CMS encourages EHR use for Medicare quality reporting

Healthcare providers will have the option to use electronic health record systems to report Medicare quality and electronic prescribing measures to CMS in some of its pay-for-performance programs next year, according to an announcement by the Centers for Medicare and Medicaid Services.

The revisions are designed “to promote adoption and use of electronic health records and to provide both eligible professionals and CMS with experience on EHR-based reporting,” CMS said in the Oct. 30 announcement.

They run parallel to efforts by the Office of the National Coordinator for Health IT to set up additional incentives for providers to measure and submit data measuring the quality of their treatments.

According to CMS, providers could use EHRs to submit information for the CMS’s Physician Quality Reporting Initiative (PQRI) program, which pays an incentive to eligible physicians and other healthcare professionals who report on specific quality measures for care for Medicare patients.

Providers also will be able to report e-prescribing usage through qualified EHR systems or registries, according to CMS. Currently, providers’ reports about e-prescribing are based on patient medical claims.

Under the fee schedule rule, providers for the first time will be able to count quality data submitted through electronic health record systems toward their eligibility for a PQRI incentive payment, CMS said.

Next year, those payments will be equal to 2 percent of their total estimated allowed charges for the reporting periods, CMS said. The final rule will appear in the Nov. 25 Federal Register.

The rule also streamlines reporting of e-prescribing and focuses on the actual use of e-prescribing by the provider. In 2010, providers will use one code for e-prescribing, but they “need to report this code at least 25 times during the reporting period to be considered a successful electronic prescriber,” CMS said.

The Medicare fee schedule puts into practice provisions of the Medicare Improvement for Patients and Providers Act of 2008, which established a program for incentive payments for e-prescribing over five years. In 2012, CMS will impose penalties on providers who are not “successful e-prescribers.”

CMS to allow EHR reporting for PQRI, e-prescribing bonuses in 2010

The new Medicare Part B fee schedule for 2010 is encouraging doctors to adopt EHRs by, for the first time, allowing practices to use real clinical data from EHRs and e-prescribing systems to report quality measures for the Physician Quality Reporting Initiative (PQRI) and e-prescribing incentive programs. The change, according to CMS, is “to promote adoption and use of electronic health records and to provide both eligible professionals and CMS with experience on EHR-based reporting,” Government Health IT reports.

Whether the incentive payments are large enough to spur many practices to switch to EHRs ahead of the 2011 debut of the federal stimulus program is uncertain, however. PQRI participants can earn 2 percent on top of their total Medicare Part B fees for reporting quality data in 2010, and another 2 percent for writing electronic prescriptions. The e-prescribing bonus drops to 1 percent in 2011 and penalties for not e-prescribing begin in 2012. CMS is trying to simplify reporting of e-prescribing by requiring a single code to be eligible for the bonus next year.

Health IT panel to heed calls for simpler EHR standards

A panel advising the Office of the National Coordinator of Health IT (ONC) said it will heed the overwhelming consensus it has received in recent public comments to develop the simplest possible certification standards for accelerating health IT adoption.

The Health IT Standards Committee’s implementation workgroup reported today that it distilled the testimony of industry organizations within and outside healthcare, as well as contributors to its public blog. The participants provided details of their experiences with adopting standards.

On the blog, physicians and practices have reported that they have difficulty improving quality and productivity with their existing electronic health record systems. As a result, they are looking for the standards to provide a “pathway to success.” The blog will remain live until Dec. 1.

Under the health IT stimulus plan, health care providers will be entitled to receive federal incentive payments only if they purchase electronic health record certified to meet standards for interoperability and other features now being worked out by the committee.

Dr. David Blumenthal, the national health IT coordinator, emphasized that “experience in the field” embodied in the comments will inform how ONC will craft the health IT certification standards that ONC will release later this year.

ONC is expected to publish in late December an interim final rule on certification standards and a notice of proposed rulemaking for the certification process. The standards rule will detail standards for what constitutes a certified EHR.

Dr. John Halamka, vice chairman of the committee, said any  refinements to the standards would likely be applied to standards for 2013 and beyond than for 2011, the first year in which providers will be eligible to receive incentive payments under the stimulus plan. In 2011, providers must adopt standards to share medication lists, medical problems, allergies and laboratory reports.

“I think we have a basic set of requirements, and there may be some polish done to them based on the comments and principles. We’re just beginning the directional cycle for 2013 and 2015,” he said.

Physician and industry comments received by the panel overwhelmingly asked that the simplest standards be put forward to provide business value and rapid adoption.

“Our posts have led to conversations with committee members here who have taken them to their constituents,” said Aneesh Chopra, the administration’s chief technology officer and chairman of the committee’s implementation work group.

Among its guiding principles, the committee should concentrate on getting buy-in from physicians for standards required in 2011 to share medication lists, medical problems, allergies and labs before moving to more complex objectives, he said.

Halamka suggested that the committee continue to gather comments about 2011 information exchanges to determine if there are ways to improve testing platforms and implementation guidance.

