'How I Met Meaningful Use'

Federal incentive checks are hitting practice mailboxes nationwide. Many practices have successfully met the government's requirements for demonstrating "meaningful use" of an EHR, and are reaping the financial rewards.

And now they're revealing what they've learned to those still struggling with the attestation process. Here's your chance to learn from those cashing in about how they attested and how you too can receive a piece of the pie. It's time to listen up; the clock is ticking. December 31, 2012 - the date by which you must attest to qualify for your $44,000 monetary incentive - is only months away, and if you don't start your 90-day reporting period by October 31, you'll be missing out. "You're either going to be on the train, driving the train, or you're going to get run over by the train," says gastroenterologist Lawrence Kosinski, who successfully attested in October, 2011. "I prefer to be at least on the train."

Prep and plan

Kosinski helped lead the attestation charge for 28 physicians within Illinois Gastroenterology Group, a multisite practice based in the Chicago region. Key to the group's success, he says, was education and understanding. "The first major piece of advice to give any medical group trying to become certified for meaningful use is to become knowledgeable of the requirements," Kosinski says. That means understanding the menu set requirements, the reporting requirements, and the quality metrics before starting the process. "The sooner you become knowledgeable, the sooner you'll be able to realize what your [EHR] system can and can't do - and if you're using a meaningful use-certified system - [knowledge] will help you determine what you need to do to measure your performance using that system," he says. For instance, Kosinski realized he needed to work with his vendor to develop the monitoring tools that would help his group gauge its adherence to the attestation requirements during the 90-day reporting period. In fact, he says, this was the "biggest challenge" they experienced throughout the process.

Steve Morgan, a family physician and chief medical information officer at Carilion Clinic in Roanoke, Va., spent much of 2010 learning about meaningful use and relaying that knowledge to the clinic's more than 600 physicians. That preparation paid off. Ultimately, most of Carilion's eligible physicians completed the attestation process by December, 2011. Successful attestation "went back to understanding the process and understanding what you had to collect at the end," he says. "You have to start mapping out your process pretty early in order to get the outcome you want."

And, he says, without such an intense amount of preparation, "We wouldn't have been in the position we're in now where we've been able to attest."

Assistance and resources

Your EHR vendor will be a great resource in helping you prepare for and understand meaningful use, but don't rely on it too much. "We found that we could not … rely totally on the vendor as far as the planning process goes," says Morgan. Physicians and administrators need to take the lead, especially when it comes to the practice-specific decisions, such as which quality metrics a particular physician will attest for, Morgan says. "The [vendor] can certainly give you an idea of how to proceed and is a good resource, but regardless of practice size, there's lots of individual decisions that you need to make."

Amit Tailor, a solo internist based in Rutherford, N.J., successfully attested in September, 2011. Though his vendor was very helpful with the process, Tailor attributes much of his success to the assistance he received from his state's Regional Extension Center (REC). "They really helped me through the process," Tailor says, "…I would definitely recommend using them."

RECs are available at no or low cost in every state to physicians in small or rural practices. REC employees assist with registering and attesting, pulling reports, explaining processes, and identifying documentation problems.

Utilizing New Jersey's REC saved Tailor time and effort, he says. In fact, when REC employees visited his practice and helped him generate data, they realized he had already been using a meaningful use-certified EHR, and he had been using it "meaningfully." As a result, Tailor already had 30 days of documentation in his EHR that aligned with the meaningful use requirements. That meant he could attest within eight weeks instead of 12 weeks.

Kosinski also established a line of communication between his practice and the state of Illinois' REC. But, he says, practices should also take advantage of the papers, guides, and other educational materials made available by sources such as state medical societies, specialty academies, the American College of Physicians, the AMA, and CMS. "They are all trying to do whatever they can for their membership to help them become meaningful use-certified," Kosinski says.

Define goals

If you're leading the charge at your practice, you may encounter difficulties convincing physicians and staff members to fully embrace the process. Though Morgan (the physician who helped spearhead the 600-physician attestation at Carilion Clinic) spent months explaining how meaningful use worked to his fellow physicians, he says he "underestimated" the importance of explaining to physicians why they were attesting. This made it difficult for them to engage with the process, he says. "If they don't understand the process and the measures, they're not going to buy in."

If you are struggling to convince physicians to engage, Morgan suggests reframing the conversation. "My philosophy on meaningful use from the beginning has been to de-emphasize the incentive part of the program and emphasize that by using an EHR meaningfully, you can drive quality outcomes, and you can improve patient care," he says. "That was the mantra from the beginning to our doctors in order to get them to better understand the background of the stimulus program and to ensure buy-in."

