By Walt West, OD, FAAO
Vision Source Vice-President of Practice Development
You can receive up to $44,000 in federal funds–provided that your use of electronic health records meets the federal government’s “meaningful use” standards. Here’s the how-to.
Most optometric practices today are thinking about implementing electronic health records–if they haven’t thought about or implemented this technology already. Widespread adoption of EHR in optometry is a big step in the right direction, but not all use of the technology is equal in the eyes of the federal government’s EHR Incentive Program. To understand what this federal program calls its “Meaningful Use” (MU) standards [see blue box below] more fully, I recently spoke with Vision Source member Scott Jens, OD, CEO, of RevolutionEHR and co-owner of Isthmus Eye Care in Middleton and Madison, Wis., who is well versed in these issues.
Mission Meaningful Use
Meet Meaningful
Use Requirements
To qualify for government incentives, you must show that your use of EHRis “meaningful” by demonstrating:
1. Use of certified EHR in a meaningful manner, such as e-prescribing.
2. Use ofEHR to electronically exchange health information to improve quality of care.
3. Use of certified EHRs to submit clinical quality measure (CQM) and other such measures selected by the Secretary of Health and Human Services.
Stage 1
During Stage 1 of Meaningful Use (2011 and 2012), eligible providers must meet 20 of 25 objectives. Some 15 core measures must be met, as well asfive additional measures that can be selected by each ECP from a menu set of 10 measures.
You must also reportsix Clinical Quality Measures (CQM), includingthree core andthree additional measures chosen from a menu set of 38 additional measures. You can download a list of these CQMs here.
Stages 2-3
CMS expects to develop and implement Stage 2 in 2014, and Stage 3 will be implemented in 2015. Click HERE for a document that outlines the difference between stage 1 and 2.
–Excerpted from ROB article “Transition to Electronic Health Records and Net $44,000 from the Federal Government” by Wes Strickling, founder and technical architect, Codex Techworks.
Dr. West: Scott, how did you gain knowledge of the EHR industry?
Dr. Jens: As a practicing optometrist and Vision Source member, I had been using a computerized practice management system (PMS) for 15 years to manage scheduling, claims filing and inventory. In 2003, our clinic group began assessing the market for an electronic recordkeeping system for patient care documentation. Along with a team of highly motivated partners, I co-founded an EHR software platform in 2006.
The mission that I have had in the past three years is to assist optometrists with the difficult decision on purchasing EHR technology and to implement to a point where “meaningful EHR use” can be achieved.
Purchase Federally Certified EHR
Dr. West: What is the EHR Incentive Program all about?
Dr. Jens: Generally, it is called the “meaningful use” program by doctors in practice. The first part of it was established in 2009 and it included an EHR software certification program to assure doctors and hospitals that the system they purchased had met strict guidelines for security, functionality and data storage.
Once EHR software has passed the certification process, the system is posted on the ONC web site’s Certified HIT Products List (CHPL) along with notations for which particular functionalities have been tested. Doctors must choose any combination of certified software systems that allow the doctors to meet the MU objectives.
From there, the doctor must utilize the software in a “meaningful” manner to care for patients. The working concept is to get all health care providers to make similar documentation for all of their patients, so in the future some pieces of data can move between EHR systems to improve the quality of care delivered and reduce health disparities.
Maximum Funding of $44,000
Dr. West: So, how are doctors incentivized?
Dr. Jens: The Centers for Medicare & Medicaid Services (CMS) developed the program to allow providers time to move up the EHR adoption ladder, allowing for “stages” of increasingly sophisticated meaningful EHR use. Doctors are allowed to adopt EHR and demonstrate MU with a 90-day demonstration period in their first year, then every year thereafter the doctors are expected to keep the MU protocols in place every day, ongoing.
