Build engaged audiences through publishing by curation.
Sign up with Facebook
Sign up with Twitter
I don't have a Facebook or a Twitter account
Start a free trial of Scoop.it Business
I recently stumbled upon the Insight Data Group website. I don't know much about the organization, but they had an interesting page on their site listing 10 (This is helpful!
Are you sure you want to delete this scoop?
Earlier this year members of the Office of the National Coordinator for Health Information Technology (ONC) pointed to the abundance of published research demonstrating the positive influence of the EHR Incentive Programs and their meaningful use requirements on care quality, safety, and efficiency. One significant takeaway from this literature review was strong evidence supporting the favorable effects of computerized physician order entry (CPOE) on patient outcomes.
According to the latest figures from the Centers for Medicare and Medicaid Services, the EHR incentive program has exceeded its total estimated payout of $22.5 billion.
CMS states in the January report that it has paid out a total of $20.937 billion in EHR incentives, with payments of $5.371 billion in 2011, $9.667 billion in 2012, and $5.896 billion in 2013. But these payments do not include another $1.942 billion to eligible hospitals in fiscal year 2014 so far, bringing the total to-date amount the program has paid to $22.78 billion.
In the final rule published in July 2010, CMS estimated the total cost would be $27.4 billion under the “high scenario” over a 10-year timeframe. Yet the estimate was subsequently revised to $22.5 billion in 2012 due to “different assumed penetration rates based on more recent data and analysis, and revised assumptions as to the timing of payments in relation to when meaningful use is achieved based on the actual experience of the programs to date.”
Nevertheless, it now appears that the original “high scenario” might be the more accurate dollar estimate as to the amount that the EHR incentive program will ultimately pay out. Case in point: in its just released fiscal 2015 budget, the Department of Health and Human Services estimated "Medicare health information technology incentive payments" of $1.436 billion to hospitals and $710 million to eligible professionals, respectively, for a total of $2.15 billion next fiscal year. However, that number does not include Medicaid incentive payments, which also factor into the cost of the overall program.
Under the current timeline, 2016 is the last year to receive a Medicare EHR incentive payment and the last year to initiate participation in the Medicaid EHR incentive program, while 2021 is the last year to receive a Medicaid EHR incentive payment. However, the program’s timelines in recent months have been changed. Stage 3 doesn’t start until 2017, which likely would require revisions of the participation and incentive payment timelines.
The electronic medical record market is poised for a competitive shakeup. As Stage 2 meaningful use demands more from hospitals, many current EMR platforms just aren't cutting it, and up to half of large hospitals are ditching their old systems for new, interoperable platforms with population health capabilities.
Two new reports, conducted by Black Book and KLAS Research, underscore the EMR market trends at hospitals with more than 200 beds. And the once ill-fated Allscripts has made a huge comeback this year, edging out a slight lead for top-ranked EMR inpatient vendor over three-time annual champion Epic Systems, according to Black Book researchers.
The reports find that from one-third to half of all large hospitals are looking to trade out their old EMRs by 2016, but, according to KLAS data, only 22 percent of those buying decisions may be up for grabs, as 34 percent of them have already officially selected a vendor, and the lion's share, 44 percent, are already strongly leading toward a certain vendor.
"Where the last round of EMR purchases was fueled by meaningful use requirements and enticing reimbursements, this next round is being fueled by concerns about outdated technology and health system consolidation," said report author Colin Buckley in a press statement. "This shift in focus will play a major factor in which EMRs are being considered."
Black Book data, which includes responses from 163 large hospitals -- which it defines as hospitals having more than 300 beds, highlights a growing percentage of provider dissatisfaction with current EMR systems, as some 32 percent of them are reevaluating their vendor's products and services, with 20 percent saying the reevaluation will likely lead to a replacement system. Vendors that have advanced population health capabilities are likely to come out on top, hospital officials point out.
"Top scoring (EMR) vendors that are attracting the available market share are looking for patient engagement tools, clinical decision support, quality measurement solutions, mobile capabilities, intelligent interoperability and financial analytics as part of their (EMR) compendium," said Doug Brown, managing partner of Black Book, in a March 10 press release. "This large hospital market segment has progressed beyond meaningful use driving purchasing decisions but is aggravated with the extraordinary delays, cost run-ups, extended implementations and glitches interrupting operations from first-choice EHRs."
Large hospitals are not the only ones considering making an EMR change. Medical practices are also updating and trading up their systems. Last year, some 23 percent of them said they would be switching out their current platform by the year's end, according to a winter 2013 Black Book report.
Stage 2 meaningful use requires that eligible hospitals meet 16 core objectives and three menu objectives -- up from 14 core and five menu objectives in Stage 1 -- many of which are still not fully understood by hospital officials.
"There's certainly a number of people who know what the requirements for Stage 2 are, but it's probably not as widespread as you might think," said Robert Anthony, deputy director of the health IT initiatives group at CMS' Office of E-Health Standards and Services, in an interview with Healthcare IT News earlier this year. "As we have gotten into Stage 2 and we've really gotten into implementation, as people are actually starting to do it or starting to think about doing it and planning for their workflow, it's like anything else: you read about it, and you think about it, but once you're actually putting it into practice, it's a different beast altogether."
There are six completely new core objectives in Stage 2, including recording electronic notes in patient records; test imaging results must be available through the EMR; record family health history as structured data; generate and transmit more than 10 percent of permissible discharge prescriptions electronically; provide structured electronic lab results to ambulatory providers.
If you're in the market for a new EHR, Technical Doctor can help. With almost 10 years of consultative experience, our strength lies in our agnostic approach to EHR. We help you select the best one for your practice today and for the future. Contact email@example.com to learn more!
- The Technical Doctor Team
By Katie Wike, contributing writer
At Rockdale Medical Center, clinical mobile apps are accelerating the transmission of data among departments, meeting HIPAA requirements and pleasing physicians.
In 2012, Epocrates Research group found 34 percent of physicians used a tablet computer and 75 percent planned to buy one within a year. Eighty-one percent of those who owned a tablet owned an iPad. Tablets continue to gain popularity due to their unmatched mobility and ease of use. Despite the trend, connecting these mobile devices to existing EHR platforms in a way that meets HIPAA security requirements may prove to be a tricky task.
For Rockdale Medical Center (RMC) in Rockdale County, GA, the answer was a clinical mobile app already approved by the FDA as a diagnostic aid. Since 1954 RMC has made its mission to provide the best care possible for all the patients in the 138-bed acute care facility. The need for a means of transmitting patient data from the emergency department to the lab and at night with a smaller staff available spurred RMC’s search for a HIPAA-compliant datasharing technology.
Compiled by Jennifer Dennard
According to practicing pediatrician Dr. Peter Masucci, a successful transition to ICD-10 requires physicians to be proactive and maintain a close relationship with their EHR vendor.
The transition from ICD-9 to the far more numerous ICD-10 code set has made its fair share of headlines since first announced by the CMS in 2008. While the CMS granted providers a one-year extension — moving the ICD-10 compliance date from Oct. 1, 2013 to Oct. 1, 2014 — providers still seem to be putting preparations at the bottom of their lengthy to-do lists. A CMS extension of Stage 2 Meaningful Use (MU) attestation deadlines into 2016 may help providers begin to focus more on making the switch, but time is quickly running out for those who have not yet given ICD-10 much attention.
