” References
Is it just me, or do other people have a problem using the word meaningful now. At least it’s a challenge with many of my healthcare friends. Although, sometimes I throw it in there just for irony’s sake. Hopefully this post was meaningful to you.

Also, a big thanks to all those that filled out the EMR and HIPAA reader survey. I’ve loved all the feedback. Interestingly enough, one of the more common feedback items was that you liked the Meaningful Use Monday series. We’ll do what we can to keep it going.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

A reader posed the following question: What happens if a physician receives a Medicaid EHR incentive in 2011, no longer meets the 30% eligibility threshold for Medicaid in 2012 and therefore elects not to apply for any incentive that year, and then has to switch to the Medicare program in 2013 because his Medicaid volume is still too low to qualify under Medicaid? Below is a follow-up to a prior post, (“Switching Between Medicare and Medicaid Incentive Programs”), that provides the additional information needed to not only answer this particular question, but also to evaluate the financial impact of other scenarios in which a provider might skip years and/or switch between programs. 

Here are the rules regarding switching programs and skipping years:

• An EP can switch between programs only once after receiving his first incentive payment, and the switch must occur in 2014 or earlier.
• When an EP switches programs, he is “placed in the payment year he would have been in had he begun in—and remained in—the program to which he has switched.”
• Medicare and Medicaid treat skipping years differently. Medicare incentives require that payment years be consecutive—so while an EP can skip a year, if he does, he forfeits that year’s incentive permanently. Medicaid incentive payments, on the other hand, can be non-consecutive with no adverse impact on total available revenue.
• The last year that payments will be available also differs between the two programs. Under Medicare, no payments will be made after 2016, whereas EPs have until 2021 to earn incentives under Medicaid.
• Although an EP who switches to or from the Medicare program could—under certain circumstances—earn more than the total Medicare incentives ($44,000), in no cases would any EP be paid more than the maximum available under Medicaid ($63,750). 

To get back to the physician in the reader’s question, when he switches to the Medicare program after skipping 2012, 2013 would be considered (and paid as) his third payment year. 

Confused? To analyze the financial implications of switching programs and/or skipping a year under scenarios that might apply to your practice, make a chart and do the math—taking into account the above rules and the schedules of annual incentives.

I’m sure many of you are recovering from the Super Bowl right now. I got exactly what I wanted from the Super Bowl: a great game. I didn’t care too much either way, but I am glad that I predicted the Giants to be the winners. Too bad I’m not a betting man. Although, I guess that’s the trick with betting….but I digress.

Time for my regular weekend round up of interesting things happening in the healthcare IT and EMR twittersphere. We’ve got some really interesting tweets this week. Here we go.

@NateOsit We also have a webinar of @eCollab12 for those that wont’ be able to make it to #HIMSS12.ecollab12.eventbrite.com #hitsm

— Leonard Kish (@leonardkish) February 3, 2012

When I created and posted my list of HIMSS 12 sessions, they hadn’t created the agenda for the eCollaboration Forum at HIMSS and so I couldn’t add any sessions. However, the eCollaboration Forum at HIMSS 12 agenda is up now, so check it out. I know there are a number of sessions I’m going to add from the forum. I also love that they have the online option linked in this tweet for those not attending HIMSS 2012.

Yes, stage 2 #meaningfuluse NPRM will be out before #HIMSS12. meaningfulhitnews.com/2012/01/30/yes… #healthIT #ONC #CMS #hitpol #EHR #EMR

— Neil Versel (@nversel) January 31, 2012

This is really important news. I think a lot of us are REALLY interested to see the final meaningful use stage 2 details. Good find by Neil Versel.

Speaking doctor-to-doctor(s) using healthcare social media bit.ly/wiqbyu #hcsm #hcsmeu

— H2Online (@H2Ohu) January 30, 2012

I’m sure we’re going to continue seeing the trend of more and more doctors gleaning value from engaging in social media. At a minimum doctors are going to start finding more and more new patients using social media including things like physician blogging. A well done practice website and social media effort is going to be really valuable for the doctor of the future.

