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

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

 

 

 

 

 

 

 

 

 

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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.

All SFMS physician members are invited to participate in a focus group regarding CalHIPSO’s (SFMS/CMA’s non-profit partner to provide assistance in EHR adoption for physicians) development of a Data Analytics Pilot Project. The new CALHIPSO project is intended to offer physicians, medical groups, and other health care organizations the ability to extract and analyze their own electronic health information in whatever manner may be desired for the purposes of quality assurance/improvement. To ensure that this project reflects the needs and desires of physicians, CALHIPSO is seeking feedback from physicians through participation in an in-person or a webinar-based focus group. Please see below for available times.

Goals

• Gain an understanding of the challenges clinical and operational leaders face in making timely, accurate operations and business decisions
• Develop an understanding of your perspectives on various clinical analytics tools if any
• Understand how you and your organization currently collect and utilize clinical and business intelligence-related information if at all
• Understand how you would relatively prioritize clinical analytics areas
• Determine the qualities you most desire or require in a clinical analytics

Focus Group Dates/Times

Each session requires a commitment to attend for two hours, either in person or via a webinar as follows:

• IN-PERSON: Monday, July 31, 5:30 – 7:30 pm, at ACCMA headquarters in Oakland
• WEBINAR**: Tuesday, July 31, 12:00 – 2 pm
• WEBINAR**: Thursday, August 2, 5:30 – 7:30 pm 

**Participants in the webinar must have access to a phone line and computer with high speed internet.

Compensation

Participants in the webinar focus groups will receive a $150 stipend. Participants in the in-person focus group will receive $250.

Registration

Please note advance registration is required to participate in the focus groups.

• Click here to complete the registration to participate in the in-person focus group.
• Click here to complete the registration to participate in the webinar focus group. 

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.