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.

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.

By Toni Brayer

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 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

 

 

 

 

 

 

 

 

 

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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.

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.

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.