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Private Payers and Meaningful Use

Posted on June 25, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Is it time for Private Payers to join in on Meaningful Use? A number of people are starting to ask this question after CSC released a recent white paper called “Meaningful Use for Health Plans: Five Things to Consider.” I’ve always said that private payers adopting meaningful use would be a HUGE deal and would likely sway many doctors who are on the fence. The question is, will private payers adopt meaningful use?

An article in the American Medical News says they will:

Private insurers are latching onto the government’s meaningful use definition to bolster their own efforts to promote EMR use and possibly impose their own financial penalties for nonuse among contracted physicians, according to the author of a new study looking at the challenges physicians face with meeting meaningful use.

Neil Versel in his story on Fierce Health IT quotes the more reasoned opinion:

“At minimum, plans should use this as an opportunity to reformulate and realign existing pay-for-performance incentives with health IT implementation and meaningful use deadlines,” CSC says. “Minimizing differences between plan-sponsored incentive programs and Centers for Medicare & Medicaid-sponsored programs will also serve to simplify compliance and achievement, for provider organizations.”

Neil also ends with this little zinger, “Those statements are long overdue. Private payers, it’s time to ante up for the quality game.”

My personal feeling is that insurance plans won’t be adopting the meaningful use objectives. That’s not to say that they aren’t or won’t “ante up for the quality game” since healthcare quality could be great for insurers. However, I think it’s a stretch to call the meaningful use objectives a healthcare quality initiative. Maybe that’s the intent, but I think it misses those goals.

The bigger reason why I believe private payers won’t adopt meaningful use is there’s far too much kick back from doctors. Insurers do an interesting dance with doctors and I think that insurance plans won’t want to deal with all the angry doctors if they force meaningful use upon them. Plus, the case that meaningful use actually will provide benefits to private payers is a murky grey with little solid foundation.

Private payers do want doctors using EMR. They do want standards for communication. They do want EMR initiatives to work and quality of care to increase. However, I’ll be surprised if they choose to latch on to meaningful use to achieve these goals. If they do, then meaningful use as means of getting the EHR stimulus will be an afterthought.

EMR Stimulus Question and Answer

Posted on June 11, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Question: My EMR claims to have all of the capabilities they will need to demonstrate meaningful use and qualify for ARRA incentives. Does that mean I will get the EMR stimulus money?

First of all, you might want to consider another EMR vendor. If they are saying this, then they are trying to mislead you and make more sales. No EMR vendor can claim that they have “all of the capabilities” for you to show meaningful use and qualify for the EMR stimulus money.

Why can I say this? Because the details for Meaningful Use are still not final. We don’t know what you’re going to have to do to show meaningful use and so how can an EMR vendor claim to have all of the capabilities? Short answer is that they can’t. So, go and read their press release again and see if they’re just telling lies or if there was a disclaimer of some sort (ie. according to the interim final rule).

On to the other point of you getting EMR stimulus money. Certainly your EMR will have to be a certified EHR (that’s still not defined either). Your EMR will also have to have the capabilities to show meaningful use. However, at the end of the day, YOU’re the one that’s going to have to see patients and Use the EMR in a way that all of the meaningful use criteria are met. If you do this to the satisfaction of CMS, then you’ll get the stimulus money.

Certainly you can’t meet meaningful use without the EMR vendor. However, the EMR vendor alone can’t qualify you for meaningful use either. It takes 2 to tango. Just remember that it’s much easier to tango when you have a great partner. A lousy partner makes it no fun for anyone.

Check out previous EMR stimulus Questions and Answers.

EMR Stimulus Questions and Answers

Posted on June 2, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

One of the challenges of this blog is writing content that will be interesting and useful to a wide variety of readers. At times I think I assume that those visiting EMR and HIPAA have read my 770 previous posts and should have a good understanding about the EMR world.

Of course, the reality is that many of the people visiting this site might only read a couple different posts. Even more significant is that they might only have a remedial understanding of EMR and in particular the EMR stimulus money. This leaves me with the challenge of keeping the long time readers interested and benefiting from the content I create while still helping the EMR newbies understand what they need to know.

In that vein, here’s some questions that I got in an email about meaningful use and the EMR stimulus. Those of you well versed in the EMR stimulus can go and enjoy EMR and EHR or add some content to the EMR wiki while I do what I can to answer.

Are there governing bodies that have been set up to “certify” EMR/EHR software vendors?
Not yet. The government hasn’t recognized any bodies that will certify EMR/EHR per the ARRA requirements. They’ve published some guidelines and rules for those bodies, but HHS has yet to recognize any of them as official ARRA EMR Stimulus certifying bodies. I expect by end of summer we’ll have a couple to choose from. The Drummond Group and CCHIT are both planning to be EHR certifying bodies, but neither has been officially recognized yet.

Do EMR/EHR software vendors have to be “certified”? If they are not “certified”, does this prevent their customers from receiving federal money?
In most cases the EMR/EHR software vendor is the one that will be certified. There has been some provisions and discussions about allowing for 2 other EHR certification options beyond just using a “fully certified EHR” software.

The first is that you could use a combination of certified software vendors. For example, you might use one certified EMR vendor for everything but ePrescribing and then you’ll choose another software vendor who is only certified for the ePrescribing portion. It seems that this type of combo certification will be allowed.