Family physician Joseph Scalia is part of a five-physician practice based in Raritan, N.J. He and his fellow physicians all attested in June, 2011. Scalia agrees it's essential for staff members to understand why they are attesting. "You really need to educate your employees - your physician and nonphysician employees - on exactly why you're going through this process," he says. "You need to show them the bigger picture." And that bigger picture, Scalia adds, is that doing the things that you're attesting to will help your practice provide better patient care, and help your practice participate in health reform initiatives, such as the patient centered medical home, says Scalia. "You can audit charts manually, but when you're running objective data by running reports like meaningful use has us doing, it's eye-opening to see how many patients are not at goal," he says. In fact, as a result of undergoing the meaningful use process, Scalia says his practice decided to make "process changes" that have lead to improved patient care.

Define roles

Assigning staff members different roles during the reporting process and educating them about their related responsibilities will help keep your process efficient and productive. Depending on your practice size, you may want to consider different staffing strategies:

Smaller practices. Scalia says it was helpful at his five-physician practice to identify a meaningful use attestation leader, aka a "super user." Scalia took on this role himself, educating and assisting fellow staff members when problems, questions, or concerns cropped up. "There has to be one individual in charge," he says.

But, he stresses, every staff member needs to take on key responsibilities. That's because all of them - physicians, other clinical staff, and administrative staff - will be involved in the documentation process. "It's very important that you work as a team, you educate your employees about exactly what you're going to be looking for, and how you will accomplish that goal," he says. "This is a team approach."

Midsize practices. Kosinski took on the leadership role at 28-physician Illinois Gastroenterology Group. But he says it was also helpful to identify an administrator to assist him with leading the charge. This staff member helped pull reports and monitored how things were progressing. "I can't emphasize how important it was to have a physician champion and then to have a staff champion," says Kosinski.

Larger practices. If you're part of a larger healthcare organization, you may want to consider establishing an EHR committee or an IT staff member to assist with moving the process forward. That policy worked well at family physician Kevin Helmen's practice, Hudson Physicians, an independently owned 30-physician clinic based in Hudson, Wis. The clinic is one of five that make up Western Wisconsin Medical Associates (WWMA). Each clinic had an already established EHR committee before starting the process, and these committees were helpful to physicians when problems cropped up. "When there were issues that we knew we needed to deal with, we were able to meet them head on," Helmen says. In total, over 70 physicians within the WWMA system successfully attested.

Document and monitor

Once you start the reporting period, it's essential to run reports and monitor your adherence to the requirements frequently, says Scalia. If not, as he learned, you could be in for a very rude awakening. A few weeks into the reporting period at his practice, they pulled reports for the first time to see how they were progressing. "We thought we were doing very well [but] when we went back to run the reports, we found that [physicians] weren't capturing [patient demographic] data correctly," Scalia says.

As a result of their misstep, he and his fellow physicians were forced to extend their reporting period and therefore delay attestation for six weeks. "Run reports early, know exactly which reports need to be run so that you're able to have the documentation in the correct place in the very beginning," Scalia urges.

Kosinski and his fellow physicians at Illinois Gastroenterology Group also encountered challenges when it came to documenting patient information as required. "We thought we were filling out great demographics," he says. "We were not." In addition, some of the physicians were not e-prescribing personally. "That had to change," Kosinski says. "That was a major challenge." As a result, some physicians had to attest up to three weeks later than the rest.

At Helmen's clinic, an IT member monitored reports and kept track of each physician's progress. This was a great help in keeping them on track, he says. When it, too, discovered that some physicians were struggling to fulfill the e-prescribing requirements, the practice was able to target relevant educational efforts to these physicians early on, and therefore avoid what could have become a major problem later. "We had to make sure that we showed them how to [e-prescribe correctly] so that when they did prescribe a medication that it was done through the electronic medical record," says Helmen.

Close the deal

If your practice is following the reporting requirements, documenting correctly, and running reports regularly to monitor your progress, actually sitting down to attest should go very smoothly, says Tailor, the solo internist from New Jersey. He attested live during a presentation on attestation put forth by the New Jersey Regional Extension Center. Tailor says it was "clear" to him he would be successful because he had monitored his progress throughout the reporting period. And, he says, sitting down to attest was "easy." "Your software is supposed to enter the data for you," Tailor says. "You just plug it in and … you're done."

If you're one of many physicians attesting within one practice, consider having one staff member serve as physician "proxy." At Scalia's practice, his billing manager attested for all five physicians consecutively and all were dubbed meaningful users within a few hours. Scalia sat with the billing manager throughout in case any problems or questions cropped up. "The first person you attest takes probably four times longer than the next because you're learning the process as you go along," he says, noting that once they got the hang of attesting, "overall it was not difficult."

In Summary

To ensure a successful meaningful use attestation:

• Understand the requirements
• Plan ahead
• Use available resources
• Secure staff buy-in
• Identify leadership and staff responsibilities
• Document properly and monitor reports

Aubrey Westgate is an associate editor at Physicians Practice. She can be reached at aubrey.westgate@ubm.com.

This article originally appeared in the March 2012 issue of Physicians Practice.