Half of the physician group practices recently surveyed expected to buy an EHR system within the next 2 years. In the rush to purchase, however, it is imperative that physicians take the time to carefully assess how each of the EHRs they are considering will impact their productivity. Productivity has always been a major concern in EHR adoption, but demographics and financial factors now conspire to make it increasingly critical. Physicians can no longer afford even the slightest decrease in productivity. Consider the following projections that affect specialists:
The demand for joint replacement surgery will soon outstrip the supply of orthopaedic surgeons available to provide it, according to studies presented to AAOS. This is partly the result of an aging population with increasing rates of obesity and arthritis, but the growing demand will also come from a younger population. A full 50% of joint replacements will be sought by people under 65—the physically active baby boomer generation with a high level of physical activity. Not only will first-time joint replacements increase astronomically (rising 673% to 3.48 million knee replacements, and 174% to 572,000 hip replacements by 2030), but the demand for revision joint replacements, (i.e., repair or replacement of artificial joints) will also increase—doubling by 2015.
The situation is similar for ophthalmologists. Higher life expectancy will create a demand for 30 million cataract surgeries by 2020. Combined with the downward pressure on Medicare reimbursement rates that will lead some ophthalmologists to limit their practices to medical ophthalmology, the result will be a greater caseload for the remaining surgeons—but these physicians will need a high-volume, highly productive practice to remain financially viable.
Dermatologists will see a two- to three-fold increase in skin cancer patients as the population ages, and the demands for their medical services will grow rapidly. Not only will dermatologists be called upon to perform more surgical procedures in their offices, but increased awareness will lead to a higher demand for screening and preventive-care services.
Physician productivity will be critical in the office as well as the operating room, since the number of surgeries performed is directly proportional to the number of office visits conducted. A physician-focused, specialist-oriented, efficient EHR will be key to a physician’s ability to meet the increased demands, satisfy patient needs, and run a financially successful practice. Given the above statistics, it would be fiscally and socially irresponsible to implement an EHR that negatively impacts physician productivity. Now, more than ever, productivity is king.
The response to last week’s Meaningful Use IQ Test revealed a tremendous thirst for information and a fair amount of confusion about the facts and realities of meaningful use. Neither was terribly surprising, given the recent hype surrounding the program’s launch and the complexity of the regulations.
Since the quiz was posted last week, 534 people have taken the test. The average score was 56% (see chart below and the breakdown of responses at the bottom of the page). These results mean that physicians will need a great deal of assistance from consultants, Regional Extension Centers, and vendors to succeed in their pursuit of the EHR incentives. If that aid is not forthcoming, there could be a large number of very disappointed providers when the incentives are distributed.
The following are some observations:
Only a small minority of our test-takers (9%) appear to truly understand the regulations and the requirements in their entirety. (Inga, from HIStalkPractice.com is one of the few who just might—based on her perfect score!)
Many people find the intricacies of the regulations baffling—as indicated by more than half of the respondents (300 of 534) knowing half or less of the information.
The fact that over one-third of the respondents did not know that providers cannot collect Medicare EHR incentives and Medicare ePrescribing incentives in the same year—no “double dipping” allowed—means that they have likely not analyzed their options to maximize the total revenue from the two incentive programs.
I thought it was interesting that nearly half of the respondents thought that the program requires reporting on only Medicare and Medicaid patients, when, in reality, the government is requiring providers to submit data on all patients.
Clearly, the message has come through that the program has been made more specialist-friendly, as physicians will be able to exclude measures that are not relevant to their practices. However, many do not understand how these exclusions factor into the demonstration of meaningful use.
The Meaningful Use IQ Test is still active, so if you haven’t accepted the challenge yet, you can still do so. I’m glad that it is raising awareness and providing valuable education. That was precisely its purpose!