Dr. Peter Masucci, a small private-practice pediatrician in Everett, MA, is likely in the minority when it comes to being ready for ICD-10. He attributes his preparedness to the proactive partnership he and his staff have formed with his EHR vendor. Dr. Masucci explains how the now-or-never situation many of his less-prepared colleagues find themselves in will likely lead them to seek new EHR solutions once the ICD-10 switch is flipped this October.
2014 Meaningful Use Changes
Free Regional Extension Center Resources:
For a Limited Time Assistance from IL-HITREC is Available For Free. To find out what services are available, Click Here to access the IL-HITREC website. To discover if you qualify for our free services, Click Here to fill out the Pre-Qualification form. About The Program:
This opportunity is made possible by a grant from the Illinois Department of Healthcare and Family Services (HFS) with funding support by the Centers for Medicare and Medicaid (CMS).
A major concern physicians have dealt with over the past 10–15 years has been choosing the right EHR solution for their practice. With the rise and fall of numerous electronic health record companies, that concern has evolved to whether a chosen EHR will still be in business five years from now.
According to the Centers for Medicare and Medicaid Services (CMS), there are over 900 EHR vendors currently on the market, many of whom offer more than one product. In some ways, the huge number of EHR choices has been a good thing for healthcare; it has forced vendors to be more innovative and to cater to the needs of their users. However, the market can’t possibly sustain this many similar projects for long. Eventually, small vendors will be swallowed up by larger vendors and many others will simply go out of business.
So how do you know if your EHR vendor will survive the EHR purge that has already started? Of course there is no way of knowing for sure, but below are a few questions you can ask yourself that will give you a good idea of your EHR’s future.
1. How long has the vendor been in business?
Past performance is usually a good measuring stick for the future. Hundreds of vendors were born after the HITECH Act was passed in 2009, which means that most EHR vendors are still relatively new. Newer EHR companies aren’t necessarily a bad thing—some of them are actually better than some of the legacy systems that have been around for decades—but be wary of any company that doesn’t have the years in business to back it up. A vendor that has already proven it has weathered the EHR storms for 10–15 years will be much more likely to survive current and future challenges than the new, promising EHRs.
Don’t just look at how long the vendor has been in business, though. Research the vendor’s track record as well. If your vendor has a high retention rate—90 percent or higher—then you’re in good company.
2. How usable is the EHR?
For years, doctors put up with EHRs that didn’t meld with their workflow, but that tolerance is coming to an end. Black Book Rankings called 2013 “The Year of the Great EHR Switch” because most EHR implementations happened in practices that were on their second or third EHR. The reason for this shift? Usability. Eighty-seven percent of doctors cited usability as their primary complaint about EHRs. (Source: http://www.prweb.com/releases/2013/7/prweb10926499.htm)
For some reason it took many years for usability of EHR systems to catch on, but now that it has, the difficult-to-use systems will have a difficult time holding on to customers. Point-and-click EHRs have never been popular among physicians, especially those who see 50+ patients a day. EHRs that utilize voice technology, though, are growing in popularity. It is highly unlikely that any EHR system will cater 100 percent to a physician’s needs and preferences, but voice offers much more flexibility than traditional point-and-click systems do, not to mention voice-driven systems are more likely to follow the workflow physicians already use.
3. How well does your vendor understand your specialty?
The reason the industry hasn’t settled on just a couple of vendors by now is because workflow among different specialties varies so widely. Physicians need vendors that are very good at their specialty, not those that claim to answer to the needs of all physicians. A vendor that dedicates itself to producing and improving capabilities that align with your specific needs will take much better care of you. Not only that, but they will be more able to evolve with you as technological demands change, giving the company more stability in a shaky market.
4. How’s the support?
Never underestimate the power of a good support team. Most EHRs aren’t designed to work flawlessly fresh out of the box; you need adequate training and ongoing support, too. A recent Software Advice survey revealed that about 60 percent of respondents reported “learning to use the system” as a one of the main challenges with their EHR, even more challenging than achieving meaningful use or finding costs to support the system. (source: http://www.softwareadvice.com/medical/userview/ehr-survey/)
As a business metric, support may be even more powerful than usability, especially since federal regulations keep tightening, limiting the freedom to change certain aspects of an EHR. A vendor that communicates with its customers regularly will stand out.
5. Is the vendor ready for meaningful use stage 2? ICD-10?
Over a thousand vendors certified for meaningful use the first time around. Less than 40 of those vendors have received complete ambulatory certification required for 2014. Add ICD-10 to the mix and very few vendors will be able to keep up with these increasingly difficult technological advancements. Vendors that don’t have a plan already in place regarding how they will re-certify for meaningful use and be ICD-10 compliant will be among the first to go.
A vendor that scores well in each of the five questions above will most likely have what it takes to make it through the next five years.
Uncertain of your EHR? Let the experts at Technical Doctor help you in these uncertain times. Email us at firstname.lastname@example.org to learn more.
A new study in the journal Health Services Research finds nearly three-quarters of physicians using electronic health records in 2011 said there were clinical benefits when patients' medical histories were kept in digital files. The study focused on doctors' perceptions of clinical benefits to patient care when EHRs were in place.
Jennifer King, chief of research and evaluation at the Office of the National Coordinator for Health Information Technology and lead author of the study, explained in the article that physicians with longer experience using EHRs were more likely to report clinical benefits.
Researchers looked at the responses from 3,180 physicians to the Physician Workflow Survey questionnaire about their experiences with EHRs.
"A majority of physicians said they were alerted to a potential medication error or critical lab value, and about one-third reported that EHRs helped them identify needed lab tests or facilitated direct communication with patients," said King.
The study’s findings may open up new opportunities for more doctors to gain health IT benefits. King said Stage 2 of theMeaningful Use Program, which provides incentives from the Centers for Medicare & Medicaid Services for EHRs, includes policies designed to enhance the use of EHRs to exchange data between providers and give patients access to their health records.
"These policies may increase the rate at which physicians are able to use their EHRs to realize benefits such as not ordering duplicate lab tests and identifying needed tests," said King.
"The study reinforces our view that meaningful use of EHR technologies can deliver clinical benefits and improve outcomes," Mickey McGlynn, chair of the Electronic Health Record Association and senior director of strategy and operations for Siemens Healthcare, commented in a news release.
McGlynn pointed out that the majority of care delivery in the U.S is provided in office settings with 10 or fewer physicians, and these environments have fewer resources to support health IT.
"Because of that, they have historically been late adopters of EHRs," she said. "Successful EHR adoption requires provider organization to integrate technology into their workflows and to adjust workflows over time to support their practices and specialties."
McGlynn added that the study might help those reluctant to invest in EHR technology to realize that benefits may not be achieved quickly but can be over time. "EHR adoption is a journey not a destination," she said. "All stakeholders must collaborate to ensure that requirements to achieve both benefits and incentives are practical and do not add unnecessary burdens to busy providers who must make patient care their top priority."
The results of the survey were reported by Health Behavior News Service, part of the Center for Advancing Health.
Do you need help selecting an EMR? Do you need assistance supporting your existing EMR? Technical Doctor can help you with both! Contact email@example.com today to learn more!
