San Francisco Medical Society Blog

CMS Confirms Sequestration Payment Cuts for EHR Incentive Program

Thu, 18 Apr 2013 16:21:55 GMT

The Centers for Medicare & Medicaid Services (CMS) has confirmed that the Medicare electronic health record (EHR) incentive program payments will be cut by 2% as required by the Sequestration Transparency Act.

The 2% "sequestration" cuts to Medicare are part of the $1.2 trillion in cuts required by the Sequestration Transparency Act, part of a deal worked out to end last year's debt-ceiling crisis.

According to CMS, the 2% reduction will be applied to Medicare EHR incentive payments for reporting periods that end on or after April 1, 2013. If the final day of the reporting period occurs before April 1, 2013, those incentive payments will not be subject to the reduction.

Medicaid (Medi-Cal in California) is exempt from the sequestration cuts.

Click here for more details on the sequestration cut as previously reported by SFMS.

Click here for our Sequestration FAQ.

Medi-Cal Extends EHR Attestation Deadline

Mon, 18 Mar 2013 14:36:34 GMT

Xerox, the vendor in charge of the Medi-Cal electronic health record (EHR) incentive payments has resolved the technical difficulties that were complicating some providers’ ability to complete their 2012 attestations. Specifically, the Medi-Cal State Level Registry was not properly allowing some providers who have been designated as members of groups to inherit and utilize the group’s information.

As of March 15, the system is fully functional.

Because of the difficulties and resulting attestation delays, the California Department of Health Care Services (DHCS) has received federal authorization to extend the 2012 attestation deadline to April 30, 2013. This deadline extension applies to all eligible professionals, not just those affected by the group attestation problem.

For more information visit www.medi-cal.ehr.ca.gov or call Xerox’s EHR Program at (866) 879-0109.

Getting Used to Electronic Health Record

Fri, 02 Nov 2012 13:57:19 GMT

By Toni Brayer

From this...

To this...

I will start with full disclosure. I still use paper charts. While I think my practice of medicine is “uber”-up-to-date... the truth is it could be 1950 when you look at my patient records. Charts are huge and some patients I’ve seen for decades are on volume 3, just to make them manageable. So this very week I am coming on board with a full blown, state-of-the-art Electronic Health Record.

The government is pushing EHRs. In fact, Center for Medicare and Medicaid Services (CMS) has already imposed a 1% penalty on doctors that are not doing e-prescribing of prescriptions. The penalty goes up to 1.5% in 2013. There are also some large incentive dollars connected with “Meaningful Use”. It is a complicated set of criteria put out by CMS that pushes physicians toward investing in the EHR.

With all of these incentives why haven’t more physicians converted? For one, it is darn expensive and the best systems require large groups or hospital funding to make it financially feasible. Staff needs to be trained, equipment purchased, software and licenses purchased, Internet technology (IT) support is needed and the doctor’s productivity and ability to see the same number of patients declines. And it totally changes how you and your staff do your work.

The advantages are numerous, however. Having access to instant, legible information all in one place, shared by all of the caregivers is huge. The EHR gives easy access to consultant notes and all tests. When I am on call at night or weekends, I can see my patient’s information and it will prevent medical errors. The EHR can be programmed to give “alerts” for drug reactions, needed screening tests and medical information.

So it is a no brainer that we all need to switch to the 21^st century and start using technology to help us deliver better care.

I have already gone through an entire day of training and will be using more of my “free” time this week to abstract my old charts, learn the system and develop my own practice templates in the new EHR. I will need “at my side” IT support when I first start using it with patients. I think my patients will understand if it is clumsy at first. And they will surely like the ability to see their own lab tests and make office appointments online.

I am looking forward to the change but also wary of what is ahead. Internal Medicine is already a grinding specialty with low pay and long hours. Spending more hours with an EHR is not appealing, but I hope the benefit to patients and safety makes it worth it in the long run.

The graph below is on a scale of 1-5. 1=poor, 3=neutral and 5=excellent. You can see that none of the EHRs scored very high with the Physician users.

Satisfaction with EHRs by Employed Internists in large Practices

Criterion Rating Average

Easy to learn
3.62

Ease of data entry
3.57

Overall ease of use (intuitive)
3.45

Ease of EHR implementation
3.43

Reliability 3.99

Adequacy of vendor training program
3.55

Vendor continuing customer service
3.63

Interactivity with other office systems
3.29

Value for the money
3.46

Physician overall satisfaction
3.51

Staff overall satisfaction
3.55

Appearance/overall usefulness of the end product (e.g., notes, consultations)
3.68

Originally published in EverythingHealth, October 29, 2012.

Toni Brayer, MD is an internist and Chief Medical Officer for Sutter Health West Bay Region. A SFMS member since 1987, Dr. Brayer has served as President, CMA delegate, Editor of San Francisco Medicine, and on numerous committees over the years. She is a Fellow of the American College of Physicians and an Assistant Clinical Professor at UCSF. Dr. Brayer blogs at EverythingHealth.net.

