Yep, the government shutdown talks were in the air again. We heard all about this back in April, we just heard about it again and now they’ve pushed the discussion out until November. I have a feeling that we’re going to continue to hear about it for a while to come. I’m just a passive political sideline observer, but I’d say the chance of a government shutdown is still very little. For all the drama of the media, I have a feeling that the drama won’t actually lead to a shutdown. A last minute deal will be reached…again and again like it did this time and the last.

However, it’s interesting to consider how a government shutdown could affect healthcare IT. In similar situations I’ve seen budgets have usually seen healthcare as an essential function and so they’ve been fine. Although, that’s really talking about the short term possibility of a government shutdown. Who knows what the long term budgets could hold for the government related entities.

Medicare and Medicaid are constantly in the cross hairs of cuts. Most doctors I know talk about how those two government programs pay them the least amount of money. Plus, they talk how many of the cuts to Medicare and Medicaid basically get passed on to them as doctors. I wonder what the super committee that’s required to cut $1.5 trillion of the federal deficit over the next decade will do with Medicare and Medicaid.

We’ve discussed many times the potential impact of the workings in Washington on meaningful use and the EHR incentive money (most think it’s safe).

For those that think what happens in Washington DC won’t really have much impact on healthcare IT, you might want to consider the email I got today announcing the keynote speakers for HIMSS 12 in Las Vegas. Donna Brazile (Democrat) and Dana Perino (Republican) will be on stage for what will no doubt be a spirited debate about the 2012 presidential elections, the political landscape and healthcare reform.

It’s going to be an interesting next couple years to see how changes in government affect healthcare IT and EMR.

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.

The Final Rule on ePrescribing was published in the Federal Register on September 6. This is the rule that adds new categories under which some providers can request a hardship exemption from the 2012 (1%) ePrescribing penalties, and it eliminates some of the discrepancies between the Medicare ePrescribing rule and ARRA. (See Meaningful Use Monday June 6.)The only change from the Proposed Rule is the deadline for filing a request—it has been extended to November 1, 2011 (from October 1). Providers should file as early as possible, however, to minimize the number of claims that have to be reprocessed. 

Requests will be reviewed on a case-by-case basis. To submit a request for exemption:

• Access the exemption request form on CMS’ QualityNet website www.qualitynet.org/pqrs
• In the “Related Links” box on the upper left, click on “Communication Support Page”, which will display the online form
• Provide identifying info (TIN, NPI, name, address, etc.)
• Indicate which hardship category applies
• Submit a justification statement explaining how ePrescribing represents a significant hardship
• Attest to the accuracy of the information submitted. 

Craft your argument thoughtfully. There is no appeal process—the decision of CMS is final.

As I usually do on Sunday, here’s some interesting tweets. Today’s tweets come from the always interesting and insightful @ahier. A little bit of my own commentary after the tweet.

@ahier – Brian Ahier
#EHR incentive program ramps up to 90,000 providers! bit.ly/npeNT4

The article says 90,000 signed up, but more interesting is that 13,000 registered in August. It also says that CMS paid Medicare EHR incentives to 1,000 physicians in August which was almost double what they did in July.

@ahier – Brian Ahier
New @Health_Affairs study of compliance rates for #EHR #MeaningfulUse found little change in hospital mortality rates bit.ly/pdGL9M

Did anyone really need to do a study on this? Sounds like a complete waste of a study to look at something that’s so obvious. In fact, I don’t think I’ve heard anyone say that meaningful use stage 1 was anything but a stepping stone. I’m not even sure meaningful use stage 2 and meaningful use stage 3 will show much improvement in a study either. However, I do think if it helps to achieve widespread adoption of EHR, then some very interesting and beneficial things can start to happen that wouldn’t have been possible without EHR adoption.

Ever since the American Recovery and Reinvestment Act became law in February 2009, giving birth to the phrase “meaningful use,” I’ve wondered when private insurers would follow the federal government’s lead and start offering financial carrots and sticks for using and not using EHRs. After all, one of the purposes of the Medicare and Medicaid incentive program was to address the fact that payers tend to reap the greatest financial gains from hospitals and physicians adopting EHRs, even though most if not all of the cost of acquiring the technology falls on the provider.