- The Technical Doctor Team
ComChart Medical Software, LLC president, Hayward K. Zwerling, MD, earlier this month posted a letter on The Health Care Blog saying that the ComChart EMR would no longer be meaningful use certified. Here’s a portion of the letter that describes the reasoning:
ComChart EMR will continued to be certified as a Complete EMR for Stage I Meaningful Use. Unfortunately, we will not be able to meet the Stage 2 (or greater) Meaningful Use certification requirements as these requirements are technically extremely difficult to implement.In addition to the Meaningful Use mandates, there continues to be a never ending stream of new mandates such as ICD-10, PQRI, Meaningful Use 2, Meaningful Use 3, SNOMED, ePrescribing, LOINC, Direct Project, health information exchanges etc. As a result of the mountain of mandates, ComChart EMR and the other small EMR companies will have to choose to implement the mandates or use their resources to add “innovative” features to their EMR. Unfortunately, the small EMR companies do not have the resources to do both.(I suspect this is also true, to some extent, for all EMR companies.)While the individual people involved in promulgating these EMR mandates (mostly) have the best of intentions, they clearly do not understand what transpires in the exam room, as many of the mandated features confer little or no benefit to either the patient or the healthcare provider.In addition to a lack of understanding of what is important during the process of providing healthcare, it has also become apparent to me that the Federal and State health information technology agenda is now largely driven by the strongest HIT companies and health institutions; the individual physician is only an afterthought in the entire process.
ComChart EMR will continued to be certified as a Complete EMR for Stage I Meaningful Use. Unfortunately, we will not be able to meet the Stage 2 (or greater) Meaningful Use certification requirements as these requirements are technically extremely difficult to implement.
In addition to the Meaningful Use mandates, there continues to be a never ending stream of new mandates such as ICD-10, PQRI, Meaningful Use 2, Meaningful Use 3, SNOMED, ePrescribing, LOINC, Direct Project, health information exchanges etc. As a result of the mountain of mandates, ComChart EMR and the other small EMR companies will have to choose to implement the mandates or use their resources to add “innovative” features to their EMR. Unfortunately, the small EMR companies do not have the resources to do both.
(I suspect this is also true, to some extent, for all EMR companies.)
While the individual people involved in promulgating these EMR mandates (mostly) have the best of intentions, they clearly do not understand what transpires in the exam room, as many of the mandated features confer little or no benefit to either the patient or the healthcare provider.
In addition to a lack of understanding of what is important during the process of providing healthcare, it has also become apparent to me that the Federal and State health information technology agenda is now largely driven by the strongest HIT companies and health institutions; the individual physician is only an afterthought in the entire process.
This choice basically means that anyone interested in meaningful use and EHR incentive money won’t be doing so with ComChart EMR. The regulations say that even someone attesting to meaningful use stage 1 in 2014 has to use a 2014 certified EHR. ComChart won’t be able to meet that requirement.
I knew that this was going to happen with a number of EMR vendors, but ComChart really missed a huge opportunity with this announcement. The most damning part of the letter is when Dr. Zwerling says “we will not be able to meet the Stage 2 (or greater) Meaningful Use certification requirements as these requirements are technically extremely difficult to implement.” I was aghast by this statement. So much so that I had a brief email exchange with Dr. Zwerling to see if he really meant what he said. Was it that they weren’t able to meet the requirements or that they chose not to meet them?
He responded, “Anything can be done, it is just a question of how much resources are going to be thrown at the problem and what is not going to get done return.”
It seems that Dr. Zwerling didn’t consult a PR or marketing person on how to make the most of this decision. Any of them would have told him that this decision could be a huge opportunity to differentiate the ComChart EHR from all the hundreds of certified carrot chasing EHR companies out there.
If Dr. Zwerling had asked me, I’d have told him that he should have said, “ComChart EHR has talked with our hundreds of physician end users about meaningful use and EHR certification and we’ve found that they don’t value any of the meaningful use criteria. Because of doctors desire to not be bogged down by meaningful use requirements, we’ve chosen to listen to our doctors and focus on what makes doctors lives easier. We’ll continue innovating our product to the needs of doctors, but we’ll be letting doctors drive that innovation versus some committee in Washington.”
I could keep going, but you get the idea. ComChart could have told every doctor out there that they were the ULTIMATE PHYSICIAN EHR that cares so much about the physicians who use their EHR that they’re shunning meaningful use because it’s detrimental to the way physicians should be practicing medicine. Making this case would not be hard and the message would resonate with the majority of physicians.
I’m not sure if this strategy would work or not. Government money that’s perceived as “free” is a hard opponent. However, government bureaucracy and headaches are an easy target that everyone understands and hates. In ComChart’s case, saying that they essentially aren’t capable of the complex meaningful use requirements is sending the wrong message. All doctors hear when they read this is that your EMR development team isn’t sophisticated or strong enough to keep up. What a missed opportunity and likely the nail in ComChart’s coffin!
Hopefully this is a warning message to any other EHR vendors who choose to go the route of shunning meaningful use and EHR certification. I’m not sure that shunning MU is a winning strategy for an EHR vendor, but being the physician advocate at least gives them a fighting chance.
Are you using ComChart? Technical Doctor can help you select a new EHR if you're interested in migrating. Contact firstname.lastname@example.org to learn more.
- The Technical Doctor Team
There’s a new data point to add to the debate over EMR return on investment.
Norton Healthcare Inc. in Louisville, Ky., has experienced a $12 million increase in federal reimbursement since it started using Epic, Louisville Business First reported. The health system, which operates five hospitals and a network of outpatient sites, is three years into a five-year, $200 million implementation.
Sounds like the beginning of some pretty good ROI. Or does it?
It’s hard to say.
ROI for records systems is notoriously hard to pin down. The word is that many hospitals don’t even try. And they might be onto something.
A revenue boost is a good sign. It’s often a result of improved coding and lower claims denial rates, as Colin Konschak of health care consulting firm Divurgent and Garrett Blair of Norfolk, Va.-based health system Sentara Healthcare recently wrote. And of course, there are the federal incentives for using an EMR—for hospitals, as much as $11 million over four years.
There’s also the rise in productivity that EMRs are expected to cause. At first, an EMR can slow down clinicians’ workflow and cost them and their organization money. But in time, the system could increase productivity.
But revenue is only part of the equation. Cost savings are the more important—and harder to calculate—factor.
Here are a few ways, as described by Konschak and Blair, that EMRs can help hospitals to save:
Less need for transcription.
Reduced use of staff time for copying and filing.
Reduced—often by 50-70 percent—use of preprinted forms.
Potentially lower malpractice premiums because of more complete documentation.
Many other potential benefits are probably real but are even less straightforward to measure. Features such as clinical decision support and electronic medical administration records, for example, could lead to reductions in medical errors—the types of mistakes the federal government no longer pays for. But measuring the money you saved from the errors you didn’t make is fairly abstract.
Many hospitals do little if anything to measure the return on their EMR investment, according to a study released by Beacon Partners last year. Healthcare Scene’s John Lynn wrote a few months ago that CIOs likely view the systems as a “necessary requirement of being a hospital today,” somewhat like cleaning supplies. So they don’t see the need to measure ROI.
To me, the “investment” part of ROI suggests that you have a choice. You put money into something now with the hope—but no guarantee—of a payoff later.
Building an imaging center on the edge of town or buying a surgical robot would probably be considered investments. Maintaining your buildings or upgrading your phones would not.
Doing something the government is making you do is not an investment. Given the reimbursement penalties that will eventually kick in for organizations that stick with paper, it’s hard to imagine that many hospital executives see EMR adoption as a matter choice.
The idea of ROI for EMR is probably outdated, a holdover from the days when having a system was optional. Hospital leaders are shopping for EMRs with an eye toward getting the best value for their money—just the way they shop for cleaning supplies, furniture or legal services.