California Physicians' EHR Systems Fall Short of Meaningful Use Criteria

Mon, 18 Jun 2012 11:49:04 GMT

Although most California physicians use electronic health record systems, only 30% of them use EHR systems that have the ability to meet the requirements of the meaningful use program, according to a report by UCSF researchers.

Under the 2009 economic stimulus package, health care providers who demonstrate meaningful use of certified EHR systems can qualify for Medicaid and Medicare incentive payments.

The report summarizes findings from a 2011 survey that UCSF and the California Medical Board conducted for the California Department of Health Care Services and the California HealthCare Foundation.

Report Findings

71% of surveyed California physicians said they use an EHR system at their main practice location (Modern Physician, 6/15);
61% said they use an EHR system that allows them to record clinical notes; and,
45% said they use an EHR system that allows them to generate reports of quality indicators such as the percentage of patients with diabetes who received recommended lab tests.

California physicians at larger health care organizations were more likely to report having an EHR system than physicians at smaller practices, the report found. The report also found that more than half of surveyed California physicians who qualified for EHR incentive payments from Medi-Cal—California's Medicaid program—did not believe they were eligible for the payments. Click here to view the 35-page report.

Recommendations

The report's authors recommended that California officials and policymakers:

Encourage EHR use among small physician practices;
Educate physicians about eligibility criteria for Medi-Cal incentive payments;
Emphasize the importance of using EHR systems that meet the meaningful use requirements; and,
Evaluate whether EHR availability and meaningful use attestation increased after Medi-Cal incentive payments were distributed (Modern Physician, 6/15).

Resources

SFMS has partnered with the California Health Information Partnership and Services (CalHIPSO) and Lumetra to assist our physician members with EHR selection and implementation.

CalHIPSO is a non-profit, vendor-neutral organization that provides technical assistance, guidance, and information on best practices to support and accelerate providers’ efforts to become meaningful users of certified EHR technology. As a federally designed Regional Extension Center (REC), CalHIPSO is working with ten Local Extension Centers (LECs)—Lumetra is the San Francisco LEC—to ensure the availability of local technical assistance, guidance, and information on best practices to support safety net providers in Northern and Southern California in the attainment of Stage 1 meaningful use of EHRs.

Help is available to physicians in all stages of EHR adoption, including:

EHR project management
Consultation on vendor selection
Strategic counsel on practice/workflow redesign
Support on system implementation, health information exchange (HIE), and privacy/security
Resources on patient education on EHRs

SFMS members: For assistance with EHR please contact SFMS, or contact CALHIPSO or Lumetra directly (contact info listed below).
Lumetra: Jeff Gutman or (415) 677-8447

CalHIPSO: Kent Waldsmith or (510) 302-3364

Source: California Healthline, June 18, 2012.

May 2012 AMA Advocacy Update: CMS Releases Final Rule on CoPs, Passage of HR 5652 and Its Effect on Physicians, EHR MU Program

Mon, 21 May 2012 15:19:45 GMT

Excerpts from the May 2012 AMA Advocacy Update. For a pdf copy of the full report, click here. To view the most current national advocacy update, click here.

AMA Protects Physician Hospital Medical Staff
House Passes Reconciliation Legislation
AMA and Others Comment on EHR MU Program
Medicare Now Accepts Physician Enrollment Applications 60 Days in Advance
AMA, Federation staff tackle physician concerns with UnitedHealth Group

AMA Protects Physician Hospital Medical Staff

On October 24, 2011, CMS published a proposed rule to revise the Medicare Conditions of Participation (CoPs) for hospitals that included a number of troubling provisions. AMA strongly advocated to CMS senior staff that the provisions therein would have the effect of severely diluting the authority of hospital medical staffs and could threaten hospital patient safety and health.

As a direct result of AMA advocacy, the final rule—released this month—makes the following improvements:

The proposed concept of a single medical staff for a multi-hospital system has been removed.
The proposed concept of the privileging of physicians without appointment to the medical staff has been removed.
A hospital’s governing body must now include at least one medical staff member.
The proposed concept of credentialing for medical staff membership in accordance with “hospital policies and procedures” has been removed; the final rule defers to state law and “medical staff bylaws, rules, and regulations.”
The mandatory inclusion of non-physician practitioners on medical staffs strongly proposed by several other groups (e.g., American Nurses Association, AARP) was not adopted.

House Passes Reconciliation Legislation

The House passed H.R. 5652, the “Sequester Replacement Reconciliation Act of 2012,” on May 10 by a vote of 218-199. This bill was a combination of the work of six House committees that were required by the FY 2013 Congressional Budget Resolution (H.Con.Res. 112) to produce legislation that would cut the federal deficit by a total of $261 billion over 10 years.

