There’s a lot of talk in the healthcare industry right now about bringing health management tools to the consumer. Whether it’s apps for your iPhone or iPad, games to play on your Wii, or free-standing health-and-wellness kiosks at your local pharmacy, digital applications seem to the delivery method of choice right now. I think those of us in the healthcare IT industry sometimes take for granted that not everybody in the US has a smartphone, computer or even Internet access, which to me always begs the question: How great are these bright and shiny health apps if the populations that need them most don’t have access to them? And aren’t Meaningful Use and Accountable Care incentives/payments targeted towards government-sponsored healthcare recipients? The most likely patient population to NOT have reliable access to the Internet?

It’s this concept of a digital divide in healthcare that I am starting to believe will truly bend the curve when it comes to absolute interoperability – the secure sharing of information between patient, provider, payer, vendor, government, etc., anytime, anywhere. Only those patients who have access to these digital healthcare technologies will begin to clamor for them at their next doctors’ visits. Only patients’ whose doctors in turn have reached out to them via email, text or social media regarding the switch to electronic medical records, development of health information exchange and the benefits to care these will hopefully bring will be ready and willing to go with the digital flow.

I was intrigued by a recent news story on NPR the other morning that detailed a recently unveiled government plan – the Connect to Compete Initiative – to offer cheaper broadband access and computers to low-income families. The story pointed out that “about one-third of Americans – that would be 100 million people, give or take – do not have Internet access in their homes.” (I’d be interested to know how many of that population are on Medicare or Medicaid, or have no insurance at all.) Participating companies will offer broadband service to eligible families for $10 a month, while others will offer computers for as little as $150.

Further investigating into the story dug up a more detailed report from Reuters, which explained that eligible families will be those who have at least one child enrolled in the National School Lunch Program. According to a recent Commerce Department report on U.S. broadband adoption, only 43 percent of households with annual incomes below $25,000 had broadband access at home, while 93 percent of households with incomes exceeding $100,000 had broadband.

I think this is a step in the right direction, and am pleasantly surprised that it’s being enacted by the government – who got this digital healthcare ball rolling downhill fast in the first place.

As more and more low-income/average/middle-class Americans – or whatever we want to call ourselves – begin to speak out about the systemic inequalities we experience in this country’s financial, healthcare and educational systems, it’s nice to think (naively perhaps) that somebody just might be listening. As we see an increase in adoption of digital technologies in the consumer space, so too do I think we’ll see a correlating increase in adoption of healthcare IT by the providers that care for them.

The CMS FAQ site has a great question up that I have a feeling a number of doctors will be interested in knowing the answer to:
I am an eligible professional (EP) who has successfully attested for the Medicare Electronic Health Record (EHR) Incentive Program, so why haven’t I received my incentive payment yet?

Here’s their answer:

For EPs, incentive payments for the Medicare EHR Incentive Program will be made approximately four to eight weeks after an EP successfully attests that they have demonstrated meaningful use of certified EHR technology. However, EPs will not receive incentive payments within that timeframe if they have not yet met the threshold for allowed charges for covered professional services furnished by the EP during the year.

The Medicare EHR incentive payments to EPs are based on 75% of the estimated allowed charges for covered professional services furnished by the EP during the entire payment year. Therefore, to receive the maximum incentive payment of $18,000 for the first year of participation in 2011 or 2012, the EP must accumulate $24,000 in allowed charges. If the EP has not met the $24,000 threshold in allowed charges at the time of attestation, CMS will hold the incentive payment until l the EP meets the $24,000 threshold in order to maximize the amount of the EHR incentive payment the EP receives. If the EP still has not met the $24,000 threshold in allowed charges by the end of calendar year, CMS expects to issue an incentive payment for the EP in March 2012 (allowing 60 days after the end of the 2011 calendar year for all pending claims to be processed).