You could say that as a society we’ve invested in the idea of EMRs and that we’re hoping for a payoff in terms of better outcomes and lower costs. But that doesn’t predict much about whether any particular hospital or doctor will see a dollar-and-cents ROI.
At Norton in Louisville, it sounds like they’re happy just to be recovering some of what they’re spending.
“It really does improve the continuity of care,” Norton’s chief medical officer, Dr. Steve Heilman, told Business First.
For now, it sounds like Norton is on track.
Get the most out of your EMR system with Technical Doctor. We are experts in most EMR systems and can help you with employee education, ongoing IT support, and network infrastructure support. Contact email@example.com to learn more!
The Official Web Site for the Medicare and Medicaid Electronic Health Records (EHR) Incentive Programs
The Medicare and Medicaid EHR Incentive Programs provide incentive payments to eligible professionals, eligible hospitals and critical access hospitals (CAHs) as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology. Eligible professionals can receive up to $44,000 through the Medicare EHR Incentive Program and up to $63,750 through the Medicaid EHR Incentive Program.
Register Now! Find out if you're eligible to participate in the EHR Incentive Programs and what you need to do by visiting our Getting Started page. Registering does not commit you to participating in the program, so register early!
Eligible hospitals and critical access hospitals (CAHs) should visit our Eligible Hospital Information page to learn about the EHR Incentive Programs
Sequestration and the Medicare and Medicaid EHR Incentive Programs
Incentive payments made through the Medicare Electronic Health Records (EHR) Incentive Program are subject to the mandatory reductions in federal spending known as sequestration, required by the Budget Control Act of 2011. The American Taxpayer Relief Act of 2012 postponed sequestration for 2 months. As required by law, President Obama issued a sequestration order on March 1, 2013. Under these mandatory reductions, Medicare EHR incentive payments made to eligible professionals and eligible hospitals will be reduced by 2%. This 2% reduction will be applied to any Medicare EHR incentive payment for a reporting period that ends on or after April 1, 2013. If the final day of the reporting period occurs before April 1, 2013, those incentive payments will not be subject to the reduction. Please note that this reduction does not apply to Medicaid EHR incentive payments, which are exempt from the mandatory reductions.
The Medicare EHR Incentive Program
Note: If you are a Medicare Advantage Plan (like an HMO or PPO), please visit our Medicare Advantage page.
Back to TOP
The Medicaid EHR Incentive Program
The EHR Incentive Program provides incentive payments for eligible healthcare providers to use EHR technology in ways that can positively impact patient care.
What is an EHR?
An electronic health record (EHR)—sometimes called an electronic medical record (EMR)—allows healthcare providers to record patient information electronically instead of using paper records. However, EHRs are often capable of doing much more than just recording information. The EHR Incentive Program asks providers to use the capabilities of their EHRs to achieve benchmarks that can lead to improved patient care.
The EHR Incentive Program is NOT a reimbursement program for purchasing or replacing an EHR. Providers have to meet specific requirements in order to receive incentive payments.
Choosing a Program: Medicare or Medicaid?
The EHR Incentive Programs are available for Medicare and Medicaid eligible professionals, eligible hospitals, and critical access hospitals (CAHs). Although most hospitals will be able to receive a payment from both programs, eligible professionals must choose which program they want to participate in. The two programs are similar in many ways, but there are some important differences between them. Click on the links below to learn more about the Medicare or Medicaid EHR Incentive Programs.
Medicare EHR Incentive ProgramMedicaid EHR Incentive ProgramRun by CMSRun by Your State Medicaid AgencyMaximum incentive amount is $44,000Maximum incentive amount is $63,750Payments over 5 consecutive yearsPayments over 6 years, does not have to be consecutivePayment adjustments will begin in 2015 for providers who are eligible but decide not to participateNo Medicaid payment adjustmentsProviders must demonstrate meaningful use every year to receive incentive payments.In the first year providers can receive an incentive payment for adopting, implementing, or upgrading EHR technology. Providers must demonstrate meaningful use in the remaining years to receive incentive payments.
Who Is Eligible to Participate?
Click on our eligibility tool below to learn whether you are eligible to receive an incentive payment under either the Medicare or Medicaid EHR Incentive Programs—or scroll down to learn more. (To learn which hospitals are eligible to participate in the program, visit our Eligible Hospital Information page.)
Eligibility Requirements for Professionals:
The right EHR installment can make all the difference. But more often than not, doctors aren’t making the best choice, instead falling prey to systems that are all flash and fundamentally difficult to use.
Among the reasons is that doctors often don’t even know the best questions to ask prospective vendors, in large part because they approach vendor meetings without having formulated a list of exactly what they want.
Docs are great at practicing medicine. Not so great at choosing EHR systems. Most physicians depend on 'system speak' from the EHR vendor" making it impossible to “look under the hood.”
That means probing for details on how the EHR collects patient data, increases your ability to improve reimbursement, and reduces dictation and transcription costs, to name a few areas where practices should be leveraging technology.
Drilling down to specifics, the following questions should help ensure that shiny new EHR doesn’t sell you short in terms of usability:
How will this work with my existing scheduling, practice management, lab and PACS/RIS system?
What is included “in the box” regarding training and support?
Who customizes the system to work within my existing workflow and time constraints?
Do you provide a unique support line for new client implementations, and what is the typical response time?
Most importantly, can you provide a demo with an existing practice similar in specialty, size and workflow? (This can be done via any WebEx type application.) Don’t sign a contract without viewing a real-time, role-based demo. Make sure to have in attendance staff representatives from all of the areas that touch the EHR — scheduling, billing, nursing, lab and record management — as well as other physicians.
Docs should do their groundwork beforehand by identifying an EHR that can clinically align to existing workflows, processes and time constraints. A one-size-fits-all EHR just doesn’t exist.
Additionally, physicians should ask for reference lists of similar-sized practices within a given specialty that are utilizing the system — and call those people to check-up on the vendor.
Practices should also obtain a breakdown of future licensing fees, as well as support and maintenance charges, and secure an escape clause in case after 120 days the vendor doesn’t supply adequate training, customization or support.
EHR Consulting? That’s a specialty of ours. As the #1 medical IT support company, we provide EMR consultation and ongoing support. Leverage our experience to get the best return on your EMR investment today! Contact firstname.lastname@example.org for more information.
- The Technical Doctor Team
With system upgrades taking shape across the country, IT is no longer just another another department in the hospital. More than ever, it’s integral to how healthcare organizations work and get paid.
But you don’t always see this shifting landscape reflected in hospitals’ leadership structures or practices.
That’s unfortunate. Getting the most out of the billions being spent on health IT will require clear vision and skillful communication at the top levels, according to a December article in the Journal of the American Health Information Management Association.
Doctors, nurses and other team members “must understand the nature of the changes—what the result of the changes will be, how their roles and work will be different, and why change is important,” author Tiankai Wang wrote.
Thoughtful language can go a long way toward minimizing staff resistance and making an implementation successful, explained Wang, a professor of health information management at Texas State University.
Leaders should practice “framing” by promoting the benefits of the technology, such as improved outcomes, lower costs and greater efficiency, Wang wrote. They should also use “rhetorical crafting” by using stories, analogies and other devices to make their message resonate.