Of interest to physicians, the Judiciary Committee included in its portion of the bill the “Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act” (H.R. 5). The HEALTH Act, originally introduced by Rep. Phil Gingrey, MD (R-GA), contains a wide range of AMA-supported medical liability reforms, including a $250,000 cap on non-economic damages. The Ways and Means Committee achieved its required $53 billion savings in part by enhancing provisions to recapture overpayments of health insurance subsidies, which were created under the Affordable Care Act (ACA), and by repealing block grants to states for social services. The Energy and Commerce Committee met its $96.8 billion target in part by including medical liability reform provisions (that differ slightly from the Judiciary Committee approved language). The Energy and Commerce Committee also achieved savings through several changes to the ACA including repealing the prevention and public health fund, defunding the “Consumer Operated and Oriented Plan” (CO-OP) program, repealing the Medicaid maintenance of effort requirement for states, and repealing the direct appropriation for state exchange grant authority.

It is unlikely that the reconciliation measure will advance beyond the House. The Senate is not expected to consider a reconciliation bill because it is not expected to approve a budget resolution.

AMA Plus 100 State & Specialty Societies Comment on EHR MU Program

On May 7 the AMA together with 100 state and specialty societies submitted a comment letter to the CMS making several recommendations for how to improve the Electronic Health Record (EHR) Meaningful Use program in response to a proposed rule on Stage 2. Included among these recommendations the comments championed the need for a robust evaluation of Stage 1, avoiding high reporting measure thresholds, removing any measures that are outside a physician’s control, only requiring measures that are relevant to a physician’s practice, streamlining the number of requirements, including adequate exclusions, and reporting on six clinically relevant quality measures covering at least two domains. The comments also advocated for removing any “back-dating” of penalties and the overall need for greater synchronization among all Medicare reporting programs.

The AMA also submitted a comment letter the same day to the Office of the National Coordinator for Health IT (ONC) in response to a proposed rule on the standards vendors must meet for providing certified EHRs to physicians. The AMA continues to advocate strongly for a greater focus on EHR usability and patient safety issues.

Medicare Now Accepts Physician Enrollment Applications 60 Days in Advance

For years the AMA has been pushing CMS to expand the time frame physicians have to submit their enrollment application. Until recently physicians were only permitted to send their application to their Medicare contractor 30 days in advance of the “effective date” which is the later of: 1) the date a physician filed an application that is ultimately approved by Medicare; or 2) the date a physician began furnishing services at a new practice location. Under new guidelines CMS has extended this date to 60 days, with some exceptions. The change is effective May 14.

AMA Tackles Physician Concerns with UnitedHealth Group

The AMA Practice Management Federation Staff Advisory Steering Committee (Committee) and Federation workgroups held their annual in-person meeting on May 3, 2012. The goal of this meeting is to: 1) discuss how to best address national payer trends; and 2) develop a plan of action to address practice management issues within the physician practice. The Committee and Federation workgroups also held their annual meeting with UnitedHealth Group (UHG) on May 4, 2012, to address current issues physician members have with UHG. Since these meetings began in 2007, 55 issues have been resolved and the groups have collaborated on 48 issues that have seen improvement. This year’s meetings were held at the AMA headquarters in Chicago and were attended by 25 Federation staff members representing 14 state medical associations, one county medical association and six national specialty societies, along with 18 representatives from UHG. Future efforts between the AMA, Committee, Federation workgroups and UHG will focus on developing action plans for collaborative ways to contain rising U.S. health care costs and to educate physicians on delivery system innovations.

California to help health providers secure Medicaid incentive payments for demonstrating meaningful use.

Wed, 04 Apr 2012 14:04:22 GMT

California has set a goal of having 10,000 eligible health care providers by June receive Medicaid incentive payments for demonstrating meaningful use of certified electronic health records, according to a CMS blog post published recently by National Coordinator for Health IT Farzad Mostashari and CMS Acting Administrator Marilyn Tavenner.

Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified electronic health record systems can qualify for Medicaid and Medicare incentive payments.

Nationwide Goals
In the blog post, Mostashari and Tavenner wrote that they have set a goal of helping 100,000 health care providers qualify for Medicare or Medicaid incentive payments this year.

As of February, more than 59,000 eligible health care professionals and more than 2,000 hospitals had received Medicare or Medicaid incentive payments, they noted.

States’ Progress
Mostashari and Tavenner wrote that many states, including California, “are partnering with local stakeholder organizations to make sure providers get the help and encouragement to achieve ‘meaningful use’ and assistance with overcoming any barriers that are blocking their progress”.

EHR Assistance
SFMS is partnering with Regional and Local Extension Centers to provide assistance with EHR adoption and implementation. REC and LEC support and serve health care providers to help them quickly become adept and meaningful users of EHRs. The target audience of RECs is primary care clinicians, but many RECs offer assistance to specialists, as well. If you need assistance as you look into transitioning to EHRs and participating in the CMS EHR Incentive Programs, consider contacting:

California Health Information Partnership and Services Organization (CalHIPSO)
www.calhipso.org
(888) 589-4897

Lumetra, San Francisco Local Extension Center
www.lumetrasolutions.com
(415) 677-2081

Assistance with EHR Adoption

Wed, 07 Mar 2012 15:55:27 GMT

Are you a primary care provider looking for assistance with Meaningful Use and EHR? SFMS is partnering with Lumetra, a local extension center for San Francisco, to fill available slots for priority primary care providers (PPCPs) to receive subsidized services from CalHIPSO.