Another guiding principle recommends that the committee separate content standards, such as those for continuity of care documents, from transmission standards, as well as separate the network layer standards from application layer standards.

Hospitals and EMRs: Stimulating a connection

Availability of government stimulus money, combined with hospitals being allowed to finance portions of physicians’ electronic medical record systems, could make EMR adoption a veritable bargain. Or the stimulus money could make hospital systems less eager to help pay for your EMR, figuring that government funds will instead.

Either way, the possibility of combining two avenues of EMR funding has added a twist to the economic picture for physicians deciding what, when and whether to buy.

Doctors can get a maximum of $44,000 in funds from the federal economic stimulus package for adopting a certified EMR system that meets the government’s “meaningful use” standards. How much physicians get in stimulus funds will be based on the percentage of their practice that is made up of Medicare or Medicaid patients. Hospitals can get their own share of stimulus funds, but the amount depends on how they’re connected with physicians.

Blumenthal: Meaningful use must result in quality improvement, more time at bedside, less duplication

HHS’ definition of meaningful use will include an organization’s ability to use health IT to improve quality and “inform clinical decisions at the point of care,” David Blumenthal, national coordinator for health information technology, wrote in an Oct. 1 letter to the industry.

CMS is expected to publish its formal definition of meaningful use by the end of the year. Expect it to require providers to use HIT to “reduce the amount of time spent on duplicative paperwork” so they can spend more time with patients, Blumenthal wrote.

“The concept of meaningful use is simple and inspiring, but we recognize that it becomes significantly more complex at a policy and regulatory level,” he added. “As a result, we expect that any formal definition of ‘meaningful use’ must include specific activities healthcare providers need to undertake to qualify for incentives from the federal government.”

HITECH ‘Meaningful Use’ More About Improving Patient Care Than Tech Itself

Dr. David Blumenthal, the national health IT coordinator, is responsible for doling out government grants to reimburse health care organizations that implement electronic records technology. According to the HITECH section of the American Recovery and Reinvestment Act, nearly $22 billion in federal fundshas been set aside to “advance the use of health information technology.” A significant portion of that amount will take the form of grants to those health care organizations that can demonstrate “meaningful use” of such IT.

However, what exactly “meaningful use” will entail has been unclear. HHS is expected to release a definition in December, InformationWeek blogger Mitch Wagner says. But those who attended the Medical Informatics Association’s symposium got a “heads up” from Blumenthal on what that definition will focus on.

FierceEMR’s Neil Versel quotes Blumenthal this way:

The meaningful use framework will be about the goals of care, not the technology.

It’s a matter of using technology to improve patient care, not just installing the technology to say you have it. Versel speculates that the goal is to make electronic recordkeeping a best practice, the EMR system a standard medical tool, just as stethoscopes and examination tables are standard now.

Take, for instance, my own experience. I visited the local immediate care center over the weekend when I got tired of a wrenched neck muscle making my life miserable.I filled out the initial paperwork, listed my maintenance prescriptions, gave them the name of my primary care physician, the date of my last visit to her office, insurance information and all the rest. When they called me back, I gave my primary doctor’s name and listed all my meds and my medication allergies (again) for the nurse who took my temperature and blood pressure.

Then, guess what? The doctor came in, looked at my chart, asked again who my primary care physician was and what kinds of anti-inflammatory and muscle spasm medications had worked for me in the past, which ones irritated my stomach and which ones didn’t. After a little over an hour, I was out of there, prescriptions in hand, confident that the pain in my neck was about to go away.

All in all, it was a good experience — especially considering I would have waited at least twice that long if I had gone to the emergency room. But, I was reminded how helpful health IT will be. If the immediate care center and my primary care office had EMR systems that allowed easy sharing of patient information — with my consent, of course — then my visit would have been even quicker. I wouldn’t have had to go through the litany of information three times, and the doctor who treated me would have had my medication history at her fingertips, allowing her to make better informed decisions.

EMRs, PHRs, HIE necessary to support

Without EMRs, PHRs and health information exchange, the patient-centered medical home may not be bound to fail, but it certainly is difficult to establish and maintain. “IT is really the key to supporting the doctor/patient relationship and making it more efficient, safer and more effective,” Dr. Paul Grundy, president of the Patient-Centered Primary Care Collaborative, tells Health Data Management. The Washington-based organization advocates the medical home, under which a primary-care physician manages and coordinates care on behalf of patients, with an eye toward prevention and management of chronic diseases.

It may be a challenge to implement the medical-home model under current reimbursement systems, but until payers start rewarding physicians for keeping patients healthy, IT may be the best avenue. EMRs with clinical decision support, PHRs that help patients monitor their own conditions and health information exchange to support care coordination all can help establish a team approach to care and treatment, HDM reports.

“This is simply about restructuring the way healthcare is delivered to catch the efficiency of technology,” adds Grundy, who also is director of heathcare transformation at IBM.