Federal officials have made it clear all along that “meaningful use” is just that, the meaningful use of the technology. The government was not simply going to write checks so providers could go out and buy technology. As the country’s largest purchaser of  healthcare services, CMS wanted some value for its money (not exactly something you hear every day when it comes to government spending).

I’d been hearing for years that major commercial health insurers also were willing to share some of the savings from EHR adoption, but not until the largest payer of them all, Medicare, did so first. The private sector usually does follow Medicare’s lead when it comes to major policy shifts. Medicare now has done so, but private payers have been mostly silent. Mostly.

This month, as InformationWeek reports, Humana teamed up with Allscripts Healthcare Solutions to offer physician practices financial incentives for purchasing Allscripts EHR systems. The deal is similar to one Humana cut last year with Athenahealth. A few Blue Cross and Blue Shield plans, notably in Massachusetts and Rhode Island, have led similar programs at the state level, with eClinicalWorks the main partner.

But unless I’m forgetting something, Humana is the only big payer that has jumped into the game. Where are the UnitedHealthcares, Aetnas, Cignas and WellPoints of the world?

Payers, it’s time to make good on the lip service you gave years ago and start passing on some of the savings you will realize from Medicare, Medicaid and hundreds of thousands of providers spending billions of dollars on EHR technology and health information exchange efforts.

This is the second in a series of EMR and EHR interviews that will be done on EMR and HIPAA and EMR and EHR. The full EMR interview with Dr. Muir can be found on the new EHR and EMR interviews website. The following is a summary of that interview written by Kathy Bongiovi.

If you’re a doctor, nurse, practice manager, EHR consultant, CEO or executive of an EHR vendor, etc with EMR experience that’s interested in being interviewed, let us know on our http://www.emrandehr.com/contact-us/“>Contact Us page.

Dr. Peter Muir of Springfield Center for Family Medicine was interviewed recently concerning his acquisition of the maximum Medicare Incentive for showing Meaningful Use of a Certified EHR. The Ohio based primary care practice has been using NextGen Ambulatory since 2003 and NextGen Management since 2006.

Dr. Muir stated that their practice chose NextGen EHR because the company focused on clinical offices. Dr. Muir and NextGen EHR share the philosophy of always searching for ways to improve the product. Dr. Muir not only believes in this philosophy but also attended a development think tank along these lines at NextGen’s headquarters. He was also drawn to NextGen because he wanted the capability of customizing his templates.

Having demographics, scheduling, clinical and billing information all on one database has had a huge impact on Muir’s practice. He feels that having a centralized database “makes reporting much easier and more comprehensive than those EHRs with separate databases or separate vendors”. The doctor admitted the conversion from paper charts to EHR was stressful for the first year but well worth it in the long run.

Since Muir’s office has been using EHRs (since 2003), there have been relatively few changes needed for Meaningful Use and any required upgrades to the system came as part of the standard NextGen maintenance fees. There was data that had to be added which was not normally collected by his practice as it had little relevance to his patients but from the patients’ perspective, there was no change in the attention patients received from Springfield Center.

The family practitioner Muir credits the CMS web site and NextGen Healthcare for not only the upgrades to their EHR software but also for their pathway documents and webinars which helped them show meaningful use. He also credits GBS of Youngstown, Ohio (his NextGen vendor for hardware, software) who also helped them implement security upgrades in 2010 in anticipation of the process.

Additionally, being a part of the ONC Meaningful Use Vanguard Program was a benefit to Dr. Muir because “it provides recognition which may allow a greater input in system design and operation.” Muir is concerned, though, that the Program’s flow of information may be difficult if multiple database silos remain in service and a lack of standardization isn’t addressed.

Especially with respect to Meaningful Use Stages 2 and 3, the doctor believes it is critical to have professional health providers utilizing some form of regional system – versus individual systems – in order to have a seamless flow of information. Muir has begun such a system within his own state of Ohio.

The doctor was intricately involved in starting CCHIE (Collaborating Communities Health Information Exchange) in Springfield, Ohio. CCHIE chose HealthBridge as their data engine and together they have partnered with other healthcare providers to provide electronic access to patients’ lab and radiology results as well as to admissions, discharges and transfer information. They have added regions in Southern Indiana and two regions in Northern Kentucky.