These openings will be competitive and enrolled on a first come first serve basis. The following conditions apply:

The referred provider must be eligible for CalHIPSO services and MUST be able to reach Meaningful Use - No specialists.
All of the enrollment spots (M1 credit) have been already filled. We are looking to replace Bay Area providers who have been enrolled, but have let us know that they will not be going live and/or reaching Meaningful Use.
Since theses providers serve as replacements for providers who had already earned enrollment credit, we will not be able to pay the medical society for their enrollments.

Please contact Jeff Gutman at jgutman@lumetrasolutions.com or (415) 677-8447 to enroll reserve providers. The eligible Bay Area counties include San Francisco, San Mateo, Santa Cruz, Monterey, Contra Costa, Alameda, Santa Clara, San Benito, San Joaquin, Stanislaus, and Merced.

CMS Releases New Health IT 'Meaningful Use' Rules

Fri, 24 Feb 2012 12:36:37 GMT

It’s time to take electronic health records to the next level. CMS on Thursday released their second-stage guidelines for “meaningful use” of electronic records, which advocates say have the potential to reduce medical errors and streamline care.

The proposed rules require doctors and hospitals to significantly step up their usage, as well as better engage patients and improve the transferability of records. Under the proposed Stage 2 standards, hospitals as well as eligible professionals—the latter category includes physicians not employed by hospitals—would have to use Computerized physician order entry (CPOE) for more than 60% of medication, laboratory and radiology orders, double the share required under the Stage 1 standards.

The CPOE requirement is one of more than a dozen core objectives that hospitals and EPs would have to meet as part of demonstrating their meaningful use of electronic health-record systems, which would make them eligible to receive federal health IT incentive payments. Other core objectives for both hospitals and EPs include the use of electronic prescribing for more than 50% of prescriptions issued, the recording of demographic data for more than 50% of patients, recording of vital signs in more than 80% of patient encounters and recording smoking status for more than 80% of patients.

In an effort to promote electronic engagement with patients, Stage 2 would require that more than 50% of patients be provided online access to their health information and demonstrate that more than 10% had actually accessed that information. Among the proposed menu objectives for EPs are electronic recording of family health history for more than 20% of patients, successful ongoing transmission of syndromic surveillance data, successful ongoing transmission of cancer case information and successful ongoing transmission of data to a specialized cancer registry. For hospitals, menu objectives include electronic recording of advance directives for more than 50% of patients and the use of electronic prescribing for more than 50% of discharge prescriptions.

CMS EHR Information Center Updates

Thu, 09 Feb 2012 11:17:24 GMT

CMS has recently updated previously-posted FAQs and added new FAQs on several incentive program topics, including reporting periods and incentive payments. Answers to common questions about disbursing 2011 incentive payments, reporting periods, determining Medicaid patient volume are now posted on the site.

The Electronic Health Record (EHR) Information Center Interactive Voice Response (IVR) system has also been enhanced to provide users with an increased number of options and services to make accessing and reviewing data easier than ever before.

For eligible professionals, eligible hospitals, or critical access hospitals (CAHs), the revised functionality vastly improves the efficiency in obtaining desired information, while also offering a more varied amount of information and options for callers. Providers can now obtain information through an extensive IVR Self-Service option. Included in this option is a reinforced privacy protection module that requires your individual National Provider Identifier (NPI), the last five digits of your Tax Identification Number (TIN), and your EHR registration ID. Once accepted, this newly enhanced Self-Service tool allows you to:

Obtain registration status
Acquire attestation status
Review payment information
Check progress towards meeting the $24,000 threshold amount

Users may access these new options by dialing (888) 734-6433, pressing 3 for Self-Service, and entering the authentication elements. These options will be available on the IVR effective February 16, 2012.

EHR Information Center Hours of Operation: 7:30am-6:30pm CT, Monday through Friday, except federal holidays. Please note that General Information and Self-Service options may be reached via IVR 24 hours a day, except during periods of planned system maintenance or upgrades.

Free Assistance with EHR and Meaningful Use

Mon, 06 Feb 2012 16:27:52 GMT

SFMS has partnered with the California Health Information Partnership and Services (CalHIPSO) to assist our physician members with EHR implementation.

CalHIPSO is a non-profit, vendor-neutral organization that provides technical assistance, guidance, and information on best practices to support and accelerate providers’ efforts to become meaningful users of certified EHR technology. As a federally designed Regional Extension Center (REC), CalHIPSO is working with ten Local Extension Centers (LECs)—Lumetra is the San Francisco LEC—to ensure the availability of assistanceand information on best practices to support safety net providers in Northern and Southern California in the attainment of Stage 1 meaningful use of EHRs.

Bay area priority primary care providers still have the opportunity to receive subsidized technical services to implement and effectively use an EHR.

