The Practice Administrator: Meaningful Use and Your Work Flow

As our practice continues to work its way through meaningful use attestation, I thought it would be interesting to discuss the ways that meaningful use is changing the way we work. It’s not news that meaningful use is changing the way we work, but it’s also changing the way we interact with patients, which changes our work flow. Sure providers who demonstrate meaningful use get to collect $44,000 per provider over five years but at what cost? Like with most things, we have witnessed first-hand some positives and negatives.

Let’s start with some of the questions that we ask our patients. One meaningful use criteria requires practices to ask for demographic information on race and ethnicity and another for e-mail addresses in order to connect patients to the patient portal. This is all new information we ask of our patients during an office visit, that we had not recorded before. While we always asked about weight and height, now we also have to keep a record of each patient’s Body Mass Index (BMI). Yes, this is an easy calculation, particularly since the EHR does the math for us once we press the “calculate BMI” icon, but it is still an additional step to consider. Pre- meaningful use, it had not been the job of specialists like us, who might advise on obesity but wouldn’t treat it, to track BMI. Post- meaningful use, we may now have several doctors tracking and managing this patient metric. The positive here is that now we can share that number with patients and as a result help them better track any treatment and results. But we have had to create a follow-up plan to ensure our practice is managing the BMI calculations and tracking.

Another area related to EHRs that has changed our interaction quite drastically are patient portals - essentially on-demand medical records which allow patients to do all sorts of things to better manage their health such as downloading their records, requesting prescription refills, and sending secure messages to our staff. On the one hand, we are empowering our patients and giving them the freedom to better manage their healthcare. On the other, perhaps we are just giving in to society’s demands for “instant gratification” and instant access and further demands on our time? Our practice is hoping for the former while preparing for the latter.

E-prescriptions (E-Prescribing Incentive Program, eRx) is another new, although highly anticipated, area that must be demonstrated for meaningful use. We can do nothing but praise this requirement. It is great for reporting, tracking, managing denials, and refills, among other things. It helps our work flow process immensely.

When meaningful use was first introduced, one of the most obviously appealing aspects was the stimulus money put on the table: the payments for each practice demonstrating meaningful use total $44k over five years. Specifically, here is the payment schedule for successful attestation:

Year 1: $18,000
Year 2: $12,000
Year 3: $8,000
Year 4: $4,000
Year 5: $2,000

But one thing to consider is the cost involved: some practices are paying more than $44,000 for a patient portal alone and some have had to pay for e-prescription modules as well as lab interface modules. With our particular EHR program we did not have any “extras,” but we were one of the few lucky ones. But then there are also costs if you don’t implement meaningful use: Medicare penalties that grow for every year of non-compliance, starting in 2015 at 1 percent and increasing to 2 percent in 2016 and 3 percent to 5 percent in subsequent years.

Whatever EHR package you pick, you will need to spend some time redesigning work flow, some templates, and some aspects of your clinical world. In the end however, I believe EHR adoption is going to be one of those areas whose benefits far exceed any downside and in fact, spur innovation and interaction in physicians’ practices.

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