Payments to Medicare EPs will be made to the taxpayer identification number (TIN) selected at the time of registration, through the same channels their claims payments are made. The form of payment (electronic funds transfer or check) will be the same as claims payments.

Bonus payments for EPs who practice predominantly in a geographic Health Professional Shortage Area (HPSA) will be made as separate lump-sum payments no later than 120 days after the end of the calendar year for which the EP was eligible for the bonus payment.

For more information about the Medicare and Medicaid EHR Incentive Program, please visit http://www.cms.gov/EHRIncentivePrograms.

This is actually something that I’ve written about before (probably on EMR and HIPAA), but I have a feeling many people weren’t looking at the details to realize why they aren’t getting their incentive money. You have to wait until you have enough Medicare Allowable Charges before they’ll pay you. I think this is a smart plan I do find it interesting that there were some clinics that had enough allowable charges in 3 months to receive the full EHR incentive money right away. I’d love to see some stats on medicare allowable charges per provider. Would be interesting to see how this aspect of the EHR incentive program affects Medicare providers.

Either way, hopefully this information will help someone who is wondering where they EHR incentive money is. Thanks to @jimtate for tweeting the FAQ and reminding me of this part of the program.

This is the first in a series of EMR, EHR and Healthcare IT interviews that will be done on EMR and HIPAA and EMR and EHR. The full EMR interview with Dr. West can be found on the new EMR, EHR and Healthcare IT interviews website. The following is a summary of that interview written by Kathy Bongiovi.

If you’re a doctor, nurse, practice manager, EHR consultant, CEO or executive of an EHR vendor, etc with EMR experience that’s interested in being interviewed, let us know on our Contact Us page.

In a recent interview with Dr. West, an endocrinologist in Washington D.C. and blogger at Happy EMR Doctor, the doctor discussed his experience in finding an EMR capable of fulfilling the needs of his specialized practice and, at the same time, saving him time. Dr. West discussed the arduous process of going from a failed to a successful EMR system.

His first experience with EMR was frustrating and he ultimately ended his relationship with the vendor. West heard other horror stories regarding failed EMRs and was convinced if he kept trying he would find an EMR that would fit his needs.

Dr. West advises other doctors and healthcare professionals to avoid rushing into any relationship with an EMR vendor and to make sure that when they sign a contract, first make sure the contract has a “satisfaction and money-back guarantee”. He suggests that anyone searching for an EMR, should find a vendor willing to let them try out their product for at least a month with no strings attached. Dr. West adds that the doctor or healthcare professional should also make sure there are not a lot of very specific hardware requirements in case the provider needs to change vendors.

Although some studies suggest a decrease in productivity with EMR systems because of a lack of customization for given specialties, West is not suffering from any of those issues and gives the credit to his EMR, Practice Fusion which is free and web based. The doctor has been able to customize templates to fit his specialty in endocrinology and is therefore able to see patients faster and complete their notes by the close of business. The benefits of customized templates, in his practice, allow “a more uniform approach to common problems, such as diabetes and thyroid nodules.” He goes on to explain that the result is a “well-defined path of questions designed to gather the most meaningful and relevant information” from the patient.

An EHR thorn in Dr. West’s side is his decision to not participate in the government’s EHR incentive plan. He thought he’d pursue the path to meaningful use, but after a great deal of frustration he abandoned his pursuit of the government’s EHR incentive money. West stated he may blog about his inner struggle with this issue. If so, his comments will appear in his blog Happy EMR Doctor.

The interview also touched upon Medicare’s recent practice of eliminating consultation codes and the consequences of this practice. By eliminating codes, Medicare has restricted providers’ ability to bill in certain instances. This has led to Dr. West and others turning away Medicare patients thereby restricting some patients’ access to care.

Dr. West’s EMR success should give all doctors and healthcare professionals the incentive to conquer the EMR puzzle and regain some of their personal time now spent handling and maintaining paper charts.