Rhetorical crafting, according to Wang, “leverages a ‘show, don’t tell’ approach to frame leaders’ message in a form that will connect more easily with staff and help them to embrace the possibilities of the coming change.”
He also advises using words such as “we” and “should” rather than “you” and “must” when talking about IT changes.
At a more fundamental level, though, IT leadership isn’t always valued in healthcare to the extent that other roles are. In 2013, average total cash compensation for chief information officers was eighth-highest of all hospital titles at about $316,000, Modern Healthcare reported.
And despite the growing importance of health IT, it’s also uncommon for hospital CIOs to be promoted to the roles of chief operating officer, president or CEO.
It does happen, though, as David Raths wrote in Healthcare Informatics. In perhaps the best known example, Cincinnati-based Mercy Health, which operates several hospitals, earlier this year named Yousuf Ahmad, who had previously served as CIO, to the chief executive role. Ahmad had also held other management roles, including president of the system’s physician group.
It’s likely a sign of the front-and-center role that IT is now taking at healthcare organizations everywhere.
You’re already outsourcing your IT needs? That’s great! Leverage those dollars with the #1 medical IT support firm and see a better return for your buck. Contact us at email@example.com today to learn more about our services.
System allows sharing of latest information on patients' test results, treatments and meds
HealthDay Reporter MONDAY, July 8 (HealthDay News) -- U.S. hospitals have made major progress in adopting electronic health records systems over the past three years, according to a new report.
The number of hospitals with a basic electronic health records (EHRs) system tripled from 2010 to 2012, with more than four of every 10 hospitals now equipped with the new health information technology, according to the report scheduled for Tuesday release by the Robert Wood Johnson Foundation.
"Given the size of our country, that's amazing progress in a very short time period," said report co-author Dr. Ashish Jha, an associate professor with the Harvard School of Public Health.
However, there is much more work to be done, the report indicates. These systems may have been adopted, but hospitals have not yet figured out how to use the new technology to improve patient safety and reduce health care costs.
For example, the study found that 42 percent of hospitals now meet federal standards for collecting electronic health data, but only 5 percent also meet federal standards for exchanging that data with other providers to allow widespread physician access to a patient's records.
"The news here is mostly good, but we shouldn't declare victory yet," Jha said. "In other industries it takes about 10 years after technology is adopted to see real efficiencies. My hope is we'll see that more quickly in health care. We don't have 10 years to waste."
Researchers believe that three factors have combined to drive adoption of electronic health records -- society's increasing reliance on information technology, new federal funding to support purchase of EHR systems, and future penalties under the Affordable Care Act that will be assessed against providers who will not use EHRs.
"It's the right incentives at the right time," Jha said. "Doctors and hospitals have been thinking about buying electronic health records [systems] for some time. This is where our society is moving. But the finances have been a challenge. The federal incentives have been very well targeted. They were well designed to help push hospitals and doctors to adopt EHRs."
Jha added that penalties for failure to act on electronic health records should not be underestimated as a motivating factor. "They are signaling if you don't do it, a few years down the road we're going to start paying you less," he said. "That motivates people to say, 'whoa, I'd better get on board.'"
The report found that electronic health record adoption has increased throughout the American health care system. It's not just big hospitals in major metropolitan centers that are purchasing the new technology. The number of rural hospitals with an EHR system increased from about 10 percent to 33.5 percent between 2010 and 2012, while urban hospitals saw EHR adoption rates rise from 17 percent to nearly 48 percent.
"We saw a tremendous amount of activity throughout all subtypes of hospitals," said co-author Catherine DesRoches, a senior scientist at Mathematica Policy Research. "The rate at which they are adopting has increased quite a bit."
The next step, in which health data is shared between providers, will be key to realizing the true potential of EHRs, DesRoches said.
For example, patient safety should improve when doctors will have automatic access to a person's health records, which allows them up-to-date information on medications prescribed, tests performed and treatments initiated.
"It also has the potential to help with costs," she said. "If you're a patient and you get to your appointment and the specialist can see all of the tests that have already been ordered, they're not going to order duplicate tests or ordering medications that might be contraindicated. The information's right there in the record."
While the United States lags on effective EHR sharing, the report found reason for optimism. More health care providers are participating in initiatives that ultimately will connect their own electronic records systems to community-wide information exchanges.
The Obama administration's proposed fiscal 2015 budget calls for a 22 percent increase in funding for the office that oversees policies and standards for the HITECH Act's electronic health record incentive program and a 5 percent increase for the agency responsible for enforcing HIPAA compliance.
Obama's budget is a statement of the administration's spending priorities for the federal government. Ultimately, Congress must approve appropriation bills to fund the government. Fiscal 2015 begins on Oct. 1.
ONC FundingUnder Obama's budget proposal unveiled this week, the Department of Health and Human Services' Office of the National Coordinator for Health IT, which oversees the HITECH program, would have a budget of $75 million, up $14 million from the current year. Six additional full-time employees would be added, bringing ONC's headcount to 191.
The proposed ONC budget includes $27.2 million, or $8.5 million more than the current fiscal year, to fund development of standards supporting interoperable and secure health IT infrastructure. In addition, ONC's proposed budget includes $2.9 million for other privacy and security related activities, "ensuring that electronic health information is private and secure wherever it is transmitted, maintained, or received," says an additional ONC budget document, the Justification of Estimates for Appropriations Committee, released by HHS on March 7.
The extra money sought by ONC in fiscal 2015 would also help support a number of other efforts, including the creation of a new Health IT Safety Center, which in fiscal 2015 "will begin a robust collection and analysis of health IT-related adverse events, which will facilitate benchmark data on the types and frequencies of events," says an HHS "budget in brief" document. ONC is seeking $5 million to fund the new safety center in fiscal 2015.
The new center "will monitor and analyze data on patient-safety events, potentially unsafe conditions associated with health IT, and patient-safety events that could be prevented by health IT," the HHS document notes. ONC will work closely with the Agency for Healthcare Research and Quality, the Joint Commission, Food and Drug Administration and patient safety organizations on this effort, the HHS document notes.
The HHS document notes that in fiscal 2015, the FDA will continue to implement key new responsibilities authorized in the FDA Safety and Innovation Act.
The FDA has been collaborating over the last year with ONC and the Federal Communication Commission in developing a "risk-based regulatory framework" to address patient safety concerns around health IT, including potentially those involving cybersecurity issues (see Health IT: A Cybersecurity Framework).
An ONC spokesman says the new Health IT Safety Center "is part of our Safety Surveillance and Action Plan based on recommendations in the Institute of Medicine report," which in 2011 suggested the government and private sector improve transparency in the reporting of health IT safety incidents and enhance monitoring of health IT products. The new safety center will be aligned with the report on the FDA framework, "which we intend to release for comment in March," the ONC spokesman says.
Meanwhile, under the proposed budget, the HHS Office for Civil Rights, which is responsible for HIPAA enforcement, would have a budget of $41 million, up $2 million from fiscal 2014. OCR would add 11 full-time staff members, increasing its workforce to 218 employees.
The funding increase will help support OCR's centralized case management operations and online complaint system, HHS notes. "The budget supports continued enforcement of the HIPAA security rule and OCR's expanded HIPAA responsibilities," the HHS document says. "OCR evaluates and ensures HIPAA and civil rights compliance through complaint investigations, compliance reviews, audits, resolution agreements, enforcement actions and monitoring, public education and technical assistance."