3 reasons why you should start a blog for your hospital bit.ly/ypCE78 #hcsm #blogging

— Mark Ragan (@MarkRaganCEO) January 30, 2012

Yes, blogging will also help hospitals in a number of ways too. Social media can benefit hospitals, doctors, practices, etc.

@DonRosenthal Tablets are for content consumption. PCs are for content creation. Much more intellectual flexibility w/ PCs. #HITsm

— Erica V. Olenski (@TheGr8Chalupa) February 3, 2012

I was fascinated by this tweet. First because I wonder what changes will make tablets more than just great for content consumption. Second, the idea of PCs being more intellectually flexible.

RT @patientslikeme: “my healthcare data is not nearly as portable/accessible as my financial data.” @jeff_cole #hcsm

— Jacqueline Thong (@jacthong) January 30, 2012

I know there are reasons why financial data is more portable and accessible than healthcare data, but it still irks me that we haven’t overcome those reasons…yet!

In a previous Meaningful Use Monday we wrote about a bunch of the Meaningful Use 2011 statistics that were put out by ONC and CMS. I know that my readers love statistics and information about Meaningful Use. Carl Bergman sent me a PDF file that contained some really interesting data on Meaningful Use stage 1 in 2011. The first pages we basically covered in the previous post, but starting on about page 10 or so there are some more detailed numbers.

Take a look at let us know which numbers you find interesting and/or unique.

If you are on of the 355 Eligible Providers who unsuccessfully attested to MU last year, CMS now offers an appeals process for both the Medicare and Medicaid programs. Here’s the section on appeals for EHR Incentive programs:

Starting December 1, 2011, CMS is accepting appeals for eligible professionals and eligible hospitals.

For general questions and for information on how to file an appeal, eligible professionals (EPs), eligible hospitals, critical access hospitals, Medicare Advantage Organizations, and Medicaid eligible hospitals may contact OCSQ’s designated appeal support contractor via the toll free number between 9 a.m. and 5 p.m. EST, Monday through Friday or via email.

1. Toll-free number: 855-796-1515
2. Email: OCSQAppeals@provider-resources.com

The Centers for Medicare & Medicaid Services (CMS), Office of Clinical Standards and Quality (OCSQ) is providing guidance on how to file an appeal.

If you click through to the How to File an Appeal link, it says that the final rule provides guidance and requirements for a Medicaid appeals process, but does not provide an appeals process for the Medicare EHR Incentive program. Although it also says that “CMS is currently implementing an appeals process for the EHR Incentive Program.”

It does also say that Provider Resources, Inc. (PRI) located in Erie, Pennsylvania was awarded the contract to handle the appeals process with the Office of Clinical Standards and Quality (OCSQ) overseeing the EHR incentive appeals process. Otherwise, it’s still pretty vague on the exact details of the appeals process other than the contact info.

I’ve read that beginning in February, appeal decisions will be posted on CMS’s Website under the Office of Clinical Standards and Quality. I hope that there’s some really good transparency in these postings so that those attesting to meaningful use in the future will be able to learn from people’s past mistakes.

If you’re someone that was denied and is going through the appeals process, I’d be interested to hear about your experience so we can share it with others that will need to do the same.

HITECH Answers recently posted a great post that gives a run down of the EHR Incentive program’s progress in 2011. Here’s their list with my own analysis and commentary of each point.

123,921 Eligible Professionals have registered for EHR Incentives, 15,255 have successfully attested to meaningful use in the Medicare program.
This seems like such a HUGE difference in numbers. That’s just over 12% of Eligible Professionals that registered attested to meaningful use. Does this mean that we’re going to see a tidal wave of meaningful use attestation in 2012? Possibly.

I believe that we’ll see more eligible professionals attesting to meaningful use in 2012. However, the question is how many of those other 108,666 will attest to meaningful use in 2012 and how many are like the Happy EMR Doctor who just registered to see the MU process. I wonder how many first hand meaningful use experiences by doctors will scare doctors away from MU attestation.