Receive technical assistance with your EHR Implementation from CalHIPSO and a network of skilled professionals who can help you make informed decisions.
Access to CalHIPSO’s EHR vendor contracts, which include reduced pricing and pre-negotiated contract terms
Educational webinars on Meaningful Use, privacy and security, EHR incentive programs, REC membership, and more!
Discounted HIPAA privacy and security compliance program tools through PrivaPlan
Obtain assistance demonstrating Stage 1 Meaningful Use

Join CalHIPSO by February 29, and membership is free through 2014. Visit www.CalHIPSO.org to enroll today.

Bipartisan Report Highlights Gaps, Recommendations For Health IT

Mon, 30 Jan 2012 16:09:59 GMT

It’s been three years since Congress approved a nearly $30 billion plan to digitize health care records, yet much of the health care industry is still drowning in paper. The Bipartisan Policy Center released a 43-page report detailing the gaps in health IT implementation–the biggest concern being a delay in getting the various systems to be able to talk to one another. The government initiative, passed as part of the 2009 financial stimulus package, gives doctors, hospitals and other providers funding incentives to switch to digital record systems. That effort is also considered one of the key elements to overhauling the country’s health care system. Proponents say that electronic records will reduce medical errors and help cut costs by reducing duplicative tests and care. It can also provide enhanced population data to find out the most effective procedures. Part of that law, known as the HITECH Act, called for health care systems to be able to share patient information. But so far, the new report notes that “the level of electronic health information exchange is very low in the U.S.” The effort has been slowed, the report notes, partially because of federal delays in setting standards for how systems should be able to communicate with one another. The report identified six barriers to successfully implementing the technology around the country and made recommendations in each of those areas. The barriers include privacy and security concerns, a lack of consumer engagement and the number of changes that providers are juggling as a result of the health care law. The report suggest that doctors, hospitals, and other providers might be more inclined to embrace the digital exchange of patient information if they had a business incentive to do so. The report notes that other causes of delays include a lack of enthusiasm among consumers, who often have misperceptions about how electronic records work and security concerns. Previous research, as the report highlights, shows that “health information exchange has a positive impact on both the cost and quality of care.” Source: Kaiser Health News, January 27, 2012.

Medi-Cal Postpones Start Date for EHR Incentive Program Enrollment to December 20

Tue, 13 Dec 2011 10:13:43 GMT

The California Department of Health Care Services pushed its enrollment in the electronic health record (EHR) system from December 15 to December 20, 2011, for individual providers. Physicians should know that this will not affect their overall incentive payments. Those who enroll in the program will be eligible for the same total incentive ($63,750) whether they enroll this year, or any year up to 2016. Enrollment in the program for hospitals and groups and clinics began as planned on October 3 and November 15, respectively. Under the American Recovery and Reinvestment Act of 2009 (ARRA, or the Stimulus Act), physicians are eligible for financial incentives for demonstrating “meaningful use” of an EHR system. Medi-Cal providers who meet certain patient volume thresholds will qualify for up to $63,750 paid out over six years, beginning as early as 2011 or as late as 2016. In the first year that a physician is enrolled in the incentive program, he or she can receive up to $21,250 for purchasing, implementing or upgrading an EHR system. Physicians will not have to demonstrate “meaningful use” until their second year in the program. Accessing these incentives will require a two-part enrollment. Physicians must first register with the Centers for Medicare & Medicaid Services at https://ehrincentives.cms.gov. They must then enroll in the Medi-Cal Incentive Program at http://medi-cal.ehr.ca.gov. Physicians qualify for incentives if:

Medi-Cal patients make up at least 30 percent of their patient volume.
They are a pediatrician with at least 20 percent Medi-Cal patient volume. (However, pediatricians with 20 to 30 percent Medi-Cal patient volume only qualify for two-thirds of the total incentive.)
They practice in a federally qualified health center, rural health center or Indian health clinic and at least 30 percent of their patient volume is “needy individuals,” such as Medi-Cal, Healthy Families, sliding scale or uncompensated care.

For more information on the Medi-Cal EHR Incentive Program, see http://medi-cal.ehr.ca.gov.

Stage 2 Meaningful Use for Medicare EHR Incentive Program Delayed to 2014

Tue, 06 Dec 2011 16:34:58 GMT

On November 30, HHS announced intention to delay implementation of Stage 2 of Meaningful Use of electronic health records (EHR) until 2014. Under previous rules, physicians who achieved meaningful use in 2011 would have had to move to the higher Stage 2 standard in 2013. Meaningful use is the set of criteria on which physicians must report in order to receive federal incentive payments for EHR adoption. What is currently published as meaningful use is known as Stage 1. Later stages will include more reporting measures and higher standards. The California Medical Association (CMA) filed comments earlier this year with the Office of the National Coordinator for Health IT asking for just such a delay. CMA believes that many physicians will have a difficult time achieving Stage 1, and the delay will give them more time to adjust their practices to the new electronic environment. According to HHS, these policy changes will be accompanied by greater outreach efforts by HHS that will provide more information to doctors about best practices. In communities across the country, HHS will target outreach, education and training to Medicare-eligible professionals who have registered in the EHR Incentive Program but have not yet met the requirements for meaningful use. Under the Medicare EHR Incentive Program, physicians can receive incentive payments as high as $44,000. Meaningful use is the necessary foundation for all impending payment changes involving patient-centered medical homes, accountable care organizations, bundled payments and value-based purchasing. For more information, click here.