The second is what’s been called a site certification. This would essentially be where a specific site (or location) would be certified against the EHR certification criteria. This is best illustrated by a hospital or clinic which has their own home grown EMR software. This EHR site certification would allow them to certify their site and give them access to the EMR stimulus money. It’s possible that an option like this won’t be available, but from what I can tell it’s looking like it will happen.

Do you think that it is possible to satisfy the Stage 1 objectives?
This is a loaded question. The short answer is that everything is possible. Whether it’s possible or not is not as important as whether doctors will do it or not. This question is hard to answer right now. Mostly because we’re missing a lot of the practical meaningful use details which doctors need to know in order to make a decision.

My gut feeling tells me that it will go about like PQRI stimulus money. Some will get the EMR stimulus and be happy. The same number will try for it and be really disappointed by the whole process. More will say it’s just not worth my time right now. That’s not to say that many of these doctors won’t (or shouldn’t) implement an EMR. I think many of them will, but they’ll do it for the inherent benefits of EMR software and not for the EMR stimulus money.

Percent of ePrescribing for Meaningful Use

Posted on April 30, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’m still really disturbed by the fact that we have so few practical meaningful use details. Sure, we have a lot of guidelines and a lot of prognosticators guessing at what they mean and how they’ll be measured. We even have a certifying body trying to guess what the EHR certification will be. Sadly, they’re all still guesses.

Let’s just take a simple example for a second and see some of the complexities.

Objective: Generate and transmit permissible prescriptions electronically (eRx).
Measure: At least 75 percent of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology.

This certainly seems pretty straight forward. Probably about as straightforward as it comes as far as objectives. Basically, 75% of the prescriptions have to be ePrescribed using a certified EHR technology to meet the meaningful use guidelines.

Of course, the real question’s going to be around the word “permissible.” What’s considered a permissible prescription? I imagine this was added because currently you aren’t allowed to ePrescribe controlled substances. If I remember right, controlled substances make up about 15-20 percent of prescriptions. Certainly it wouldn’t be fair to include something that you’re not legally allowed to prescribe electronically in the requirements. Are there other exceptions under the “permissible” rule?

What’s going to happen once ePrescribing of controlled substances is allowed? Will doctors then be required to flip a switch and start sending controlled substance prescriptions electronically as well? Once they’re allowed, they’ll be considered permissible, no?

Let’s also not be surprised if the technology is built to do eprescribing in 2 systems (controlled vs not controlled). Of course, this adds a bit more complexity to measuring the 75% of prescriptions done electronically.

Also, does it give anyone else a bit of angst that the EHR software is basically going to spit out a report saying, “Yes, I ePrescribed 75% of my prescriptions.” I’m not sure how you scale a more sophisticated solution, but just taking some report from an EHR seems plenty gameable to me.

Will ONC be going around and doing some audits of the submissions to ensure that the data was actually good and not messed with? Can you imagine the challenge of having to audit some 300+ EMR vendors. Good luck with that.

I also love how the ePrescribing has to be done with a certified EHR system. A part of me really feels for those specialists that only write a few prescriptions a week. They get to learn the fun thing we call ePrescribing and they forget what they learned by the next time they have to ePrescribe.

UPDATE: Thanks to Russ in the comments, he pointed out the issue of calculating a percentage when your EMR won’t know if you just handed them a paper prescription instead of ePrescribing. I guess the criteria assumes they’re going to order the script and then print it out instead of sending it electronically? So, maybe the criteria should say 75% of scripts ordered in the EMR sent electronically. Just makes me laugh to think about it.

Lest ye think paper scripts don’t happen with an EMR, we can at least argue for them happening during EMR downtime (or printer or workstation or internet or…downtime). Although, they happen other times as well. How will an EMR calculate that percentage of prescriptions? Are they going to translate the freetext note that was entered into the EMR about the paper script that was given? Ideally the doctors will just enter in the script after the fact, but that’s not always the case.

I’m sure I’m missing other intricacies. My point is that there’s still a lot of unanswered questions around meaningful use. It would be nice to get some answers. It would be nice if ONC had a way to get and provide practical answers. You’d think they’d want that type of interaction as well.

Need for additional guidance…The Meaningful Use Mantra

Posted on February 22, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

John Halamka wrote some interesting comments about the various feedback he’s heard on the meaningful use guidelines on his blog. He gives some interesting insight into why ONC’s interim final rule is so vague (basically regulation/rule making mess). However, I couldn’t help but see how many times John Halamka used the words:

Need for additional guidance

This is no news to people like myself who’ve been writing about this since the beginning. There is a great desire for information on how to get the EMR stimulus money.

The real problem is that when things are vague and not well defined, then misinformation starts to take its place to satisfy our need for information and guidance. We want to be informed and so people start informing us even if the information is incorrect.

Today I got an email from someone stating that “We have the EMR already installed by a certified institution” and so they wanted to know how they could get the EMR stimulus money.

I felt so bad for this emailer. Someone (likely their EMR vendor) had either told them a lie about certification or more likely is that this person didn’t understand the details of the “certified EHR” component of the stimulus money. This is going to be a major challenge going forward as doctors who don’t have time to follow all the stimulus money movement get bad information. Plus, it’s only going to get worse if we continue to get partial pieces of information.

Sadly, most of the people emailing me about the EMR stimulus will continue to get the “Need for additional guidance” response from me. At least until ONC provides some additional guidance.