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Are You Ready for EHR Reform?
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As we discussed last month, there are a variety of presentations and hearings at this year's upcoming Mid-Year Forum that address critical issues facing ophthalmology today. All sessions provide helpful information and advice for YOs and practicing ophthalmologists alike, but one in particular discusses a topic that is critical to your practice: the session on getting paid for using an electronic health record (EHR) system, chaired by Michael Chiang, MD.

What are EHRs?
EHRs have been around since 1960s in various forms, and in earnest since 1995. They allow physicians to store a patient’s records electronically and to share those records across multiple practices, as well as download and store in various formats. This not only saves on storage costs, but also provides an easy and convenient way to access patient records at, theoretically, the click of a mouse.

The downside of EHRs is that they are still not so easy to use and take time, specifically the user interface. Additionally, the technology itself is quite expensive. According to Flora Lum, MD, deputy director of the H. Dunbar Hoskins MD Center for Quality Eye Care and Academy’s policy director for quality of care, “If EHR were easier to implement and less expensive, more people would likely use it.”

So, to encourage the use of EHRs across the medical field, the federal government passed a law in 2009 authorizing the CMS to provide reimbursement incentives to physicians and hospitals that adopt EHRs. Those incentives will then turn into penalties in 2015 if you don’t adopt, with penalty fees starting at 1 percent, then growing to 2 percent, 3 percent, on up to 5 percent.

EHR Incentive Requirements
As Dr. Lum explains, it’s not just that physicians have to adopt EHRs, they also must meet a lot of requirements … and in this draft rule stage, those requirements are pretty stringent. “While we still won’t have a final law by the Mid-Year Forum, we will discuss the “proposed” draft law at the hearing. And within the law there are two key criteria of the law that ophthalmologists need to be concerned with: (1) the need to use certified technology, and (2) the need to demonstrate ‘meaningful use.’”

In terms of the technology, the average cost of an EHR system is $50,000 per physician, with an average monthly cost of $1,000 per physician. However, what meets certification and who certifies hasn’t been defined as of yet.

On the “meaningful use” side, there are 25 criteria to meet the definition of “meaningful.” One of the main concerns for ophthalmologists about these 25 measures is the fact that the focus of the federal government has been on primary care practitioners.

“This makes it more complicated for specialties,” Dr. Lum says, “because there are things that don’t apply, such as blood pressure and weight measurements. It can be hard to fulfill these requirements when specialties don’t do them in the normal course of practice. Moreover, 80 percent of all patients’ records need to meet the meaningful-use criteria.”

Who Should Implement EHR?
Implementing an EHR system is a major business decision and needs to be made on an individual practice level, weighing the benefits and costs. Dr. Lum believes that there are certain groups of ophthalmologists for whom it would make sense to adopt EHRs sooner rather than later. They include multi-doctor practices (especially those with multiple locations), and YOs. Others fall somewhere in between.

“For YOs, this is the future of the health care business,” says Dr. Lum. “ YOs grew up in the electronic age, so electronic health records will likely fit their work style and comfort level much better.”

Additionally, YOs starting a new practice will have an easier time implementing EHRs right from the start. “It can be cumbersome to transfer old records,” says Dr. Lum. “If you start from scratch with EHR, it’s much easier.”

For ophthalmologists with existing practices, this transferring of records may be a stumbling block as they grapple with how to incorporate old data into an EHR system. In the short term, it may need to be a blend of both paper records and EHRs.

Dr. Lum says there is a small group of physicians who may wish to opt out of implementing EHRs if the return on investment is not there — such as those with a small practice (one to two doctors) or if the physician is close to retirement (say, within five years).

Why Start Today?
A major impetus to implement EHRs in the next couple of years is financial. “If you demonstrate meaningful use in either 2011 or 2012, then you are eligible for the maximum amount of incentive payments over five years’ time,” says Dr. Lum. Physicians who begin using EHRs in 2011 or 2012 are eligible for up to $44,000 over five years.

The meaningful-use criteria will be phased in in three stages, which will get progressively harder to meet. In later years, these stages will become more compressed in order to fit within the payment window. Additionally, incentive payments will decline over the next few years; the maximum possible incentive drops to $24,000 if you start in 2014. Penalties kick in 2015 and increases from 1 percent to 5 percent of your total Medicare payments. In short, the later you adopt, the less money you get.

EHRs Make Sense for YOs
While making the switch is clearly an individual decision and may not meet everyone’s needs, YOs should seriously consider it, as benefits are pretty significant. And even though there are several unknowns (e.g., what denotes a compliant EHR system, as well as the evaluation, submission and payment of reimbursement processes), Dr. Lum suggests you start the process sooner rather than later for several reasons:

  • It takes time to research companies with EHR technology. You need to make sure they are compliant with the certification criteria, and while the certification process has not quite been finalized, companies are aware of the incentives and should offer to refund the cost of the technology if it fails to make certification.
  • It also takes time to set up your EHR implementation plan, team and training.
  • The earlier you start to implement criteria of meaningful use, the more flexible and responsive you can be when it comes time for evaluation.
In Summary
Clearly, the EHR hearing at this year’s Mid-Year Forum will provide a wealth of information for all who attend, including an opportunity to ask questions directly of a representative from the Office of the National Coordinator for Health Information Technology, the office that developed the proposed rules and is gathering comments on the rule.

If you haven’t yet secured your place, there is still time to register. And if you cannot attend, never fear. You can visit the American Academy of Ophthalmic Executives’ EHR Central to read more about EHR eligibility and incentive payments.

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About the author: Kimberly Day is a freelance health writer and medical editor and a frequent contributor to YO Info. She is the co-author of Hormone Revolution and ghost writer of Eat Papayas Naked.

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