Among OCR's enforcement activities slated for 2014 is the resumption of HIPAA compliance audits, which have been on hiatus since the agency's pilot audit program wrapped up in 2012 (see HIPAA Audits a Step Closer to Resuming).
Unlike the pilot audits, which were conducted by the consulting firm, KPMG, the next wave of HIPAA audits will be performed by OCR's internal staff.
OCR officials recently confirmed the agency is taking the first steps to resuming the program. In a Feb. 24 notice in the Federal Register, OCR said it will survey "up to 1,200 HIPAA covered entities, including health plans, healthcare clearinghouses and certain healthcare providers, and business associates, to determine suitability for the OCR HIPAA audit program."
In fiscal 2013, OCR resolved more than 9,500 complaints of alleged HIPAA violations, and collected about $4 million in HIPAA settlements related to its enforcement activities, the HHS document notes. OCR projects that it will collect about $5.5 million from HIPAA settlements in fiscal 2014, which the agency will use to further fund its enforcement activities, according to the HHS document. Under HIPAA Omnibus, penalties for each HIPAA violation can range up to $1.5 million.
CMS this week (1/28/2014) sponsored a “2014 EHR Meaningful Use Webinar”. Covered during the session were the “usual suspects” that included meaningful use, timelines, and hardship exemptions for the upcoming potential fee adjustments. A few slides buried near the end of the presentation provided insight into the ongoing EHR incentive audits and appeals process. Here are a few facts I found most telling, along with my commentary.
You may be audited this year. Is your practice compliant? Get a HIPAA Risk Assessment done immediately and protect yourself! Contact firstname.lastname@example.org today to schedule yours!
By Christine Kern
CMS data shows over 50 percent of organizations joining ACO initiatives did not reduce health spending targets in initial year
Just over half of the 114 organizations that joined a Medicare accountable care effort in 2012 failed to reduce health spending below targets during their first 12 months trying to do so, newly released CMS data shows. Preliminary results highlight the uneven progress made to date by hospitals and doctors coordinating treatment and reducing unnecessary care to reduce healthcare costs.
Late last year, Health and Human Services Secretary Kathleen Sibelius stated in a CMS press release, “Accountable Care Organizations are delivering higher-quality care to Medicare beneficiaries and are using Medicare dollars more efficiently. This is a great example of the Affordable Care Act rewarding hospitals and doctors that work together to help our beneficiaries get the best possible care.”
“This program puts the control in the hands of physicians and allows them to take the lead in an innovative way to deliver the right care to the right patient at the right time,” said the executive director of the Palm Beach ACO and South Florida ACO, Kelly Conroy in the same CMS release. “We are honored to be a Medicare Shared Savings Program Accountable Care Organization, and after 18 months in the program, can proudly say that we have seen measurable success. We are so impressed with our participating physicians’ enthusiasm towards the cultural shift, and it demonstrates that physicians are primed for the future of medicine.”
Yet the initial findings are showing a much less enthusiastic return on investment. Modern Healthcare reports the inconsistent preliminary results are similar to the mixed performances in Medicare's smaller test of accountable care. The CMS Innovation Center's Pioneer ACO model, also launched in 2012, saw nine of 32 organizations exit the program after its first year. Nine of the remaining 23 organizations saved money, according to an independent audit.
Medicare officials are not discouraged by the numbers. Jonathan Blum, principal deputy administrator for the CMS, said the performance to date has increased officials' confidence in accountable care's ability to lower Medicare spending and improve the quality of care. Leaders anticipated that the first year would require investment and reorganization among ACOs to save money in later years, he said. “We have built the ACO program for long-term savings.”
Preliminary data reveals that Medicare will keep $128 million from the first year of the shared-savings program, while successful ACOs will share another $126 million. Final results will be published by the CMS later this year.
Industry experts question the findings, however. Dr. Kavita Patel, managing director of the Brookings Institution's Engleberg Center for Healthcare Reform, said “It's good news that there's savings. Period. “However, we must ask how and why ACOs did not save money. “We can learn more from what's happening in the remainder of the organizations.”
The following is a guest blog post by Joel Kanick in response to the question I posed in my “State of the Meaningful Use” call to action.
If MU were gone (ie. no more EHR incentive money or penalties), which parts of MU would you remove from your EHR immediately and which parts would you keep?
Joel Kanick President and CEO of Kanick And Company and Lead Developer and Chief Architect of interfaceMD
In fact, the pursuit of Meaningful Use (MU) certification has given our company many new ideas that allowed us to go above and beyond the bar MU already set.
Initially, doctors bought into EMRs for the financial incentive. Now that they are educated consumers, they want everything that was promised to them to work for them. Doctors have learned that EMRs are only one small part of the Healthcare Information Technology (HIT) puzzle. They need help putting the rest of the puzzle together.
No one is complaining about MU regarding the direction it is taking healthcare or HIT industries.
Any complaining that comes from a vendor is usually because their technology is outdated and behind the technology curve. They are angry because MU is calling them out. So, shame on vendors for becoming rich, fat and lazy, and not keeping with current technology.
Of the complaints I hear from providers, there are two scenarios:
First scenario: the providers who resent the government telling them how to practice medicine. However and upon deeper review, these providers already ask and track most of all these data points. They just don’t like the way it has been required and thus crammed into their current systems. I understand their anger, they were not consulted as to how to fit all this into their workflow and so it is cumbersome to use.
Second scenario, the providers’ office is still using fax machines, some required by their EMR vendor. They are still dictating (PCs, iPhone apps, phone recorders) all their exam data and still relying on paper charts. In practices of all sizes, providers complain of MU because they don’t want to change how they operate their business. After all, they have been doing it this way for many years, successfully. They complain of this change because they fear the unknown.
They are doctors; highly skilled and highly educated in medicine but not in business or technology. I see so many doctors closing their privately held medical practices to join a group practice or a hospital setting. Most will freely admit that it’s because they don’t want to address the fear and go through the anticipated pain of migrating to a paperless environment. They don’t know how to choose or maintain the system, with or without MU.
What I know MU is positively doing:
Selfishly, from my point of view, the largest complaint regarding MU2 is that it requires all pertinent health information be exported and imported in a standard format allowing providers to easily change EMR vendors. This MU requirement should scare some EMR vendors!
Effectually, MU is pushing change and as a result it is getting a bad rap.
Does your Practice need in help in implementing ICD 10 enabled solutions? Connect with us to know what options you have! Click here
CCHIT head Alisa Ray, clearly, is trying to put it delicately. EMR vendors are “struggling a little bit” when it comes to meeting 2014 criteria. “It has been a slow start,” Ray told Healthcare IT News.
Usually, hearing this would lead to an inside baseball discussion of vendor operations, which wouldn’t be very exciting. But the thing is, meeting 2014 certification criteria is necessary to allow providers to meet Meaningful Use Stage 2. So vendor struggles in complying with CCHIT’s criteria should concern providers a great deal.
There are three areas of Stage 2 that are proving to be an issue for vendors: clinical quality measures, interoperability and automated measure calculation for reporting metrics, Ray said.
This has led to a real lag in certifications. About 40 companies had listed products with the CCHIT in 2011, but a scant 21 percent of those have stepped up and gotten certified in the 2014 criteria.
According to Ray’s chat with Healthcare IT News, “almost everyone has struggled and been surprised by the complexities” of meeting 2014 standards. Despite having gone through the process yearly since 2006 with CCHIT, several have had to go through repeated certification trials to meet criteria.