January Deadline Approaching for 5010 Transactions

Mon, 05 Dec 2011 18:01:30 GMT

SFMS is advising physicians to not expect a delay in the 5010 compliance deadline, which is January 1, 2012. All physicians, other health care professionals, payors and clearinghouses that submit HIPAA transactions will be required to use only the 5010 transactions as of the deadline. If physicians are not ready, they risk claim rejections and interrupted cash flow. Use of the 5010 code set applies to electronically submitted administrative transactions, such as checking a patient’s eligibility, filing a claim or receiving a remittance advice.

HOW to prepare for 5010

The biggest concern for practices will be complete implementation and full functionality of 5010 transactions on or before the compliance deadline to avoid transaction rejections and subsequent payment delays. If you have not yet started your conversion process, take action now. The following tips may help you meet the deadline:

Talk to your current practice management system vendor.
Talk to your clearinghouses or billing service (if you use either one) and health insurance payors.
Identify changes to data reporting requirements.
Identify potential changes to existing practice work flow and business processes.
Identify staff training needs.
Test with your trading partners, e.g., payors and clearinghouses.
Budget for implementation costs, including expenses for system changes, resource materials, consultants and training.

What if I’m not ready by the compliance deadline?

Any 4010/4010A1 transactions sent on or after January 1, 2012, will be rejected as non-compliant and will not be processed. CMA has queried the largest payors and published the actions they will take. If you will not be ready by the compliance deadline, talk to your trading partners, e.g., payors, clearinghouses and billing services, to determine what actions you can take to continue having your transactions processed and receive payments. Click here for more information. The Office of E-Health Standards and Services will accept complaints associated with compliance with Version 5010, NCPDP D.0 and NCPDP 3.0 transaction standards beginning January 1, 2012. HIPAA-covered entities that are subject to these complaints must produce evidence of either compliance or an established plan to become compliant within the enforcement discretion period. Complaints may be submitted electronically or via paper.

Would Payors Continue to Accept 4010?

CMA surveyed the major payors in California to find out which of them will continue to accept 4010 transactions beyond January 1, 2012. Click here for the results of which payors will continue to accept 4010 beyond January 1, 2012.

An Unfolding Success Story: Electronic Medical Records Transition Moves Ahead

Mon, 28 Nov 2011 13:30:27 GMT

It’s hard to think of any major portion of President Obama’s health policy that hasn’t engendered intense argument. But one at least comes close: the provision of the 2009 federal stimulus law that pushes medical practices to update their record-keeping for the 21^st century. The aim is to ensure that all of the nation’s medical records are computerized by 2014. There seems to be a broad consensus that increased use of electronic data will improve the quality of health care in the country and ultimately lower costs. And here’s why. In roughly three out of four doctors’ offices in the country, patient charts are still updated by hand and stored in vast, color-coded filing cabinets. If a patient changes doctors, the file has to be mailed or faxed and the new doctor often has trouble reading the previous doctor’s hen scratching. Patients walk out of a medical office with one or more tiny pieces of paper to get prescription drugs filled. When they come back for a follow-up, they have to bring a bag full of drugs so the doctor will know what the patient is taking. Given such cumbersome procedures, few would argue that computerization isn’t needed. But the federal program did lead to complaints in the beginning. Critics warned that doctors who serve mostly low-income patients would lack the time or inclination to make the painstaking switch to electronic records. They worried that the nationwide push would widen the so-called “digital divide” that already exists between doctors in affluent parts of the country and those in underserved urban and rural areas. So far, that hasn’t happened. The $19 billion medical records law—which pays doctors to switch to an electronic system or upgrade one they’re already using—is having an impact on the entire health care industry. And small primary care practices that treat Medicaid patients are no exception. As of last week, the U.S. Department of Health and Human Services reported, more than 100,000 primary care doctors across the country had taken advantage of federal incentives to adopt a certified electronic medical record system. Half of the doctors were members of small practices that serve Medicaid and Medicare patients, and the rest worked in community health centers, public hospitals, rural health clinics and other public settings.

A national campaign

In addition to cash for doctors—$65,000 for every Medicaid physician and $44,000 for Medicare practitioners—states have been given millions of dollars to set up education programs aimed at helping the medical profession qualify. These advisory groups, called regional extension centers, have the job of translating some 700 pages of complex federal rules on so-called “meaningful use” of electronic health records. Some 22 states have set up regional centers, and several states have exceeded federally set goals for the number of doctors they enroll. For Medicaid doctors — those with 30 percent or more of their patients covered by the federal-state program — qualifying for the first $21,000 federal installment is relatively easy. They simply have to adopt or upgrade a certified electronic records system.

