HHS gathers health care stakeholders to discuss electronic health record incentive demonstration

Two big players in the health care spending debate gathered stakeholders to promote an initiative that aims to reduce spending in Medicare by expanding the use of health information technology.

As one stop of many around the country, representatives from the U.S. Department of Health and Human Services and Centers for Medicare and Medicaid Services held a round-table discussion in Austin on March 27 to gather feedback, answer questions and encourage communities to apply for the Electronic Health Records Demonstration Project, announced in February. Kerry Weems, acting director of CMS, led the discussion.

The five-year demonstration project rewards physicians in small- and medium-sized primary care practices with incentive payments for adopting EHRs and showing continual improvement in the care of Medicare patients over specified clinical quality measures. Total payments over the period could reach $58,000 per physician or $290,000 per practice. CMS will accept applications from communities around the nation “with broad connectivity and diversity of practices” until May 13, eventually choosing 12 finalists. With each community engaging up to 100 practices, CMS estimates the project to reach 3.6 million patients.

At the round-table discussion, individuals from organizations representing health care professionals, health plans, hospitals and all levels of government asked the CMS acting administrator to describe and define terms of the project, with one even asking if CMS would consider delaying implementation until possible hurdles with recruitment, measurement, reporting and community infrastructure could be addressed.

Stephen Fitzer, CEO and executive director of the Bexar County Medical Society, expressed skepticism that CMS would be able to find 12 geographic areas with enough primary care practices eligible and willing to participate. Citing a restriction barring states from applying that are already participating in a CMS EHR project, he said that only 23 U.S. states are eligible to apply. In addition, only 91 primary care physician practices qualify to participate out of thousands of physicians in the San Antonio metro area, he said.

Fitzer also noted that while individual physicians and physician practices can expect to receive compensation, administrators of the project would not, making it less attractive for state-level organizations and government to participate. Other meeting attendees questioned the reporting procedure and how incentives would be awarded if practices already have high-performance EHRs.

Weems told the group that this project will be much different from other government-led demonstration projects in that CMS purposefully did not define many of its terms, even what qualifies as a “community.” This, Weems said, will encourage the applicants to set their own terms, gather all of the resources and stakeholders in their communities, and use that ownership to ensure the project’s success. Weems said the ideal applicant will clearly define the role of all stakeholders: physicians; insurers; the state; large, self-insured employers; and others. He expects CMS to receive up to 30 applications that will range from large, urban cities to entire states or inter-state regional partnerships, though he indicated that CMS may lower the number of practices needed to qualify to 150.

Linda Carney, M.D., a solo family physician in Buda who told the group about her experiences adopting an EHR, said that this demonstration will require the participation of all types of stakeholders at all levels. “To make this project work in Texas, TAFP, TMA and other professional medical organizations will have to bring everyone to the table and clearly define what each of their roles will be,” she said.

HHS encourages widespread implementation and adoption of EHRs and other health information technology to improve patient care, transform the way medicine is practiced and delivered, and produce significant savings to the Medicare system.

Carney told the group that her EHR helps her provide high-quality care to her patients in the town of 5,000. “As a solo family physician, some people ask me if I’m part of a dying breed, but I’m not,” she said. “I have a secret weapon—my electronic health record.”

She said her EHR allows her to access a patient’s information, make referrals to other specialists, or forward insurance information to other physicians at the click of a button.

One of her patients, David Saxon, accompanied Carney to the meeting to express his contentment with Carney’s use of an EHR and commitment to this technology. He called her a “heads-up doctor” because she is able to pull up his entire medical history on her computer in the exam room and use an extensive discussion with him and any test results taken in the office to provide a comprehensive diagnosis. He compared this informed, interactive physician with another type of doctor: a “heads-down doctor” who must keep his head in a paper chart and does not have as much freedom to discuss care options with the patient because of time wasted searching for information.

While Carney is a proponent of using this technology to reduce medical errors and give her more time with her patients, she admits that it’s not easy for physicians, especially solo physicians, to adopt EHRs. She specifically pointed out that the training process is ongoing as new staff join the practice and the patient population expands.

CMS expects to announce four of the chosen community partners in May 2008 with the remainder announced in 2009. Once chosen, participating physician practices will use their EHRs to perform tasks such as clinical documentation, ordering of lab tests, recording lab tests and ordering prescriptions.

Incentive payments will be determined based on the physician’s score on the Office Systems Survey, which will be administered annually to track the level of EHR implementation. By the end of the second year, the physician practices will be required to have an EHR certified by the Certification Commission for Healthcare Information Technology, which ensures privacy, security and interoperability, Weems said. In years three through five, physician practices must show increased performance with the EHR to receive incentive payments.