3.077 Eligible Hospitals have registered EHR Incentives and 604 of those have successfully attested to meaningful use.
This is almost 20% of hospitals that have registered that have attested to meaningful use. It’s not surprising that this number is a lot higher than eligible professionals. I still believe that the wave of meaningful use attestation will come from these other 2473 hospitals and probably many more that still haven’t registered. I haven’t seen a good number of how many hospitals are in the US. Does anyone know that number? The EHR incentive money that goes to hospitals will dwarf those of eligible professionals.

$2,533,689,145 has been paid out in Medicare and Medicaid Incentives.
$2.5 billion sent out in 2011. I just went back to the first time I tagged meaningful use on this site on April 3, 2009 (coincidentally I have 19 pages of 10 posts each tagged with Meaningful Use). Amazing to think that it’s taken basically 3 years to spend $2.5 billion on EHR.

277 hospitals have received payments under both Medicare and Medicaid and of those 12 were CAHs.
That’s about half of the hospitals that have attested to meaningful use under Medicare are also getting the Medicaid EHR incentive money as well.

22% of eligible professionals that have been paid EHR incentives are Family Practitioners and 20% are Internal Medicine.
I must admit that I would have thought that the percentage of family doctors that got paid EHR incentive money would have been a lot higher. I guess when you have so many other specialty areas I shouldn’t be that surprised. I also wonder why the internal medicine number is so high. These numbers actually make me believe that a lot of family practice doctors are sitting out when it comes to meaningful use.

41 States Medicaid programs were open for registration. Two additional States launched in January of 2012.
I wonder what’s holding back the other 7 states. From what I’ve seen all the states will eventually get there.

More than 1500 EHR products have been certified by ONC-ATCBs.
That’s a lot of EHR software. I still put the EHR company list at about 300 EHR vendors. 1500 includes multiple versions of the same software, partial EHR certification for products like data warehouses, ePrescribing, etc. The best thing that’s come from the ONC-ATCB program is that it has made EHR certification basically irrelevant in the EHR selection process. Every EHR vendor is certified now. This is much better than the false assurances that EHR certification provided before. I still dislike what EHR certification has done to the industry, but at least it’s not misleading doctors the same way it was before.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

Having just experienced the attestation process firsthand as I watched an SRS client successfully attest to meaningful use, I am happy to report that this part of demonstrating meaningful use is relatively easy—a bit tedious if you are attesting for multiple providers, but not at all difficult. CMS has created a user-friendly, web-based attestation system. Assuming that your EHR provides the information you need in a useful format, you have successfully met all the required measures, and you come prepared, there should be no reason to have an unsuccessful attestation.

Here are some tips that will ensure your success:

• Register in advance: Even though you can register as late as at the time of attestation, the combined task would be overwhelming—particularly if you are attesting “on behalf of” a provider. Registering in advance ensures that everything is up-to-date in NPPES and PECOS and that you have all the necessary information.
• Make sure that all measures have been met: If your EHR does not show the percentages for measures that have thresholds, do the math yourself to verify your success on each one. CMS offers a worksheet that you might find helpful for this purpose. Verify that you have also met all other (non-numerical) measures. If you fail to satisfy even one measure, do not attest now—go back and try another reporting period.
• Have documentation for each provider:
  - Registration confirmation page with registration ID#

  - Password

  - EHR certification number

  - Reporting period dates (make sure it covers at least 90 days)

  - Printout of all meaningful use measures: numerators and denominators, exclusions and reasons

    (when there is more than one possible reason)

  - Clinical Quality Measure report: numerators, denominators, exclusions

• Do not hit “Submit” until you have reviewed the “Attestation Summary” page: Double check your data. Make sure that you have said “yes” to all yes/no measures and that your numbers are entered accurately. The summary page does not display percentages, so you have to do the math yourself to be sure that you meet the thresholds.
• Submit attestation and print the “Submission Receipt” as confirmation: If you have done everything correctly it will state that “all measures are accepted and meet MU minimum standards.”

While not necessary, I highly recommend having a second person help you attest. A second set of eyes will shorten the time the process takes and will reduce the potential for errors in posting your data.