Meaningful Use

For Medicare doctors, who are paid higher rates, the first step is steeper. They must qualify under the meaningful use rules immediately. For example, physicians’ practices must maintain an up-to-date computerized list of medications and allergies for each patient, provide patients with summaries of every office visit, and transmit prescriptions electronically. Ultimately, Medicaid doctors will have to adhere to the same set of rules in order to get subsequent installments of their $66,000 total incentive payment. But they have quite a while to do that. Medicare doctors must be certified by 2012 in order to receive their full incentive. After that, they have until 2014 to qualify for a smaller incentive of $24,000. Medicaid doctors have until 2021 to fully qualify. In the meantime, states are developing what is known as a health information exchange that will allow doctors who convert to electronic systems to access patient records within the state through secure portals, and ultimately transfer records across the country.

Medi-Cal EHR Incentive Program Enrollment Starts on December 15, 2011

Fri, 18 Nov 2011 10:50:13 GMT

The American Recovery and Reinvestment Act of 2009 established the Electronic Health Record (EHR) Incentive Program for Medicaid and Medicare providers. Beginning in 2011, eligible Medi-Cal professionals and hospitals will be able to receive incentive payments to assist in purchasing, installing, and using electronic health records in their practices. Effective 11/15/2011, California has opened registration for groups and clinics. Group/clinic representatives can register their group/clinic(s) in the State Level Registry. Provider registration is scheduled to begin on 12/15/2011.

Program Eligibility for Professionals

Professionals must not be hospital-based (may not perform 90 percent or more of their services in a hospital inpatient or emergency room setting) and must meet at least one of the following criteria:

Have a minimum 30 percent Medicaid patient volume
Have a minimum 20 percent Medicaid patient volume if they are a pediatrician
Practice predominantly in a FQHC or RHC and have a minimum 30 percent patient volume attributable to needy individuals

Providers can review the EHR Incentive Programs: Medicaid Eligible Professional page on the CMS website for more information. Click here to learn more about this incentive program or consider registering for the November 30, 2011 complimentary webinar hosted by SFMS/CMA. Register at www.cmanet.org/events.

Study: EHRs Improve Diabetes Care, Improve Clinical Quality

Thu, 01 Sep 2011 10:31:26 GMT

Researchers from Case Western Reserve University report that provider practices using electronic health-record systems had higher rates of compliance with clinical quality improvement measures for diabetic patients than did their clinical counterparts using paper-based record systems. The study found more than half of diabetes patients got the best care as measured by four standards if their providers used electronic health records. This compares to just 7 percent of patients whose providers used old-fashioned paper, they reported in this week’s New England Journal of Medicine. Click here to read the full article.

Update on CMS EHR Incentive Programs

Thu, 25 Aug 2011 13:27:23 GMT

To date, over $149 million in incentive payments have been made under the Medicare Incentive Program, and over $248 million has been paid under the Medicaid Incentive Program across the nation.

Registration Reminder

Registration for the EHR Incentive Programs is open and CMS is encouraging Medicare providers to register early to avoid potential payment delays. In order to register, providers will need their:

National Provider Identifier (NPI).
National Plan and Provider Enumeration System (NPPES) User ID and Password.
Payee Tax Identification Number (if you are reassigning your benefits).
Payee National Provider Identifier (NPI), if you are reassigning your benefits.

To register, please go to www.cms.gov/EHRIncentivePrograms/20_RegistrationandAttestation.asp. If you have problems with the registration process, you can contact our EHR Information Center from 7:30 am to 6:30 pm (Central Time) Monday through Friday, except federal holidays, at (888) 734-6433.

National Provider Call – Registration Open

CMS will host a rescheduled National Provider Call on the Physician Quality Reporting System & Electronic Prescribing Incentive Program on Monday, August 29, from 10:30am to 12:00pm EST. This educational call was originally scheduled for August 16.

Target Audience: Medical coders, physician office staff, provider billing staff, health records staff, vendors, and all Medicare FFS providers. Registration Information: In order to receive the call-in information, you must register for the call. Registration will close at 1:30pm on August 26 or when available space has been filled; no exceptions will be made. For more details, including instructions on registering for the call, please visit http://www.eventsvc.com/palmettogba/082911.

Deadline for Eligible Professionals to Begin Reporting Period for 2011

A reminder that October 3, 2011 is the last day for eligible professionals to begin their 90-day reporting period for calendar year 2011. Eligible professionals have until February 29, 2012 to register and attest to receive an Incentive Payment for the 2011 calendar year, but the reporting period for which they are attesting needs to be 90 consecutive days within the 2011 calendar year. If a provider does not participate in the Medicare Incentive Program in CY 2011, they can still begin participation in CY 2012 and receive $18,000 for their first year’s incentive payment. Remember, for demonstrating meaningful use through both the Medicare and Medicaid EHR Incentive Programs, the EHR reporting period for an EP's first year is any continuous 90-day period within the calendar year. In subsequent years, the EHR reporting period for EPs is the entire calendar year. Under the Medicaid program, there is also an incentive for the adoption, implementation, or upgrade of certified EHR technology, which does not have a reporting period.