Dr. Muir’s advice to fellow doctors is that unless they are planning to retire within the next couple of years they should not delay in the implementation of an EHR. The longer they wait, the more difficult and time consuming the transition will be because, with time, the activities of daily practice will be much broader and more demanding. Additionally, he suggests providers select a system that does not just meet Meaningful Use requirements. His advice is to “select a system that assists you in providing better medical care”.

Read the full transcript of Dr. Muir’s interview.

CMS published a list (pdf) of the first providers who received incentive payments under the Medicare portion of the EHR program. What distinguishes these incentive recipients from those announced in early January—(See “Meaningful Use? Not Yet”)—is that these providers actually had to attest to earning these incentives by demonstrating meaningful use. The earlier recipients received their payments through the Medicaid program, which for the first year’s incentive only requires adoption, implementation, or upgrade of a certified EHR, not meaningful use.

There are 320 providers on this first Medicare list. Here’s how the list breaks down:

• Approximately 40 are hospitals/health care centers.
• As anticipated, the vast majority of the physicians are primary-care providers—over two-thirds if you include cardiologists.
• Surgical specialists are significantly underrepresented—also as expected. (There are only 11 orthopaedists, for example.)
• And for some reason, there are a relatively large number of podiatrists among these first meaningful users.

So, if you are in need of some tips on how to successfully meet the meaningful use requirements and/or navigate the attestation process, you might want to browse through the list (pdf) and see if you recognize any names.

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.

I hope that by now, readers have heeded the advice I gave in a previous post, “No Matter What Else You Do in 2011, You’ve Got to ePrescribe” and are covering their bases regarding ePrescribing under MIPPA. Even though providers can’t collect a meaningful use incentive (as a Medicare participant) during the same year that they earn an ePrescribing incentive, having the ePrescribing workflow in place for MIPPA purposes will prepare them well for meaningful use.

Meaningful Use Core Measure: ePrescribing

More than 40% of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology.

This is a core, i.e., required, measure that can only be excluded by an EP who writes fewer than 100 prescriptions during the reporting period and attests to that number of prescriptions. A continuing ePrescribing challenge faced by some specialists is the inability to ePrescribe Schedule II-V drugs. CMS took that issue off the table—at least for the purposes of meaningful use—by limiting the calculation to “permissible prescriptions.” (The definition of “permissible” excludes controlled substances because it is based on the rules that were in place in January 2010, when the Final Rule on Meaningful Use was published.)

The good news about the ePrescribing measure is that in the course of satisfying this one measure, providers will be simultaneously addressing 4-5 other measures—CPOE, maintaining a medication list, drug-to-drug and drug-allergy checks, and the menu measure requiring implementation of a drug formulary. Of this list, those that require more than simply “enabling the functionality” will be the topics of future Meaningful Use Monday posts.

Important notes about MIPPA and EHR Incentives:

• It is possible to be deemed a successful ePrescriber in one program, but not the other, because the two programs have different specifications, so make sure to understand the rules for each.
• If you choose to pursue the EHR incentives rather than the ePrescribing incentives this year, you must still continue to comply with the MIPPA requirements, (i.e., use the G-Code), to avoid 2012 and 2013 penalties.

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.

Brenda asked:
As a private OT clinic that does not contract with medicare/ medicaid, are we required to use electronic medical records? We do submit claims to private insurance companies electronically.

Answer:
The short answer is no.

In fact, NO ONE is REQUIRED to use EMR whether they take Medicare or Medicaid. However, if you take Medicare or Medicaid, then you have to be a “meaningful use” of a “certified EHR” in order to: 1. Get the EHR Incentive money and 2. Avoid the government penalties for not being a meaningful user of an EHR.

Some might argue that the work to show meaningful use is not worth the effort compared to the incentive money you receive. Plus, the penalties for not using an EHR are not that big of an issue (see this post on the EMR penalties ) Although, there are plenty of people arguing on the other side. For example, Meaningful Use is relatively easy (at least in Stage 1) and the penalties are going to be a major issue for their clinic since they have such a large Medicare or Medicaid population.

Then, there are the doctors that are leaving Medicare and Medicaid behind completely (see this doctor as an example). The argument here is that Medicare and Medicaid are the lowest paying payers out there and now they’re going to penalize them even more so they might as well just stop taking them. We’ll see how many adopt this strategy.

