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The Growing EMR Tea Party

Posted on November 8, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I wrote a post a few months ago asking if meaningful use will put medicare in a bad position. In that post, Dr. Borges makes an argument for why meaningful use is going to have a negative impact on Medicare. In the comments, David Swink offered this additional comment about what he calls the EMR Tea Party:

I agree with Dr. Borges. He, and many other physicians of like mind, compose the EMR Tea Party — those who do not object to the modernization of record-keeping, but do object to the top-down “carrot-becomes-the-stick” approach to EMR that is being foisted on them. He is a medical John Galt (of Atlas Shrugged), who is more likely to retire or otherwise deny his talents as a “Giver” to society than to succumb to the diktats of the “Takers”.

The idea of a physician EMR Tea Party is quite interesting. I have seen a number of doctors like Dr. Borges that are leaving Medicare to avoid the meaningful use requirements. I’ve also seen that pretty much every doctor I’ve ever talked to would love to stop taking Medicare. However, I’ve also seen that a large majority of doctors don’t have that option because so much of their patient population is on Medicare. Plus, some percentage of those doctors don’t want to leave Medicare patients high and dry.

With this in mind, I’m not quite seeing the leave Medicare Tea Party getting that much momentum. However, I am seeing an EMR Tea Party that is swelling among doctors that want their EMR software to improve productivity, improve patient care, and allow them to be doctors instead of data entry clerks. This growing movement is much more powerful.

Meaningful use has a major impact (mostly negatively) on these desired EMR results. You might remember my post on the EHR Certification excuse as an example. I think this is also a reason why we have yet to see any private payers requiring EHR certification or meaningful use. They don’t want to anger doctors by requiring them to do many things which are unnatural to their current workflow and provide little value to the payer.

The real question is how big will this EMR Tea Party get over time. Not to mention, as more hospitals acquire ambulatory practices, will doctors have the influence they need to affect these changes?

EHR Incentive Increases Medicare Costs

Posted on September 25, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

There is a major trend happening in healthcare that was covered pretty well in The New York Times. That’s right. EHR doesn’t often get much play in the major journals, but this is a really big deal. Plus, I’ve had doctors write into me about the subject as well.

The key finding that The New York Times article discusses is that Medicare costs have gone up substantially for those using an EHR. This is happening because doctors are upcoding more than they’d done previously. It’s a bit ironic to me that this is going to be a major problem for Medicare since 6 years ago when I first started writing about EHR software one of the major reasons to implement an EHR was to increase your revenue by upcoding.

I’ll never forget the first time I saw the challenge of coding first hand. I was at AAFP sitting at a table of physicians who were there to discuss EHR. This older lady and a gentleman shared with the group that they were chronic under coders. It felt a bit like an AA meeting where these doctors were finally coming clean on their habits. The rest of the doctors in the group just nodded their head since they knew that under coding was a major issue in healthcare.

What Medicare or the administration didn’t seem to realize is that the cost of Medicare is based on this under coding. Doctors have been under coding for so long that it just became part of the cost structure. Little did those in Congress think that by spending $36 billion on EHR (or whatever number you prefer) they’d actually cost Medicare billions of extra dollars. I bet the CBO didn’t plan for that in their budget projections.

This new trend in upcoding begs the question on whether doctors are doing this legitimately or if this is a form of fraud and abuse that’s being made possible by EHR. In a completely unscientific way, I suggest that probably 95% of the upcoding that’s happening is legitimate. Plus, a large portion of the 5% upcoding fraud and abuse would have been happening regardless of EHR. Why do I believe that so little of the upcoding is legitimate?

It goes back to that experience at AAFP where I heard doctors talk about their under coding habits. There was an underlying tension in their statements that they would love to bill more, but they had a number of underlying fears that made them choose not to code higher. First was fear of audit. The last thing any doctor wants is an audit and if under coding will avoid the dreaded audit, then it is the price to pay for that comfort. Second, I’ve heard doctor after doctor talk about times a patient examination should have been at a higher coding level, but their documentation didn’t match that higher level code. The doctors chose to under code the visit as opposed to documenting the normal findings in the visit which would allow them to code at a higher level.

EMR doesn’t do much for the first fear described above. However, EMR often makes it possible for a doctor to code a normal finding in the EMR that they wouldn’t have taken the time to code in a paper chart. I expect that this accounts for a good portion of the upcoding we’re seeing. Combine that with easy chart reviews and EMR coding engines and you see Medicare costs increasing by billions of dollars thanks to EHR. Oh the unintended consequences of government intervention.

States Lagging Behind in Medicaid Meaningful Use Payments

Posted on March 30, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

If I were part of CMS, I’d be pretty annoyed right now: Apparently, state Medicaid programs are beginning to be a wet blanket in the race to get providers up to Meaningful Use standards.  According to InformationWeek, a dozen states aren’t yet paying out Medicaid incentives, and some of those haven’t even launched incentive programs yet.  Not good news, to say the least.

According to a new post on CMS’s official blog, CMS has handed out Medicare and Medicaid incentives to more than 59,000 eligible professionals and 2,000 hospitals. It also noted that the Medicaid program alone had made more than $1.8 billion in MU incentive payments between January 2011 and the end of last month.

That’s not a bad start, but the slow pace of some Medicaid MU programs is a drag on meeting CMS’s overall goal, which is to have 100,000 providers get MU payments this year.

True, some states are clearly doing their level best: Ohio, which wants to reach 40 percent of eligible providers, Washington, whose goal is 7,000 EPs and hospitals, California, which is trying to get 10,000 providers set up for Medicaid incentives by June; and New York, which hopes to get 6,000 providers get incentive payments in 2012. And 43 states in total have launched a Medicaid incentive program and begun registering applicants, the article reports.

But then there’s the naughty states, which include Hawaii, Idaho, Minnesota, Nebraska, Nevada, New Hampshire, and Virginia — which haven’t launched their Medicaid incentive programs at all. As of December, however, CMS expects (demands?) that all states be making Medicaid incentive payments by June, according to a CMS official quoted in the story.

In the grand scheme of things, I’m pretty confident that Medicare, not Medicaid incentives, are going to drive the train here.  That being said, it is worth asking whether the states’ lagging efforts will create serious problems for the MU program. As I see it, it could go either way, but regardless, it’s not a good sign.

Will a Decrease in the Digital Divide Lead to an Uptick in EMR Adoption?

Posted on November 10, 2011 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

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.

Haven’t Been Paid your EHR Incentive Money Yet? One Possible Reason Why

Posted on June 28, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

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.

Learning from One Doctor’s Experience with EMR – EMR and EHR Interviews

Posted on June 7, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

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.

How will Healthcare IT and EMR save on Medicare costs? – EMR Video Series

Posted on May 28, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

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.

Nephrologists (Dialysis Centers) and EMR Stimulus Money

Posted on January 17, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

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.

Creative EMR Price Reduction

Posted on November 12, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

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.

Meaningful Use Rule Clarification by John Halamka

Posted on July 28, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

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?