Meaningful Use Specification Sheets

A reminder that specification sheets on meaningful use, for both hospitals and professionals, are available at www.cms.gov/EHRIncentivePrograms/30_Meaningful_Use.asp in the Downloads section. These sheets provide detailed information on each of the meaningful use measures, including specifics on how to calculate numerators and denominators, what qualifies for exclusions, and more.

EHR Assistance

Regional Extension Centers (RECs) are federally funded organizations under the Office of the National Coordinator (ONC) and cover every geographic region of the United States. They support and serve health care providers to help them quickly become adept and meaningful users of EHRs. The target audience of RECs is primary care clinicians, but many RECs offer assistance to specialists, as well. If you need assistance as you look into transitioning to EHRs and participating in the CMS EHR Incentive Programs, consider contacting:

California Health Information Partnership and Services Organization (CalHIPSO)

www.calhipso.org (888) 589-4897

Lumetra, San Francisco Local Extension Center

www.lumetrasolutions.com

(415) 677-2081

CalHIPSO expands online education program to help physicians achieve meaningful use

Mon, 08 Aug 2011 16:00:05 GMT

CalHIPSO (the California Health Information Partnerships and Services Organization) is now offering free online education courses to help physicians understand how to achieve meaningful use in their practices. SFMS partners with CalHIPSO to assist our physician members with EHR implementation. CalHIPSO is a non-profit, vendor-neutral organization that provides technical assistance, guidance, and information on best practices to support and accelerate providers’ efforts to become meaningful users of certified EHR technology. Webinars are presented on Wednesdays at 5 pm and last about 20-30 minutes (they are available for on-demand viewing in the CalHIPSO Member Portal), and covers topics such as meaningful use objectives, privacy and security, and vendor selection. These courses are complimentary to CalHIPSO members and are available for CME/CNE credit. For more information, please visit the CalHIPSO website.

Be Prepared for New 5010 HIPAA Transactions

Tue, 05 Jul 2011 16:18:44 GMT

The deadline for transitioning electronic transactions to the updated 5010 version of the Health Insurance Portability and Accountability Act (HIPAA) transactions standards is January 1, 2012. Physicians will be required to conduct electronic transactions such as claims submissions, eligibility verification, claims status, remittance advice, and referral authorizations using the updated transaction standards. If physicians’ practice management systems are not up to new standards, they will risk not receiving electronic payments from private insurers and Medicare. The new HIPAA 5010 regulations impact all health care providers who:

Send or receive electronic administrative transactions directly to payers—both private and public; and,
Send electronic data to a billing service or clearinghouse that submits transactions on your practice’s behalf.

What is 5010? The new data standards come out of the Health Insurance and Accountability Act of 1996. It demands for more specificity in what data must be entered and transmitted, with the hope that the claims process will be more efficient and more details will be available about the patient visit. For example, physicians must submit a nine-digit, rather than a five-digit, ZIP code on all claims submissions and submit a street address rather than a post office box. 5010 also allows physicians to distinguish between principal diagnosis, admitting diagnosis, external cause of injury, and patient reason for visit codes. Guidelines for Claims Submission Using HIPAA 5010 Standards Step 1: Impact analysis – Conduct an internal analysis to determine the impact the change to 5010 will have on your practice. Step 2: Vendor, payer, billing service, and clearinghouse connections – Contact your practice management and electronic medical record vendor for details on the installation of upgrades to your system. Contact your clearinghouses, billing service, and payers to find out when upgrades will be completed and when they can accept 5010 transactions. Step 3: Installation of vendor upgrades Step 4: Internal testing and staff training – Once the upgrades are completed, conduct internal testing of your systems to ensure you can generate the 5010 transactions. You will need to train staff during the process of implementing and testing your system. Step 5: External testing with clearinghouses, billing service, and payers Step 6: Making the switch to 5010 – After you have completed external testing with some or all of your trading partners, you may switch to using only the 5010 transactions. You are permitted to begin using the 5010 transaction before the compliance date as long as you and the other organizations agree to the early switch. Step 7: Backup plans – In case transaction is rejected after the switch, make a plan for an interruption in cash flow. Some suggestions: Submit as many transactions as possible before January 1, 2012; decrease expenses before January 1, 2012, to increase cash reserves; establish a line of credit with a financial institution. Source: “5010 Implementation Steps: Getting the Work Done in Time for the Deadline,” AMA. Where Can I Find More Information?

Criterion	Rating Average
Easy to learn	3.62
Ease of data entry	3.57
Overall ease of use (intuitive)	3.45
Ease of EHR implementation	3.43
Reliability	3.99
Adequacy of vendor training program	3.55
Vendor continuing customer service	3.63
Interactivity with other office systems	3.29
Value for the money	3.46
Physician overall satisfaction	3.51
Staff overall satisfaction	3.55
Appearance/overall usefulness of the end product (e.g., notes, consultations)	3.68