ICSA Labs’ Amit Trivedi, meanwhile, noted that while there were close to 3,000 listings, with many having multiple listings — Cerner alone had 800 — so far there less than 300 on ONC’s Certified Health IT Products list.
There are signs that EMR vendors will catch up, the HIT story suggests. For example, vendors have been working particularly hard to offer Continuity of Care Documents or Direct messaging, a capability providers must demonstrate for Meaningful Use Stage 2, said Matt Kohler, vice president of Network Infrastructure Services at Surescripts.
But vendors clearly have some serious development challenges ahead if they want to keep up with the pace set by Meaningful Use Stage 2. If I were a provider reading this, I’d call my vendor right away and see where they were at in the certification process.
Is your EMR vendor ready? How about your IT support company? Contact Technical Doctor at email@example.com today to learn how we can help you through this transition.
As we wrap up 2013, I thought I’d take a look back at some of the major things that happened in 2013. They will be topics you’re very familiar with, but hopefully this will tie a nice bow on the top of 2013 as we look towards 2014.
ICD-10 Got Real – There are still many organizations that aren’t focusing on ICD-10 or that are underestimating it, but for the most part I’m seeing a lot of concern around ICD-10. I’ve started a whole series on ICD-10 and as I’ve been preparing posts the impact of ICD-10 is going to be huge. I think people are just starting to realize it and 7-8 months from now there’s going to be a lot of organizations that are going to go into panic mode. Some of the panic they could solve if they started working on ICD-10 today. Some of the panic will likely come from outside vendors who end up not delivering ICD-10 the way they should.
ACO’s Are Still a Mystery – Some of the ACO work from the government is coming into some focus, but that barely feels like an ACO to me. Of course, it’s all how you define an ACO. I mostly see defensive efforts by organizations trying to group and align themselves with other organizations for whatever reimbursement changes come down the pipe. However, I don’t think any of them really know what’s coming (and I don’t claim to know either).
Meaningful Use Stage 2 Hit Us – We got a meaningful use stage 2 extension and a meaningful use stage 3 delay, but we didn’t get what many were hoping would be a meaningful use stage 2 delay. That means organizations have little choice but to proceed with meaningful use stage 2. As I’ve seen more and more organizations get into MU stage 2, I’ve seen two main actions: workarounds and complaints.
I believe the inverse relationship between incentives and requirements is starting to become an issue. It will certainly blow up when the even more challenging meaningful use stage 3 requirements hit and the EHR incentives are gone.
Consolidation (Hospital and Physician Practice) – Everyone tells me private practice acquisition is cyclical and at some point we’ll see a return to independent doctors. However, I haven’t seen that cycle happen yet. All I see our hospitals acquiring practices like crazy. Not to mention hospitals joining together as well. I wonder if the prediction I heard of only 5-10 major health systems will play out.
HIPAA Omnibus Landed (and is mostly forgotten) – HIPAA Omnibus is in place whether a practice likes it or not. Most never realized it went into effect or have forgotten it already. Watch for 2014 to be the year that it starts biting organizations in the backside. Give us 4-5 stories about HIPAA Omnibus making a physician’s life miserable and then we’ll see more people getting HIPAA training, fixing their business associate agreements, and maybe even implementing encryption on their devices. Maybe I should have added this to my 2014 wish list I’ll post tomorrow
We can help with most of these items for your practice. Contact firstname.lastname@example.org for more information.
If I’m remembering right, this was actually just an extension of Bush’s goal of having 100% EHR adoption by 2014. Obama took Bush’s original EMR aspiration and kept it going.
Although, I do have a real problem with people who like to call it an EHR mandate. It’s really not a mandate. A mandate for me implies that you are required to do it or there’s some grave consequence to it. It’s not like you’re going to be thrown in jail for not using an EHR or not be able to practice medicine if you don’t use an EHR (although some have hinted at this idea). Certainly the HITECH act has provided some Medicare penalties that could be considered a grave consequence to not adopting an EHR. Although, when you consider this example of the Medicare penalties it doesn’t look all that grave of a concern to me.
What other penalties are there to not adopting an EHR by 2014?
There certainly are other potential issues with not adopting an EHR that are worth considering:
1. Ability to Sale Practice – I don’t think we know all the details of how this will play out, but be sure that many younger doctors are going to want to purchase a practice that has an EHR. The common thinking I’ve seen going around is that a practice will be more valuable if it is electronic.
2. Government Mandated Reporting – While the government can’t really mandate the use of an EHR, it seems reasonable that the government could require certain reporting be done. Of course, you could manually do this reporting, but at some point the manual way will be much harder than using an EMR where the reporting can be automated.
3. Reimbursement Requirements – At some point the insurance companies are going to require their data electronically. So, if you’re going to want to keep accepting insurance, then you’re going to need to be electronic. I think the insurance companies are still watching and waiting to see what happens with meaningful use before they decide how they’ll approach it. However, you can be sure that they want more data and electronic is the way to make that happen. Of course, you could always go back to cash pay if you don’t like it.
4. Patients – It hasn’t happened quite yet, but get ready for a new patient base that wants their doctor to be electronic. No, you won’t have a “Got EMR?” sign outside your office to market to patients like we once talked about on EMRUpdate. It will come in more subtle things like the ability to schedule an appointment online. The ability to request refill requests electronically. Not having to carry (and possibly lose) their prescription to the pharmacy and then wait for it to be filled. Not having to fill out the same paperwork over and over and over again. Once patients get a real taste for these features, they’re going to be more selective in the doctors they choose to use.
5. ROI for Your Practice – There are plenty of arguments for and against the use of an EMR from an ROI perspective. I personally side on the positive ROI side based on this list of potential EMR benefits. Certainly it takes a smart EMR selection process and a well done EMR implementation to achieve the ROI, but I know a lot of people who’ve saved a lot of money thanks to their EMR. Add in things to come like doctor liability insurance discounts and the ROI will get even better over time. I know one practice who was having tough times financially. Their implementation of an EHR helped to solve some of those financial issues.
I’m sure there are plenty of other reasons that could “force” you to move to using an EMR. Of course, this CDC study on EHR adoption says Physician EMR use is at 50%. Although, in that link I use their study to show that it’s probably closer to 25% EHR adoption. Either way, we still have a long way to go to achieve Obama’s dream of 100% EHR adoption by 2014.
Do you have an EMR? If not, Technical Doctor can provide consultation for your practice to help you select the right product. Contact email@example.com today and allow us to help you!
