EHR Incentive Program: A Progress Report

SOURCE: Physicians Practice

Hampshire OB-GYN adopted its EHR in 2004, years before CMS’ meaningful use program began. Yet there were several time-consuming adjustments that even this EHR-savvy practice, in Northampton, Mass., had to make to comply with the Stage 1 rules.

“We had a few small obstacles,” recalls practice administrator Gina Wall. “We had to figure out how we would handle the clinical summaries. Providers might perform a function but not click the box. We had to monitor that.”

Also, the practice had not been collecting all of the demographic data required, so front-desk staff had to be retrained on a new work flow that would allow patients to privately answer or decline certain questions, such as ethnicity.

To help clinical staff, Wall tasked her practice’s clinical manager to oversee the work flow changes and training of all providers and staff using the EHR, and to work with the billing supervisor to make the changes necessary to meet meaningful use.

The practice also examined its existing performance-based measures to see what would make sense for attestation.

But six months later, Wall says the practice is more focused than ever on objectives that improve patient care. For example, problem lists are up to date on all patients, not just OB patients.

“We can immediately see what comes up on a problem list, and provide patient care, such as screening of chlamydia, or counseling,” says Wall. “Patients are getting a broader spectrum of necessary services that are more targeted.”

Like Hampshire OB-GYN, Desert Ridge Family Physicians in Phoenix made several changes to how it was using its long-established EHR to meet meaningful use requirements. For example, Desert Ridge was also briefly tripped up by the race-and-ethnicity question, and it needed to implement a patient portal in order to provide an electronic copy of care plans to patients within three days of their physician encounter. Practice administrator Dan Nelson credits his vendor, NextGen, with simplifying the transition with its educational programs.

“The challenge for us was turning some of those components provided by NextGen into a new work flow for our practice, and getting used to the EHR’s reports, and monitoring physicians,” says Dan Nelson.

But many practices that implemented EHRs after CMS’ Stage 1 rule release have had a harder time. According to our Technology Survey, 18 percent of respondents said it took more than 18 months to implement their EHR after purchase, and 5 percent of respondents called the process of EHR implementation “traumatizing.”

“It’s an expense and it’s a disruptive force in your practice,” says Tashjian. “And while after three months, every doc I’ve ever met says ‘I won’t go back’ [to paper], during those first three months [of implementation], it’s a difficult transition.”

Still, experts believe the sooner a practice attests for meaningful use, the easier it will be. Likewise, the longer a practice waits to attest, the lower their possible maximum incentive payment. What’s more, in the final rule for Stage 1, CMS said it will penalize providers who have not demonstrated meaningful use with a 1 percent reduction of annual Medicare payments in 2015, that increases another 1 percent each subsequent year until the penalty reaches 5 percent.