Doctors who began use of Certified EHR Technology to achieve MU in 2011 or 2012 can receive maximum funding of $44,000 (under the Medicare program of reimbursement) or $64,000 (under the Medicaid program, which requires 30 percent of the patient base to be covered by Medicaid). Doctors who have waited, and will begin their MU process in 2013, still achieve a maximum of $39,000 incentive payments, but starting in 2015 or later will cause CMS to deduct penalties from the doctor’s payments from CMS.
Meaningful Use Timeline 2012–and Beyond
Any doctor who plans to perform his or her first year of Meaningful Use demonstration for a 90-day period within this calendar year must have an EHR in place and begin to use it meaningfully by Oct. 3, 2012.
Doctors who have not yet purchased a certified EHR technology will not be able to do so prior to this date and get it installed and staff trained in time to have 2012 count as their first year of MU.
The good news is that a doctor can pursue EHR adoption in nine months and have ample time for 2013 to count as his or her first year of MU.
The critical date to remember is December 31, 2015 because CMS, the federal program overseeing implementation of EHR, will penalize doctors (via payment deductions) who don’t implement and prove Meaningful Use of EHR by the end 2015.
Launch Participation in Meaningful Use
Dr. West: What do doctors need to do if they have not yet begun participation in the MU program?
Dr. Jens: Registration: Optometrists who choose to be Eligible Providers perform online registration at the CMS EHR Incentive Program web site: https://ehrincentives.cms.gov/hitech/login.action.
Demonstration of Meaningful Use: After purchase and implementation of a Certified EHR Technology, the doctor performs clinical practice with EHR use that is compliant with the MU standards, for 90 days in the first MU demonstration year.
Incentive Payments: Doctors return to the CMS web site and submit the MU data from their software in a process called attestation. The doctor is paid in approximately eight weeks once that year’s Medicare Allowable Charge maximum has been met.
Picture of Successful Meaningful Use Practice
Dr. West: What does a successful MU practice look like?
Dr. Jens: Meaningful use pushes a doctor to perform e-prescribing, to electronically exchange health information to improve quality of health care and to submit clinical quality measures.
To prepare for MU, doctors and their clinical staff must begin to increase details in case history taking. For example, routine evaluation of the patient’s medications as prescribed by the optometrist, as well as reviewing medication lists prescribed by other providers, must be done. A careful listing of the patient’s medication allergies is also necessary.
Clinically, optometrists need to become comfortable with new measures of a patient’s general health, such as capturing blood pressure, height, weight and smoking status. ODs will need to become accustomed to delivering clinical summary reports to patients, providing certain levels of quality care to patients with glaucoma and diabetic retinopathy, and utilizing the EHR’s clinical decision support rules.
Understand that MU is establishing a new standard for general medical documentation. Core optometry practice management activities are not considered in the definition of MU. There are no considerations for the software’s capabilities to schedule appointments, track a patient’s financial history, to file claims in an electronic format, or to search for patients with particular history or interest in eyewear, contact lenses, or other products or services. There are no objectives attending to documentation of refractions, IOPs, C/Ds, phorias, accommodation or ocular health.
Growth of Complete Adoption of EHR in Optometry
Dr. West: What is the state of MU in optometry today, and what do you think we’ll see in the future?
Dr. Jens: According to information published by CMS at the end of June, over 7,500 optometrists have registered with the EHR Incentive Program but only approximately 2,500 have received incentive payments. Nonetheless, those doctors have received nearly $40 million that they can use within their practice as they choose, often earmarking it for ongoing software costs, improving hardware, or performing other capital improvements.
The MU program follows a staged process that allows doctors to evolve in their EHR utilization. The Stage 1 MU objectives will be in force through 2013. Starting in 2014, new and more stringent Stage 2 objectives will be implemented expecting more specific actions by the doctor and more electronic exchange of health information. Stage 3 objectives will likely take effect in 2015, but they will need to be further detailed through future government rulemaking.
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Walt West, OD, FAAO, is vice-president of practice development for optometric alliance Vision Source. To contact him: wwest@visionsource.com
