Installing the future

Disbursement of incentive payments for electronic health records becomes a reality for physicians

By Erin Redwine

Health information technology plays a prominent role in the practice of family physician Kevin Spencer, M.D. He is partner at Premier Family Physicians, a nine-doctor practice in Austin, Texas, and they began implementing an electronic health record system about a year and a half ago to achieve better outcomes, measure these outcomes, and change processes to serve patients better. As an added bonus, the practice began receiving incentive payments in January 2011 for implementing their EHR and showing “meaningful use.”

Though Spencer expects the incentive payments will cover an estimated 70 percent of the overall cost of implementation, the incentive was not the main reason he and his colleagues pursued an EHR.

“Before meaningful use was meaningful use, we wanted to be able to offer our patients the ability to communicate with us via e-mail, to look and schedule their own appointments online, to embrace technology, to let them see their medical record and results on the webpage, and to be a kind of practice that was using technology to really take better care of people.”

The incentive payments were put in place through HITECH—the Health Information Technology for Economic and Clinical Health Act. In 2009, HITECH allocated over $30 billion in financial incentives for physicians to adopt EHRs and develop a technical support infrastructure with payments to start in 2011. The goal was to encourage widespread adoption of health information technology by 2014 in the hope that the implementation of HIT would reduce overall health care expenditures by improving the quality and coordination of care and public health activities.

The “meaningful use” criteria are a set of 25 objectives, and there are three stages over the next five years that set the baseline for electronic data capture and information sharing. In stage one, physicians must meet 20 of these 25 to qualify for an incentive payment by demonstrating the utilization of the system and improving the quality of patient care. As meaningful use transitions to stages two and three, it is likely that physicians will be required to meet all objectives and participate in a health information exchange to be eligible for incentive payments, says Tyler Patterson, HIT marketing and resource coordinator for the Texas Medical Association.

Spencer is part of a group of “early adopters,” those who start in 2011 or 2012. The early adopters are eligible for the full incentive—up to $44,000 in bonus Medicare payments or $64,000 in Medicaid. Physician incentives through the Medicare program will be awarded annually from 2011-2016. The amount of the incentive is reduced when the physician starts after 2012, and the last year to begin the Medicare program and earn an incentive is 2014.

The Medicaid program offers six years of incentives. Participating physicians must enter the program by 2016 and the final year of the program will be 2021.

Spencer says meeting the meaningful use criteria hasn’t been difficult. “We didn’t have to do any extra work except truly utilizing the system. The EHR has a dashboard that tallies all of it for us without us doing any work except the criteria itself. So if you put all the demographics in correctly, keep your problem list correctly, e-prescribe, interface with the lab, and give out clinical summaries, then the computer actually tracks that it is happening for you.”

Another concern is how implementation of the EHR will affect physicians’ day-to-day productivity and efficiency. He says all the physicians saw the same number of patients in the beginning but wouldn’t necessarily chart all of them in the EHR. “Physicians had to stay later to do their work, but by the six-month mark life was back to normal.”

Off-site training of employees, building new charts on the EHR system as patients came for appointments rather than migrating all of the data at one time, and weekly increases in the number of patients physicians would chart on the EHR during business hours cut down the loss in productivity and efficiency.

“There are a very large but finite number of issues that everybody has to deal with,” says David Kibbe, senior advisor for AAFP’s Center for HIT. “Some physicians are incredibly able to use information technology software, take the program, and start using it within a couple of hours, and some are incompetent with electronics. But if someone is pursuing the incentives, most likely they are going to get them.”

Whether HITECH can take the credit or not, widespread adoption of health information technology is becoming a reality. According to Kibbe, an estimated 60 percent of AAFP members have implemented an EHR and 15 percent plan to implement one. Just 25 percent say they will not implement an EHR.

“Electronic health records are moving us in a direction of greater productivity,” Kibbe says. “It is inevitable that we have to move in this direction so we might as well do it now.”

The process of implementation can be a daunting task with over 350 EHRs to choose from. To help physicians in choosing an EHR compatible with their practice and to aid in implementation, the law put in place 50 Regional Extension Centers around the country. The four RECs in Texas staff technical consultants that help physicians through the process of converting from a paper office to a wired office. The cost for a primary care physician to receive help for an entire year is $300.

Family physicians can also find assistance through AAFP’s Center for HIT website. The site houses resources on the four stages of EHR adoption—preparation, selection, implementation, and maintenance—as well as articles on meaningful use and best practices, CME opportunities, and access to the Physician Product Reviewer and EHR User Directory—a database of reviews searchable by regional availability, initial cost, hosting models, and operating system.

Kibbe says those who plan are the ones who do well with EHRs. “Spend a lot of time in the planning stage and have a game plan for implementation and selection.”

Spencer says his practice “did a very extensive search.” They considered 30 products initially, taking four months to make their final decision. They considered EHRs based on usability and general business parameters like the companies’ financial standings. They made trips to other physicians’ offices where the systems were in place and to the final company’s headquarters. The vendors traveled to Spencer’s practice to demonstrate templates and compatibility within the office.

Though the incentives are available now, penalties will kick in starting in 2015 for non-hospital-based physicians who haven’t adopted and begun using an EHR. In 2015, physicians will be penalized 1 percent of their Medicaid and Medicare payments. The penalties escalate to 2 percent in 2016 and 3 percent in 2017, but will not increase past 5 percent. However, Kibbe says the penalties will likely change since stage two of meaningful use “will almost definitely be delayed.”

Regardless of delays, Spencer says the meaningful use criteria will form the basis for how all physicians practice medicine going forward.

“The days of practicing without an electronic health record and achieving meaningful use are going away rapidly and so as I watch the marketplace, I just don’t see anyone being able to survive long term [without an EHR],” Spencer says. “Once you are on the other side of it and you are able to see the quality difference and the outcome measures you can get, I think it is going to be a good thing for medicine ultimately.”

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RESOURCES ON THE WEB

AAFP Center for Health Information Technology
www.centerforhit.org

TMA Medicare and Medicaid EHR Incentive Instruction Guides
www.texmed.org/MedicareEHR, www.texmed.org/MedicaidEHR

TMA Regional Extension Center Resource Center
www.texmed.org/REC

TMA Meaningful Use Webinar
www.texmed.org/MUWebinar

CMS EHR Incentive Program Overview
www.cms.gov/EHRIncentivePrograms

CMS EHR Incentive Registration and Attestation System
http://go.cms.gov/dXtA5d

Texas Medicaid EHR Incentive Program Site
www.tmhp.com/Pages/HealthIT/HIT_Home.aspx

Texas Regional Extension Centers

Gulf Coast Regional Extension Center (GCREC)
University of Texas Health Science Center at Houston
(713) 500-3479 or www.uthouston.edu/gcrec

North Texas Regional Extension Center (NTREC)
Dallas-Fort Worth Hospital Council
(469) 648-5140 or www.ntrec.org

CentrEast Regional Extension Center (CentrEast REC)
Texas A&M Health Science Center
(979) 862-5001 or www.centreastrec.org