2014 Clinical Quality Measures TipsheetLast Updated: August, 2012Criteria for Reporting Clinical Quality Measures1. Medicare EHR Incentive ProgramBeginning in 2014, the reporting of clinical quality measures (CQMs) will change for all providers. EHR technology that has been certified to the 2014 standards and capabilities will contain new CQM criteria, and eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) will report using the new 2014 criteria regardless of whether they are participating in Stage 1 or Stage 2 of the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. Although clinical quality measure (CQM) reporting has been removed as a core objective for both EPs and eligible hospitals and CAHs, all providers are required to report on CQMs in order to demonstrate meaningful use.2013 Eligible Professionals (EPs), will continue to report from the 44 measures finalized for Stage 1 in the same schema laid out for Stage 13 core/alternate core3 additional measures for EPsEligible hospitals and CAHs will continue to report the 15 measures finalized for Stage 1Beginning in 2012 and continuing in 2013, there are two reporting methods available for reporting the Stage 1 measures:Attestation (https://ehrincentives.cms.gov/)eReporting Pilots:Physician Quality Reporting System EHR Incentive Program Pilot for EPseReporting Pilot for eligible hospitals and CAHs
2014 and Beyond EPs must report on 9 of the 64 approved CQMsRecommended core CQMs – encouraged but not required9 CQMs for the adult population9 CQMs for the pediatric populationNQF 0018 strongly encouraged since controlling blood pressure is high priority goal in many national health initiatives, including the Million Hearts campaignSelected CQMs must cover at least 3 of the National Quality Strategy domains (See “Measure Selection Process” below.)Eligible Hospitals and CAHs must report on 16 of the 29 approved CQMsSelected CQMs must cover at least 3 of the National Quality Strategy domains (See “Measure Selection Process” below.)Beginning in 2014, all Medicare-eligible providers beyond their first year of demonstrating meaningful use must electronically report their CQM data to CMS. (Medicaid EPs and hospitals that are eligible only for the Medicaid EHR Incentive Program will electronically report their CQM data to their state.) See “Reporting Options for EPs” and “Reporting Options for Eligible Hospitals and CAHs” below for more information.
Measure Selection ProcessCMS selected the recommended core set of CQMs for EPs based on analysis of several factors: Conditions that contribute to the morbidity and mortality of the most Medicare and Medicaid beneficiariesConditions that represent national public health prioritiesConditions that are common to health disparitiesConditions that disproportionately drive healthcare costs and could improve with better quality measurementMeasures that would enable CMS, States, and the provider community to measure quality of care in new dimensions, with a stronger focus on parsimonious measurementMeasures that include patient and/or caregiver engagementIn addition, CMS selected all CQMs to align with the Department of Health and Human Services’ National Quality Strategy priorities for health care quality improvement. These domains include:Patient and Family EngagementPatient SafetyCare CoordinationPopulation and Public HealthEfficient Use of Healthcare ResourcesClinical Processes/EffectivenessWhen selecting their CQMs to report, EPs, eligible hospitals, and CAHs must select CQMs that cover at least three of these six domains. A complete list of 2014 CQMs and their associated National Quality Strategy domains will be posted on the CMS EHR Incentive Programs website (www.cms.gov/EHRIncentivePrograms) in the future. CMS will also post the recommended core set of CQMs for EPs.Reporting and submission periods for EPs, Eligible Hospitals, and CAHs in their first year of Meaningful Use submitting CQMs via attestation beginning with CY/FY 2014Provider TypeReporting Period for First Year of Meaningful Use (Stage 1)Submission Period for First Year of Meaningful Use (Stage 1)*
Reporting and submission periods for EPs, Eligible Hospitals, and CAHs beyond their first year of Meaningful Use submitting CQMs electronically beginning with CY/FY 2014For 2014 only, all providers regardless of their stage of meaningful use are only required to demonstrate meaningful use for a three-month EHR reporting period. Medicare providers can either report their CQMs for the entire year or select an optional three-month reporting period for CQMs that is identical to their three-month reporting period for meaningful use.For Medicare providers, this 3-month reporting period is fixed to the quarter of either the fiscal (for eligible hospitals and CAHs) or calendar (for EPs) year in order to align with existing CMS quality measurement programs, such as the Physician Quality Reporting System (PQRS) and Hospital Inpatient Quality Reporting (IQR). CMS is permitting this one-time three-month reporting period in 2014 only so that all providers who must upgrade to 2014 Certified EHR Technology will have adequate time to implement their new Certified EHR systems.In subsequent years, the reporting period for clinical quality measures would be the entire calendar year (for EPs) or fiscal year (for eligible hospitals and CAHs).
2. Medicaid EHR Incentive Program2013 and Beyond EPs, eligible hospitals, and CAHs participating only in a Medicaid EHR Incentive Program will submit their CQM data directly to their State.Each State is responsible for sharing the details on the process for electronic reporting with its provider community.Subject to CMS’s prior approval, the process and the timeline are within the States’ purview.
Patient portal technology enables patients to use a web-based connection to communicate with their healthcare provider. Forty percent of U.S. office-based physicians currently have a portal through their electronic health record or practice management system, according to research released by Frost and Sullivan in September 2013.
Although the technology can be utilized in a variety of ways, practices generally set up a portal to give patients the following capabilities:
A potent driver of portal growth is that Stage 2 of meaningful use under the federal EHR Incentive Program requires "patients to electronically view, download and transmit electronic copies of their own medical records." Physicians must engage at least 5 percent of their patients via an online portal under Stage 2.
Medical Practice Insider identified patient portal products listed on the Office of the National Coordinator for Health IT (ONC)'s Certified Health IT Product List (CHPL) that have been certified to 2014 Edition criteria under the EHR Incentive Program. We further filtered to obtain products categorized by ONC in the CHPL as being applicable to ambulatory practices and modular in nature (as opposed to complete EHR systems with an integrated portal component).
Details on those products appear in the comparison table below and on hyperlinked individual pages compiled by Medical Practice Insider. Use the available hyperlinks to navigate among the products you wish to analyze.
Need help selecting an EHR? Technical Doctor offers EHR consulting and ongoing support for hundreds of doctors and is standing by to assist you! Contact us at firstname.lastname@example.org for more information today.
I’ve had my fair share of customer service lately – the over-the-phone, on hold for ages kind of customer service experience that I try to avoid. My first occurred when all of the Apple mobile devices in our house decided to go kaput due to user error. My husband and I had neglected to update our operating systems, and so our phones and tablets went dark in protest. The call to Apple customer support was lengthy, but not as painful as I had expected. We spent a good three hours over the span of two evenings on the phone with Ellie (sp?), perhaps the most patient, good natured call center rep I’ve ever encountered. She took us step by step through the update process for four separate devices, and was fast friends with my husband by the end of the second session. (The words “friendly” and “outgoing” don’t do him justice.) I went to sleep that night ready to wake up via the new alarm feature my update and Pandora upgrade would now allow.
My second experience occurred during the North Georgia Digital Economy Conference, where keynote speaker General (Ret.) Larry Ellis spoke about Vetconnexx, a program that recruits, trains and hires returning disabled veterans for work in call centers. General Ellis, who is also CEO of Vetconnexx, used a phrase any customer can relate to: “de-escalate.” As he playfully noted, not many people call customer support to chat. Most have a problem, and some level of anger and frustration built up as a result. Thus, call center reps are trained to de-escalate calls. I assume it helps when they begin calls by letting customers know they are speaking with a veteran.
Surely EMR end users often find themselves in the same boat. A quick Google search of EMR popularity based on customer support/service (after go live) yielded no clear resources. Perhaps it’s part of KLAS vendor assessments, but I couldn’t tell based on a visit to their website. I wonder what sort of difference great customer support makes to a provider who is trying to decide whether to adopt, or rip and replace.
While the importance of my Apple devices to my lifestyle is in no way comparable to the importance EMRs play in the care of patients, I can’t help but assume that great customer support increases brand loyalty in both cases. I’d like to hear what providers have to say about this. Have you stuck with a particular vendor because of their outstanding customer support? Have you bypassed a lower-cost option in favor of an EMR known for its customer service capabilities? Please share your thoughts, recommendations and advice in the comments below.
EHR Consulting and Support? That’s a specialty of ours. As the #1 medical IT support company, we provide first class EMR consultation and ongoing support. Leverage our experience to get the best return on your EMR investment today! Contact email@example.com for more information.