AHIMA Meaningful Use White Paper Series
Paper no. 6a

Papers 5a and 5b in this series reviewed the functionality measures for providers and hospitals described in the notice of proposed rulemaking on meaningful use, published by the Centers for Medicare and Medicaid Services on January 13, 2010. This paper offers an overview of the requirements for reporting clinical quality measures for eligible providers. A companion paper (6b) provides an overview of the requirements for hospitals.

When Congress developed the meaningful use EHR incentive program, one of its goals was to improve the quality and efficiency of care for the Medicare and Medicaid populations. Accordingly, hospitals and providers that participate in the program will be required to capture and report clinical quality measures using certified EHR technology, in addition to the functionality measures they must report to prove they are using EHR technology in a meaningful way.

For purposes of the incentive program, CMS defines clinical quality measures as the “processes, experience, and/or outcomes of patient care, observations or treatment that relate to one or more quality aims for health care such as effective, safe, efficient, patient-centered, equitable, and timely care” (p. 1871). (more…)

AHIMA Meaningful Use White Paper Series
Paper no. 5a

The fourth paper in this series reviewed the EHR certification requirements related to the notice of proposed rulemaking on meaningful use, published by the Centers for Medicare and Medicaid Services on January 13, 2010. This paper offers an overview of the health IT functionality measures for eligible providers. A companion paper (5b) provides an overview of the requirements for hospitals.

Eligible providers (EPs) participating in the meaningful use program will be required to report on quality measures. The measures defined in the proposed regulation were developed to meet the stated objectives in support of the health outcome policy priorities.

The measures are grouped into two categories: HIT functionality measures and clinical quality measures. This paper focuses on the HIT functionality measures, which were developed to demonstrate the use of certified EHR technology in daily work processes.

Eligibility

Measures in Stage 1 are not set at 100 percent. However, most are set at a relatively high threshold to ensure the intent of the objectives and measures are met (e.g., 80 percent), while recognizing that there are technical hindrances and other barriers that may prevent full compliance. For other objectives and measures that depend on health information exchange, the thresholds remain low, since most areas of the country do not have the infrastructure to support this function.

CMS anticipates raising the threshold in subsequent stages as the capabilities of health IT infrastructure increases. It also anticipates redefining the objectives to go beyond capturing data in electronic format to include the exchange of the data in structured formats. The intent of escalating measures “is to ensure that meaningful use encourages patient-centric, interoperable health information exchange across provider organizations regardless of provider’s business affiliation or EHR platform,” CMS writes. (more…)

The oft-delayed Red Flags Rule, scheduled to take effect November 1, may be in for a major change. A bill that passed the US House October 20 and arrived in the Senate the next day would exempt, among others, healthcare practices with 20 or fewer employees from meeting the law’s requirements.

The amendment is intended to relieve the administrative burden on small businesses.

The Red Flags Rule, part of the Fair and Accurate Credit Transaction Act of 2003, requires “creditors” and financial institutions to develop and implement written identity theft prevention programs. As described in the rule, creditors are organizations that maintain consumer accounts that receive multiple payments or payments made in installments.

In full, HR 3763 amends the Fair Credit Reporting Act to exclude “any health care practice, accounting practice, or legal practice with 20 or fewer employees.” It also excludes any other business that the Federal Trade Commission, which oversees the rule, determines:

• knows all its customers or clients individually;
• only performs services in or around the residences of its customers; or 
• has not experienced incidents of identity theft, and identity theft is rare for businesses of that type. (more…)

AHIMA expressed support for a federal program establishing regional health IT extension centers that assist providers, but it registered concern that a program implemented ineffectively would cause confusion and contention and ultimately distract from the goal of EHR adoption and implementation.

AHIMA’s comments were in response to a draft description of the program published May 28 by the Office of the National Coordinator for Health IT. Specified under the American Recovery and Reinvestment Act, the program calls for a central Health IT Research Center with affiliated regional extension centers that provide direct assistance to providers. The centers will help providers meet requirements for receiving bonus Medicare and Medicaid payments under a separate ARRA provision.

AHIMA offered recommendations around four main comments: (more…)

The Department of Health and Human Services released its program plan for enacting the health IT incentives provisions called for in ARRA. By the end of 2009, HHS will have drafted necessary program policies and published them for public comment. These policies will include a definition of “meaningful use.”

HHS will also use this year to plan necessary support for the program, including a national outreach program.

In 2010 HHS plans to conduct outreach to eligible professionals, develop the final program rules, and create systems to monitor and evaluate the payments.

Medicare incentive payments to hospitals will begin no sooner than October 2010; payments to eligible professionals will begin no sooner than January 2011. Medicaid incentives to professionals and hospitals both will also begin no sooner than January 2011.

The American Recovery and Reinvestment Act provides $17 billion in Medicare bonus payments for eligible individuals and hospitals that adopt certified electronic health record systems. The Medicare payments run until 2016. The Medicaid payments extend until 2021.

In 2015 a series of Medicare payment reductions will begin for eligible professionals and hospitals that are not meaningful EHR users.

Several days ago the New York Times featured an article titled “How to Make Electronic Medical Records a Reality.” EHRs and their challenges have become a popular topic in the mainstream media. Maybe that’s what a couple billion dollars of federal money will do for a topic that’s been scuffing along.

The Times piece nicely highlights the challenge of implementing health IT in small physician practices, a primary healthcare target in the recently passed American Recovery and Reinvestment Act, or ARRA.

“There’s no way small practices can effectively implement electronic health records on their own,” says Dr. Farzad Mostashari in the article. “This is not the iPhone.” (more…)

Physicians seeking to transform their primary-care practices are seeing increasing support for the patient-centered medical home model. Growing recognition from payers and new help with the transition are advancing the model as a viable future for primary care.

In December consulting company TransforMED began offering products and services publicly for the first time, following a two-year national demonstration project aimed at showing the healthcare model’s efficiency and benefits to both patients and physicians.

TransforMED, a wholly owned subsidiary of the American Academy of Family Physicians, offers services ranging from practice assessments and consultations on partial implementation to assistance with full medical-home operations. The company’s services are offered in tiers, allowing a practice to transition in incremental steps. (more…)

In the August magazine, Mark Leavitt, MD, PhD, describes how product certification reduces risk and effort in selecting electronic health record systems. Certification also plays a role in promoting financial incentives for physician practices that adopt EHRs.

Organizations offering incentives necessarily put eligibility requirements around EHR systems to ensure that participating systems can deliver baseline benefits in quality measurement and improvement. Certification from a recognized body offers them a “solid qualifying mechanism” to do that, Leavitt says. (more…)

In the August issue we published a selected bibliography of research and writing on EHRs in physician practices. This is the extended version, as promised in the print issue. (more…)

As EHRs take center stage in the healthcare movement, numerous surveys have attempted to determine their rate of use, affect on quality, and the barriers to their implementation. The results usually agree in general, but the exact numbers they produce can differ greatly. One reason is that even objective studies can be unscientific.

The Institute for Health Policy (IHP) wanted a definitive answer on how many physicians were using EHRs. They got their chance with a grant from the Office of the National Coordinator for Health Information Technology (ONC), which they used to produce the study “Electronic Health Records in Ambulatory Care—A National Survey of Physicians.” The survey, which appeared in the July 3, 2008, issue of the New England Journal of Medicine, aims to provide a scientific, accurate look at physician EHR use. (more…)