‘Meaningful Use’ Will Strengthen Physician Practices

Physicians looking at federal government efforts to encourage use of electronic health records (EHRs) may wonder whether the strings attached to the incentives will result in new bureaucratic obstacles. Will the requirements and new technologies really help physicians enhance patient care and manage their practices more efficiently?

Last December, the U.S. Department of Health and Human Services issued much anticipated guidelines for implementing American Recovery and Reinvestment Act (ARRA) provisions that incent physicians to install and use EHRs. ARRA includes up to $44,000 in Medicare incentive payments  over five years to eligible physicians who meet meaningful use criteria for integrating EHRs into their practices. ARRA also imposes escalating penalties for noncompliance after the end of the five-year period, in the form of reduced Medicare reimbursement rates.

The interim final rule – which went into effect on Feb. 12, 2010 – details a tiered implementation schedule beginning in 2011. The rule represents “the first step in an incremental approach to adopting standards, implementation specifications and certification criteria to enhance the interoperability, functionality, utility and security of health information technology and to supporting its meaningful use.” 

Although many physicians are aware of the ARRA incentives and the recently published guidelines for meaningful use, Steve Tolle, senior vice president of physician solutions at Ingenix, believes many are so consumed by the day-to-day demands of their practices that they have yet to fully realize how the technology and these guidelines will affect them.

“The average physician did not wake up this morning saying ‘today is the day I am getting an EHR,’” said Tolle. “There are more pressing concerns for most physicians, including their ability to provide patient care, keep schedules and manage back-office tasks such as billing, reporting and claims submission. However, physicians are starting to realize that the federal government’s effort to encourage use of EHRs provides them with a platform from which to address a broad set of challenges across their practice,” he said.

Interim final rule sets the bar

As currently drafted, the meaningful use standards are aggressive, but “very well thought out, patient-centric and largely take into consideration the dynamics of a real physician office,” according to Kim LaFontana, vice president of strategic initiatives at Ingenix. It will be challenging to physicians to meet several aspects of the requirements, though doing so will be necessary to truly enhance clinical care. “Meeting these standards will propel the health care profession forward, but there are some details that need to be hammered out first.”

For example, one of the “Stage 1” objectives of the rule pertains to computerized provider order entry (CPOE) and requires authorizing providers to personally input medication, lab, radiology/imaging and referral information into the EHR. CPOE is a “beautiful concept,” according to Tolle, but the burden on the provider, who today may assign an assistant to update medical records, may impede adoption. “Is the objective that the information be entered at the point of care, or that the physician actually enter it?”

LaFontana concurred, adding that regulators should focus more on what physicians should be trying to achieve and less on how it will be achieved. “The worst outcome here would be for doctors to attempt, but soon abandon ,requirements that are too burdensome. Our primary consideration should be ensuring that physicians don’t take an undue hit to their productivity,” she said.

As another example, the interim final rule requires physicians to perform medication reconciliation – the process of comparing a patient's prescription orders to all of the medications that the patient has been taking – of two or more medication lists 80 percent of the time. “Physicians rarely have access to more than one patient medication list to review,” said Tolle. Often times, the patient provides that list. And, he said, “their recollection may be incomplete or inaccurate. Because of that, true reconciliation is rare and it seems like an unrealistic goal until health IT systems across the nation are more integrated and interconnected, and have been widely in use for a period of time.” 

Despite the specificity of meaningful use requirements, it is important to remember that the underlying objective of the requirements is to create “meaningful change,” LaFontana explained. “The practical impact of meaningful use requirements is that they will lead to positive improvements to physician practice work patterns, and ultimately to patient care,” she said.

“Physicians already know that their time with patients is limited. EHRs will arm physicians with more complete and accurate information, so they and their patients get the most from their visit,” she continued.

Aligning meaningful use requirements with physician needs

Over the past year, Ingenix has worked with public policy makers drafting suggestions for meaningful use requirements, providing the company’s insights gained through extensive experience working with physicians to implement health IT systems. Foremost, Ingenix advocated rules that integrate helpful information into the physician’s workflow and encouraged investments in systems and infrastructure that support actionable content, connectivity and access. 

To ensure that federal incentives for EHR adoption achieve results, health IT systems must solve real problems for physicians, Ingenix CEO Andy Slavitt told a Health IT Policy Committee Hearing on Health Plans in December 2009. “The killer applications that emerge from the EHR infrastructure will gain mass adoption by attacking problems common to physicians and creating obvious benefits,” he noted. 

Ingenix’s CareTracker system is an example of just this type of innovation. CareTracker provides an integrated EHR and practice management system that simplifies administrative tasks such as billing and scheduling, and provides fast, convenient access to patient records, lab results and e-prescribing tools. CareTracker is a zero-footprint EHR that can be implemented in weeks for as little as $390 per month.

Meeting evolving standards

Policy makers have created a phased-in approach to implementing meaningful use rules, which means that requirements will evolve and increase over time. “Physicians need to consider whether the EHR they purchase today will be flexible enough to meet their future needs,” said Tolle.

He noted that software updates designed to meet changing needs are seamless to physicians using CareTracker. Because the system is Web-based, Ingenix can implement new features necessary to meet meaningful use requirements for all users simultaneously. “That flexibility and ease of use will serve Ingenix clients today and in the months and years to come,” he said.

Because CareTracker provides revenue and practice management modules in addition to the EHR, physicians can improve office efficiency in tandem with meeting meaningful use requirements. “When physicians spend less time trying to get claims paid, they will have more time to address workflow changes and improve clinical results,” said LaFontana. “Excellent care begins with great physicians who are supported by a well-run practice.”

The bottom line is that physicians face day-to-day concerns about their businesses, Tolle concluded, and “Ingenix brings a lot to the table to help them solve their business challenges and improve the care they provide.”

¹ “H.R. 1, the ‘American Recovery and Reinvestment Act of 2009’ explanation of Health Information Technology (HIT) Provisions,” American Medical Association. 
 
² “Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology,” Interim Final Rule, 75 Federal Register 2014 (Jan. 13, 2010). 

³  Slavitt, Andy; Statement to the HIT Policy Committee (Dec. 15, 2009).
⁴  Id.

Be sure to sign up for future issues of Ingenix Innovations, and visit the archive for recent issues.