SMARTDC Monthly Newsletter- A Timely Summary of Your IT News

Dr. Blumenthal floats idea of multiple paths to 'meaningful use'

National health IT coordinator Dr. David Blumenthal seemingly wants some flexibility built into future requirements for "meaningful use" of health IT. But providers shouldn't be cheering just yet, since the Health IT Policy Committee--and perhaps the American Recovery and Reinvestment Act itself--might stand in the way.

Speaking at this month's meeting of the HIT Policy Committee, an HHS advisory panel, Blumenthal mused about distinguishing between "vanilla meaningful users" and others that might be able to demonstrate significantly better-than-average outcomes, healthsystemCIO.com reports. According to Blumenthal, some in the latter group "might say, 'If I've accomplished performance outcomes which are three standard deviations better than other institutions, related to 10 outcomes criteria using health information technology, maybe I should be exempt from the task of checking boxes, because I'm there; I've risen above the criteria you put in the regulation."

He also suggested that the Policy Committee might think about creating separate paths to meaningful use for various classes of providers when crafting the rules for Stages 2 and 3 of the federal EHR incentive program. "I'm just posing this as something to think about," said Blumenthal, who noted that he hadn't run the idea past legal counsel yet. "Offering more flexibility with greater monitoring might be a chore, but could also be, if constructed correctly, not more complicated."

At least two committee members expressed concerns that such an approach truly would be a chore. "I like the idea, but would we have to go through the same process for this that we are going through for the set of criteria we're struggling with for Stage 2 meaningful use measures?" asked Dr. Neal Calman, president and CEO of the Institute for Family Health. "Are we saying we have the capability to determine three alternative sets of criteria for 2013?" Software entrepreneur Paul Egerman also wondered whether creating separate tracks might place an economic burden on organizations without a lot of money. "It's important that there is no economic aspect to these classes, that poorer institutions can participate in the same way," Egerman said.

Half of Health Care Providers Now Use EHR System

In a report released by CompTIA, fifty percent of health care providers have adopted a "comprehensive" or "partial" electronic health record system. Under the 2009 economic stimulus package, health care providers who demonstrate "meaningful use" of certified EHRs can qualify for Medicaid and Medicare incentive payments.

The study surveyed 370 IT firms in the U.S. , and reported 40% of which are in the health care industry, and 300 U.S. health care providers. The results have a margin of error of plus or minus five percentage points.

According to the study:

• 34% of health care providers use a comprehensive EHR system;
• 16% reported using a partial EHR system;
• About 29% said they are evaluating their EHR options; and
• 20% said they had not looked at the issue.

EHR Satisfaction

Among health care providers who have adopted EHR systems:

• 59% said they were "completely" or "mostly" satisfied; and
• 36% said they were partly satisfied and partly dissatisfied.

According to the study, the reliability of EHR systems is the most reported complaint among health care providers. In the next 12 months, about half of health care practices will increase their IT expenditures, according to the study.

Health care providers who plan on making health IT purchases will seek new network equipment and tablet PCs that can give providers greater mobility, according to the study.

According to MGMA, EHRs improve the bottom line for physicians

In a report issued by MGMA, Independent physician practices can earn nearly $50,000 per full-time-equivalent physician with an EHR than those still stuck in the paper world, the Medical Group Management Association reports.

The report, based on a survey of MGMA membership, found that EHR-equipped practices not owned by hospitals or integrated delivery networks had $178,907 in higher median revenue per FTE physician in 2009 than similar practices without an EHR. Though operating costs were $105,591 higher per doctor with an EHR, the net result was $49,916 greater operating income for each FTE physician.

Multispecialty practices owned by hospitals or IDNs did nearly as well, reporting a mean $42,042 higher operating margins with EHRs than without, according to the MGMA, which released the study this past Monday at the organization's annual conference in New Orleans. Benefits tend to rise over time, as well. Independent practices that have had EHRs more than five years had operating margins 10.1 percent greater than practices in their first year of EHR usage. That is largely because the highest implementation expenses tend to occur in the first year, after which time practices often see costs go down for transcription and medical records staff.

A panel of doctors defines Medicare payment rates?