Full Disclosure: Practice Fusion is an advertiser on this site. However, they didn’t know we were doing this interview with Dr. West. Also, Happy EMR Doctor, Dr. West’s blog, is part of the Healthcare Scene blog network.

Ok, so this was the first video that I made in the EMR video series (see the other video I posted on EMR data sharing). So, I stumble around a little bit on the video, but I think I provide some interesting answers to the question. Although, I’ll admit that it’s a really hard question to answer.

Here’s the question I try to answer in this video:
How will Healthcare IT and EMR save on Medicare costs?

Let me know if you like these videos. Also, let me know what I might have missed in this video.

I often get questions from readers of my sites and I often don’t know the answer. So, instead of acting like I know the answer, I like to put it out to my readers to see what they have to say about the topic. This is one of those cases. Here’s the question I got about Nephrologists and Dialysis Centers and EMR stimulus money.

I am interested in finding out how dialysis centers qualify for the EHR incentive money and best practices for Nephrologists, NPs, and/or PAs running dialysis centers for attestation.

This is an area I’m not that familiar with. So, if you know more than I (which many of you do), let us know your thoughts in the comments. I’ll update the post if needed too.

My only general thought is that it wouldn’t seem like I’ve seen an exception that would exclude nephrologists so I assume they could be considered an “eligible provider.” I also imagine that they probably have a large number of Medicare patients so that they can easily meet the Medicare reimbursement requirements and they might even meet the Medicaid requirements.

I guess the real question might be whether nephrologists and dialysis centers use a “certified EHR” or not. If not, then they’re likely up a creek. If they do, then my next question is whether or not it’s worth their time to ask their patients if their smokers (amongst other meaningful use requirements) every time they come for a visit.

Talk amongst yourselves in the comments.

I always love creativity and so I have to give credit to the marketing people at meridianEMR. They’re providing an interesting price reduction in their EMR that keys off of many physicians anger over the potential 21.9% Medicare reimbursement cuts. Here’s a few portions from the meridianEMR offer:

In order to provide physicians with relief from Medicare fix uncertainty, meridianEMR is offering a special “meridianEMR Doc Fix.” This includes a 21.9% reduction on all new meridianEMR system orders for new Urology customers starting November 10, 2010 and ending December 31, 2010. This unprecedented offer during these uncertain times directly reflects one of the core values of meridianEMR, which is partnership with clients.

“If the government does not rescind the “Doc Fix” of 21.9%, our offer still stands. We encourage our potential new clients to move forward with confidence that they will be receiving the market leading Urology EHR at the most affordable price ever offered by meridianEMR. This is our way of standing by their side in a challenging economic environment,” commented Lawrence Drappi, Executive Vice President, meridianEMR.

I’m sure that many doctors will appreciate the gesture. Pretty creative to key off of cuts that have been seen as such a negative thing. I wonder if other EMR vendors will follow their lead. Many of the EHR software out there could use at least a 21.9% cost reduction.

In MedCity News, John Halamka makes an effort to summarize as simply as possible the Quality Measures:

I’ve been asked to summarize the Quality Measures as simply as possible

a. The Core Measures for All Eligible Professionals, Medicare and Medicaid are in the Final Rule Table 7, page 287. The Measures are

• Hypertension: Blood Pressure Measurement
• Tobacco Use Assessment and Tobacco Cessation Intervention
• Adult Weight Screening and Follow-up

b. If the denominator for one or more of the Core Measures is zero, EPs will be required to report results for up to three Alternate Core Measures. The Alternate Core Measures for Eligible Professionals are in the Final Rule Table 7, page 287. The Measures are

• Weight Assessment and Counseling for Children and Adolescents
• Preventive Care and Screening: Influenza Immunization for Patients ? 50 Years Old
• Childhood Immunization Status

c. The Clinical Quality Measures for Submission by Medicare or Medicaid EPs for the 2011 and 2012 Payment Year (EPs must choose 3) are in the Final Rule Table 6, page 272 . Here’s a summary of the 44 quality measures that CMS posted last week.