The number of different government programs, and the length of the rules that describe how to take advantage of each of them, can be overwhelming. But one thing is eminently clear: the importance of ePrescribing in 2011. There are three compelling reasons to ePrescribe in the coming year:
Physicians can earn a 1% bonus on their 2011 Medicare revenue. Aside from the patient-care and physician-efficiency benefits that ePrescribing offers, ePrescribing on at least 25 unique Medicare encounters in 2011 will qualify a physician for an additional 1% of that year’s Medicare Part B Fee-for-Service revenue under MIPPA (Medicare Improvements for Patients and Providers Act). That money would be received in the fall of the following year.
2011 ePrescribing activity protects physicians from the Medicare ePrescribing penalties in 2012 and 2013. Odd as it sounds, while bonuses for 2012 and 2013 will be based on successful ePrescribing in each of those years, penalties for those years will be assessed based on 2011 activity. To avoid penalties in 2012, (1% of Medicare revenue), physicians must report ePrescribing on 10 unique Medicare encounters between January and June, 2011. To avoid penalties in 2013 (1.5% of Medicare revenue), physicians must report at least 25 times during the full 2011 year.
ePrescribing is a great way to begin the transition to an EHR, particularly if a physician intends to participate in the EHR incentives program (ARRA). ePrescribing is an integral part of the Meaningful Use requirements and—with the right software—a great way to begin the transition to a digital office.
Based on the above, I offer a few strategies for consideration. The rules, and the interplay between them, have created a number of consequences, that intended or not, can be used by physicians to their financial advantage:
It is important to start ePrescribing early in 2011. Ironically, even if a physician meets the 25-prescription minimum and earns the 2011 incentive, he or she would still be subject to a penalty in 2012 if that ePrescribing activity—no matter how extensive—occurs only in the second half of the year. So at a minimum, ePrescribe 10 times in the first half of the year and 15 times in the second half.
Since the rules (MIPPA and ARRA) do not allow collecting under both programs during the same year, physicians can maximize the combined revenue by earning the ePrescribing bonus in 2011, and waiting to begin participation in Meaningful Use until 2012. Beginning in 2012 still allows a physician to qualify for the full 5 years of EHR incentives ($44,000 as a Medicare provider).
Another irony is that, although ePrescribing is integral to ARRA, it is possible to satisfy the measures for one program and not satisfy the requirements of the other in any particular year. The requirements differ, and the onus is on the physicians to meet each set of rules to qualify for the respective incentives.
As confusing as the above appears, it is actually even more so, because there are also some exceptions. Not surprisingly, there are organizations (MGMA and AMA, for example) actively petitioning the government to reconsider the basis for 2012 and 2013 ePrescribing penalties and asking for harmonization of the MIPAA and ARRA regulations. For further information on the implications for your practice, I invite you to take advantage of the educational resources available through SRSsoft by calling our Government Affairs Department: 201-802-1300 X 1229.
In an unusual display of bipartisanship, Congress made it clear that they have no intentions of cutting physician reimbursement—even in a time when the country is facing severe economic challenges. By unanimous consent, the Senate passed the Medicare and Medicaid Extenders Act of 2010, extending Medicare rates through the end of 2011 and preventing the threatened 25% cut that was to go into effect on January 1. The following day, the House of Representatives passed the payment fix by an overwhelming (nearly unanimous) vote of 409 to 2, and President Obama’s signature is expected imminently.
Physicians should feel reassured that the uncertainty and concern that the SGR formula creates each year—and no doubt will until the calculation is redefined—should be tempered. This year’s resolution, albeit not an increase, can be taken as an indication that the annually feared drastic reductions are not likely. Physicians can now plan accordingly and make business decisions and capital investments that enable practice growth.
I’ve written before about the economic challenges facing physicians—in particular, the problem of stagnant or declining reimbursement rates. With no permanent fix to the SGR formula in sight, physicians are concerned about overhead, productivity, and patient mix. To maximize the value of their time and to increase—or at least maintain—their income if reimbursement rates fall to an unacceptable level, some physicians are considering dropping out of Medicare or limiting the number of Medicare patients they see.