One word of Caution…
There’s a possibility that insurance companies will hop on board the requirement of an EHR and Meaningful Use (see this post about private insurance and meaningful use ). I’m sure they’re keeping a keen eye on how well it goes for the government before making any decisions. My gut feeling is still that they won’t wholesale take the governments approach to EHR and meaningful use. Instead, they may require some sort of electronic documentation or reporting requirements which are more easily performed with an EMR. Essentially it will be an extension of their requirement to have claims submitted electronically.

Despite the myth that EMR is a requirement, so far no one can require you to use an EMR. They can only provide incentives and penalties if you don’t (which only the government has done to this point). Although, there’s always the aspirational goal that Bush and Obama have made of Full EHR by 2014.

The longer answer is…EMR is not a Requirement….yet?

Be sure to check out all the EMR Stimulus Questions and Answers posts.

There is a great deal of skepticism about when EHR incentives will be paid and how providers will actually get their money. This is not surprising, given the negative early experiences with the PQRI program and the fact that ePrescribing providers are having to wait until September or October to receive their bonuses for the prior year for the MIPPA incentive program.

The good news is that CMS is promising to distribute the first EHR incentives in May, following successful attestations of meaningful use for the initial 90-day reporting period.

So how will this happen? A common misconception is that the first year incentives are automatically $18,000. According to the legislation, the incentives are earned at a rate of 75% of Medicare Part B FFS Allowable Charges up to the maximum, (i.e., $18,000 for year 1). What this means is that once a provider successfully attests to meeting meaningful use, CMS will check to see if he/she has generated sufficient Medicare revenue to warrant the $18,000 incentive—i.e., $24,000 in charges. If so, CMS will issue the check. If not, CMS will wait until the provider reaches $24,000 and then release the incentive payment. For the few providers with very small Medicare populations, CMS will wait until February 2012 to receive all of the provider’s claims for 2011, and then send an incentive in the amount of 75% of his/her 2011 Medicare charges.

Lynn Scheps is Vice President, Government Affairs at EMR 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.

In one of my recent discussions with a reader of EMR and HIPAA, they said they loved this site because I don’t have any agenda. Then, they quickly clarified, your only agenda is to have transparency in the process. Your agenda is to bring to light all the information related to a certain topic so that doctors can make an informed decision.

I think this reader hit it right on the head. I really don’t have an agenda. I’m generally pro-EHR, but I understand doctors misgivings on why they’re concerned about doing it. Although, I am completely fanatical about having transparency and good information (both good and bad) about the EMR and EHR process.

That’s why I get all worked up when EMR advertising or EMR sales people provide misleading information. In fact, I have a whole category on my site for what I refer to as EMR Sales Miscommunications. To be honest, most of the misinformation is not intentional (although, there are certainly exceptions). Instead, it’s usually someone answering a question for which they don’t actually know the real information.

Today’s misleading information comes from a blog post by Athena Health (which was also included in their newsletter). The title basically says it all: “A Shreveport OB-GYN Gets $21,250 for Meaningful Use of an EMR”

Impossible!

As Lynn pointed out in her latest Meaningful Use Monday post, no one has been able to show meaningful use yet. The government hasn’t done any checking on meaningful use yet. Not to mention, not a single person has been paid any EHR incentive money for Medicare yet (where we’re going to see the bulk of meaningful use).

Instead, the blog post describes that the practice got the EHR incentive money because they have a “high Medicaid population.” Which makes total sense, because in the Medicaid EHR incentive program there is currently no requirement that you be a meaningful user of an EHR. The title could have more accurately read, “A Shreveport OB-GYN Gets $21,250 from the Medicaid EHR Incentive Program for Buying an EMR.”

The crazy thing is that I’m sure that many people at Athena Health know the difference and realize that it’s a terrible title. In fact, the title was probably written by some marketing or PR person who barely knows the difference between Medicaid and Medicare. Let alone the difference in how the various EHR incentive programs work. Although, why would someone with knowledge at Athena Health change the headline when it benefits Athena to have that misinformation out there?

This kind of stuff gets under my skin. I hate when people are misled by bad information. Add in the complexities and vagueness of meaningful use and the EHR government hand outs and it’s a the perfect microcosm for misleading marketing.

UPDATE: Props to AthenaHealth for updating their blog post to correct the misleading information.