d. The Clinical Quality Measures for Submission by Eligible Hospitals and Critical Access Hospitals for Payment Year 2011-2012 are in the Final Rule Table 10, page 303. The Measures are

• Emergency Department Throughput ’ admitted patients Median time from ED arrival to ED departure for admitted patients
• Emergency Department Throughput ’ admitted patients Admission decision time to ED departure time for admitted patients
• Ischemic stroke ’ Discharge on anti-thrombotics
• Ischemic stroke ’ Anticoagulation for A-fib/flutter
• Ischemic stroke ’ Thrombolytic therapy for patients arriving within 2 hours of symptom onset
• Ischemic or hemorrhagic stroke ’ Antithrombotic therapy by day 2
• Ischemic stroke ’ Discharge on statins
• Ischemic or hemorrhagic stroke ’ Stroke education
• Ischemic or hemorrhagic stroke ’ Rehabilitation assessment
• VTE prophylaxis within 24 hours of arrival
• Intensive Care Unit VTE prophylaxis
• Anticoagulation overlap therapy
• Platelet monitoring on unfractionated heparin
• VTE discharge instructions
• Incidence of potentially preventable VTE

Everything clear now?

The idea that there will be penalties is a joke. The ongoing (10 years and counting) SGR debacle has thoroughly disgusted physicians who have already begun to reduce or completely eliminate Medicare patients from their practice. If Medicare starts to nickel and dime those still willing to take Medicare patients – for not using e-prescribing, not participating in PQRI (which is cash-negative for those who participate) or not implementing EMR, they’re even dumber than they’ve already demonstrated.

Pile on 5010 implementation, ICD-10 CM implementation, another ongoing PECOS fiasco, the interminable MAC transitions, RACs, PERMs, Z-PICs, HEAT, etc. and Medicare (or Congress) thinks a penalty will motivate physicians to buy new software – or that the doctors will tolerate a payment reduction when their 2010 payments are LESS than their 2000 payments?

I can’t remember where I found this quote. Probably on a LinkedIn forum or something. This voice is actually getting louder. Notice that it doesn’t really talk about whether they want to use EMR software or not. It’s really the start of what could be a huge exodus from Medicare as opposed to a revolution against EMR software. Plus, it highlights the fact that doctors (and people in general) don’t want to be forced to do something. Yes, even something that could be a benefit to them. Of course, that’s why I’ll keep telling doctors to not worry about the stimulus and the penalties and focus instead on the list of EMR benefits.

One of my readers pointed me to an article talking about the potential Medicare penalties that will be enforced starting in 2012 to physicians who don’t use e-Prescribing. Here’s the relevant info:

As previously reported, the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorizes incentive payments for eligible professionals who are successful e-prescribers. Under the MIPPA, the incentive payments are set at 2 percent for 2009 and 2010, 1 percent for 2011 and 2012, and 0.5 percent for 2013.

However, the MIPPA provides for a penalty to arise in 2012 for not successfully satisfying e-prescribing requirements. The penalty will be a percentage reduction in Medicare physician fee schedule payments equal to 1 percent for 2012, 1.5 percent for 2013, and 2 percent for 2014 and subsequent years.

It’s interesting to see these penalties. They’re almost as large as the penalties for not showing meaningful use of a certified EHR. Yet, I see so little discussion about these penalties. Is there a reason doctors aren’t worried as much about this as the EMR Stimulus Medicare penalties?

Also, it’s no wonder that many doctors are wondering whether they should continue to accept Medicare or not. First, the 21% Medicare cuts that have been floating out there. Second, the EMR stimulus medicare cuts. Now, the cuts for those that aren’t ePrescribing. Of course, all of these cuts are to the “insurance” that has in general the smallest reimbursement already. Are the insurance companies next to implement these cuts?