Meaningful Use

Physicians must meaningfully use electronic health records to qualify for Medicare and Medicaid incentive payments under the American Recovery and Reinvestment Act - a.k.a. ARRA, HiTech, or Stimulus Bill. The law requires the Department of Health and Human Services to publish a final rule on the initial definition or definitions of “meaningful use” by the end of 2009. A formal definition of meaningful use of EHRs is in the works and may even be released as this article is published.

Meaningful use is significant in that it “changes the focus from technology potential to ways in which clinicians actually use” EHRs, Charles Friedman, deputy national coordinator of the Office of the National Coordinator for Health Information Technology, said during the Government Health IT conference and exhibition. And, of course, it gets a lot of attention as a key component in the payment incentives plan.

The Stimulus Bill provides for incentives over five years and it is likely that meaningful use will evolve over those five years as well. The general language in the bill indicates physicians must use a certified EHR that has e-prescribing and information exchange (interoperability) capabilities, and that can report quality data. Sounds straightforward, doesn’t it?

Let’s tackle each of these qualifiers.

Certification. Most industry experts expect a “certified” EHR is likely to mean a CCHIT-certified EHR. CCHIT held Town Call web conferences during June to gather input on new paths to the certification of EHR technologies, with the goal of supporting more rapid, widespread adoption and meaningful use under ARRA.

E-prescribing. E-prescribing among physicians has experienced a boost with the 2 percent incentive bonus this year, and of course the knowledge of the pending 1 percent reduction in Medicare Part B allowed charges in 2012, which increases to 2 percent in 2014.

Information exchange. Interoperability means the exchange of health information. Sharing health information among care providers can mean sending orders electronically to a lab and getting results back in the same fashion. Many, many existing EHR implementations in physician practices across the country are now routinely exchanging lab information.

Data reporting. Reporting quality data may provide the greatest challenge to physicians newly adopting an EHR. In a 2008 MGMA Information Exchange, one-third of medical practices that reported measures did so by incorporating information into their super bills or by using an addendum to their super bill to submit information via the claims-reporting process. Even for groups already using an EHR, collecting quality measures may not be a simple process. Some providers continue to dictate, often using a voice recognition tool, without incorporating structured data into their encounter summary. Provider productivity is not adversely impacted in this case, but all the potential benefits of an EHR are not realized either.

It is important to plan now for EHR implementation because most of the financial benefits ($30,000 of the total $44,000 Medicare incentives per qualified physician) come in the first two years, meaning that providers will want to show meaningful use early. There is no reason to delay your selection or implementation because of meaningful use definitions. The operational impact of the EHR alone, when successfully implemented, will be without comparison to anything else a practice can do. Get in the game now, not later, and build on your implementation - you can bet that products will be upgraded to meet emerging definitions and requirements.

Rosemarie Nelsonis a principal with the MGMA healthcare consulting group. She conducts educational seminars and provides keynote speeches on a variety of healthcare-technology and operational topics. Drawing upon her diverse experience, Rosemarie provides practical solutions to help medical groups succeed in their practices. She may be reached via physicianspractice@cmpmedica.com.