Physicians seeking incentive money under the carrots-and-sticks Health Information Technology for Economic and Clinical Health (HITECH) Act might need to prepare for some hoop-jumping. They’ll also need to make behavioral changes in their patient care regimen, say practice management experts.

 

“The advent of electronic records marks the introduction of a new technology into the practice of medicine, which has been going on for eons,” said Steven Burkett, CEO of UT Medical Group in Memphis. “Changing the process and work flow of physicians gets into the personal characteristics of how a physician wishes to care for patients. The electronic format requires standardization in a way that paper doesn’t.”

 

The American Recovery and Reinvestment Act of 2009 established HITECH Act programs under Medicare and Medicaid to provide incentive payments for the “meaningful use” of certified Electronic Health Records (EHR) and Electronic Medical Records (EMR) technology.

 

“Providers that meet the meaningful use requirements will be eligible to receive up to $44,000 to $63,750 in incentive payments; non-adopters will be subject to Medicare reimbursement penalties, beginning in 2015,” explained Adele Allison, national director of government affairs at EHS Inc., a Birmingham, Ala.-based company specializing in EHR and practice management software systems. “The goals of HITECH are to push provider EHR adoption of certified EHR technology and to have those providers capture structured clinical data, move that data interoperability, and report data to CMS and states.”

 

A common misunderstanding within the physician community, Allison said, is that incentive dollars are not for purchasing EHR technology, but for the meaningful use of such technology.

 

“Meaningful use will ultimately drive the types of products physicians will implement and the standards required for health information exchange,” she said.   

 

Defining “meaningful use” is a problem, noted Harold Ingram, president-elect of MGMA (Medical Group Management Association) of Mississippi, and CEO of PerforMax Inc., a medical practice management firm based in Jackson, Miss.

 

“MGMA at the national level has responded during the comment period indicating that the requirements are too aggressive and that a more gradual approach should be pursued. The definition of meaningful use can be modified after the comment period. However, with the pressure on Congress to rein in spending, I’m not encouraged that the requirements will change substantially.”

 

Ingram also pointed out the reduction in payments by 1 percent for providers who don’t use an electronic record system by 2015.

 

“The law requires the agency to continue incrementally reducing payments to a maximum of 5 percent in 2019 for those providers failing to use an EHR,” he said. 

 

Electronic record companies are gearing up to try to meet these guidelines; most will probably engage third-parties to help them accomplish the task, which will probably increase the cost to practices because of third-party fees, Ingram said. 

 

“A significant problem for a practice is that the implementation of an EHR requires time,” he added. “To receive payment in 2011, the practice has to demonstrate meaningful use by no later than July 1, 2011. If a practice is interested in trying to qualify for the 2011 incentive payment, it needs to begin implementing the EHR now.”

 

Richard Ly, director of Madison Park Solutions, a healthcare technology consulting firm based in Orlando, Fla., said smaller offices will likely choose to move forward in a piecemeal method. 

 

 

Allison cautioned: “Remember, higher quality is often less costly and quality improvement is critical. Make sure your technology partner is certified and can help you through the transition because the devil is most certainly in the details.”

 

The key to making electronic records commonplace rests in behavioral change, noted Burkett.

 

“People who develop the electronic records and technology supporting the delivery of care must understand how their products impact the workflow of physicians and other clinicians,” he said. “Medical professionals will come to understand what they have to do differently to use the technology and how the process helps them take better care of their patient, gives them greater value, and provides greater patient satisfaction. You’re going to see a lot of activity around electronic records over the next several years, and it’ll likely look a lot like going on a diet and increasing your exercise to lose weight. Not many people will like it initially.”  

 

Even though implementation of electronic records will be challenging, the benefits will trump obstacles, said Burkett.

 

“It’ll take time and a generation of physicians utilizing the EHR to realize the benefits of the electronic record and not just consider it an electronic repository,” he said. “It’s a tool that’ll help us as patients while also creating opportunities to improve health status with populations.”