Does a secret panel of physicians handpicked by medical specialty trade groups wield too much power over Medicare fees? That's a question the Wall Street Journal has raised in an article on the Relative Value Scale Update Committee (RUC). That's a panel of 29 doctors handpicked by medical specialty trade groups and convened by the American Medical Association. Its main focus is to estimate how much work a physician must do to perform a task.
 
While the group has no official government standing, CMS usually follows at least 90 percent of its recommendations on how much to pay doctors for their work. A Wall Street Journal analysis of Medicare and RUC data suggest that services received too much money in some cases, because the fees were based on obsolete assumptions. For example, more than 500 doctor services that are performed as mostly outpatient or in doctors' offices in 2008 still automatically include significant payments for hospital visits the day after the procedure, which would usually be part of an inpatient stay.

Opponents of the panel say the committee promotes a system that spends too much money on fancy procedures, while giving basic primary care that could keep patients healthier from the get go and save money short shrift. Critics also point to a conflict of interest. "It's indefensible," Tom Scully, a former CMS administrator and now a lawyer in private practice, told the WSJ . "It's not healthy to have the interested party essentially driving the decision making process."

Robert Berenson, vice chair of the Medicare Payment Advisory Commission (MEDPAC), a Congressional Watchdog, noted that the setup "produces increased spending for Medicare and for the rest of the system." Within the panel, some clashes between primary-care doctors and a surgical faction have occurred. In one instance, primary-care doctors called for the addition of another primary care seat on the panel, but got voted down. According to J. Fred Ralston, president of the American College of Physicians, the panel seemed more heavily weighted to specialties that are more procedure-oriented.

Dr. Barbara Levy, a Seattle-area gynecologist who heads up RUC, told the WSJ that the panel is not meant to be representative. And she seemed to deny any conflict of interest. "The outcomes are independent of who's sitting at the table from one specialty to another," she said.

Dr. Blumenthal: 2013 Meaningful Use to Ramp up HIE, Decision Support

Dr. David Blumenthal, the national health IT coordinator, sent a strong signal to healthcare providers and vendors to expect that more complex requirements for health information exchange and clinical decision support tools will be among forthcoming requirements for the next stage of meaningful use. The Office of the National Coordinator for Health IT is now beginning to do “early reconnaissance” around development of stage 2 meaningful use requirements, according to Blumenthal.

“We know there were a set of unfinished tasks, things we passed over in the effort to get the first stage of meaningful use out the door,” he said at an industry event Sept. 21 about states which are leading in electronic prescribing and where he took the opportunity to communicate some future plans. The provider and vendor community “should look forward to a much more robust set of requirements around health information exchange, an exchange that consciously ignores economic relationships, geographic relationships and political jurisdictions.

“We want information to follow patients,” Blumenthal said. Also, he anticipates a bigger push in stage two for clinical decision support, which stage one only hinted at. “I can tell you as a user of electronic heath records that I value the information that it has made possible, knowing that I could find old radiological reports without scrambling through a folder.” “Even more, I value the way clinical decision support made me a better doctor, the way you can make decisions better and more scientific and more consistent with the patients' needs,” he added. Blumenthal delivered his remarks at an event acknowledging the 10 top states in which physicians are using e-prescribing. Massachusetts led the states, followed by Michigan and Rhode Island , according to health IT firm Surescripts, which conducted a nationwide survey on e-prescribing.

Physicians and other health professionals in Massachusetts sent more than 11 million prescriptions electronically in 2009, representing 32.3 percent of all prescriptions in the state, according to Surescripts, which sponsored the event.

The other states in the Surescripts top 10 were Delaware , North Carolina , Connecticut , Pennsylvania , Hawaii , Indiana and Florida . E-prescribing use is growing substantially across all states in the U.S. In 2009, 47 states more than doubled their use of prescription routing while 39 more than doubled their use of prescription benefit information, according to the findings.

More than 200,000 providers now use e-prescribing, according to Surescripts. But Blumenthal highlighted the fact that the number represented just one third of all physicians. “A lot has been done but an enormous amount remains to be done,” he said. Electronic prescribing can be a gateway for many healthcare providers to get started on the path to meaningful use by introducing physicians to electronic transactions, he said.