As another means of increasing their income, many physicians are now also re-evaluating their participation in the EHR incentives program. Specialists, many of whom who had previously dismissed participation because they thought it would require adding primary-care workflows to their practice, are now giving the program a second look—in light of Dr. Blumenthal’s encouraging comments about the applicability and excludability of meaningful use requirements for specialists. (See “Just What the Doctor Ordered.”)
However, demonstrating meaningful use will still demand additional work, and certified—or to-be-certified—EMRs are not alike in how they facilitate doing this. It is critical for physicians to understand and evaluate the differences among EMRs in terms of how they deliver meaningful use capability and the impact on the time it takes to meet the requirements with each. Here are a few suggestions of what to look for in assessing the value of different solutions:
How easy is it to enter the required data? (This is particularly important as requirements become more demanding in future stages of the program.)
What changes will you have to make to the way you see patients?
How will you document the care you provide?
Does the system effectively allow delegation of tasks to staff members to minimize the time physicians must spend doing data entry?
Does the vendor’s software platform enable keeping up with evolving requirements?
The most valuable resource a physician has is his/her time. The software physicians select will have a significant impact on how they use that time.
A frequent concern I hear in my conversations with physicians is that they are challenged by increasingly harsh economic pressures. Healthcare reform, lower—or at best stagnant—reimbursement rates from government and private payers, and the higher proportion of lower-paying Medicare patients are reducing or capping practice revenue. At the same time, overhead costs are escalating unrelentingly, since employees still expect raises and other operating costs continue to rise. While the common perception is that physicians are not businessmen/women, they are in fact running small businesses; and now, more than ever, they need to focus on ways to maintain business viability in light of lower margins.
The above graph illustrates the economic challenges. Click on it to enter your own practice data and assumptions concerning anticipated growth or decline in reimbursement and expenses, and observe the effect on physician income—the green line. Given that physicians have no control over reimbursement rates, the only way to positively impact that green line is by effecting fundamental changes to practice operations—and the right EMR is critical to this end.
First, it is imperative to significantly reduce overhead—the orange line. Government programs that may, or may not, deliver short-term financial incentives do not address cost structure. What is needed is an EMR that delivers sustainable and significant reductions in the staff-to-physician ratio and more efficient management of all resources—depressing the orange line. Increasing revenue—the blue line—requires increases in physician productivity and patient volume. The challenge here is to wade through EMR marketing hype to identify the EMR that will actually shift the orange line down and the blue and green lines up.
A reader raised an interesting question on the EMR and HIPAA blog this week. She asked if practices without a Medicare or Medicaid patient base are simply “out of luck” with regard to the government’s EHR incentive program. John Lynn responded:
“…not qualifying for the EMR stimulus money might just be the best thing that’s happened to your practice. That means you won’t be distracted and you don’t need to wait. You can hone in on the other EMR benefits and start reaping those benefits without all the bureaucracy.”
In other words, she can feel free from government pressure to make any particular type of EMR decision. This is exactly the same advice I give to all physicians, regardless of their eligibility for the government’s program—the voluntary nature of the EHR incentives gives you absolute freedom to make the decision that is in the best interests of your practice. Sandra Brown, M.D., reflected that feeling—shared by many physicians—in her response to a past EMR Straight Talk post, when she said that she felt “liberated” by the fact that the government couldn’t force physicians to take the money.
Physicians should use this freedom to evaluate EMRs based on ease of use, speed, flexibility, and any other criteria that they—rather than the government—feel will facilitate delivery of the anticipated benefits, such as:
A practice-wide, 100% successful adoption rate
Increased physician productivity
More efficient use of staff time
Revenue growth with decreased overhead
Enhanced patient care and service
Back-office efficiencies—improved revenue cycle
Decreased malpractice exposure
These benefits are guaranteed to far exceed an elusive $44,000 incentive, and physicians can begin realizing a significant ROI immediately—if they chose the right EMR.