Published with the approval of MedAxiom from its "2013 Perspectives: A Year in Review" report.
“Certainly, the population of physicians eligible for meaningful use incentive payments fell way below where we expected it to be going into 2013,” said Mike Mytych, president at Health Information Consulting, LLC. “At the end of , we had literally less than 20 percent of eligible physicians across the U.S. who had received incentive payments, according to Medicare. That’s pretty small.”
At the end of December 2012, federal records showed that 96,000 eligible physicians had received an incentive payment for the early implementation and attestation of an EHR system, out of a total 505,000 eligible doctors. Mytych (pictured) said those systems must be in place and the providers must meet meaningful use rules by 2015, or face potential federal Medicare penalties. (That deadline, he added, is subject to change.)
The current deadline for implementation of Stage 2, requiring practices to have implemented 90 days of consecutive meaningful use, is now set for next year. Mytych, however, predicts that the deadlines and penalties may be pushed back as well after the Department of Health & Human Services reviews the comments on proposed rules. “It would be good to see them push the deadline back but keep in mind that the federal government will make money off this, since they’re making more in penalties than paying in incentives,” he said.
Mytych has worked with practices nationally, helping them buy and implement EHR systems, and notes that adapting their workflows to meet meaningful use criteria is “harder than people expected it to be. It’s not something that’s a walk in the park for doctors to do. Just because a practice has begun using an EHR system doesn’t mean it’s meeting meaningful use criteria.” Mytych said that the numbers, while certainly lower than what has been hoped for, clearly demonstrated that the medical industry has made substantial steps toward universal adoption of EHRs.
Cardiologists, he noted, are farther ahead than doctors practicing in other specialties. The EHR adoption rate among cardiologists is closer to 85-90 percent, with more than half actively following meaningful use criteria in their practices. Mytych said there are several reasons: “Organizations like MedAxiom have done a good job of educating their members on the benefits of EHR and meaningful use,” he commented. “Cardiologists also have a greater focus on measuring clinical performance and the use of registry data, as well as being aware of the high cost/ high reward aspect. They’ve always been better at this.”
In addition, Mytych pointed out that cardiologists routinely work with sophisticated digital technology, such as nuclear and echo cardiography testing, leading to a higher degree of technical acumen than other doctors. “A lot of what they do is digital in nature, so they’re used to those kinds of capabilities. That makes it relatively easier for them to adopt EHR systems,” Mytych said.
The seemingly inexorable move toward integration between cardiology practices and larger healthcare organizations (HCOs) is also playing a role in the adoption of meaningful use and EHR systems, according to Mytych. While the vast majority of practices have been acquired by hospitals, Mytych said those that stay independent must remain “a good data trading partner,” with the ability to share analytical information about their patients. “There will be a lot of pressure on independent practices to be compliant,” he noted. “Cardiologists will also be asked to be more interoperable with other doctors. This not only includes the exchange of records, but they will also have to be compliant with meaningful use rules about exchanging the summary of care record at each transition of care for their patients.”
But combining different systems increasingly places different pressures on those parties, Mytych said, adding that practices that have been bought out are being asked to move to hospital-based systems like Epic or Cerner. The abrupt change can be disruptive to the practice that’s used a different EHR system for four to five years. “Among hospitals using the Epic system, there’s a very strong bias that says, ‘if we bought Epic, and paid that money, you’re going to use Epic.’ It’s not always true, but probably more than 80 percent of the time. It can be a tough road to go down.”
Mytych cited several cases in which hospitals have kept multiple systems and integrated them, using health portals that enable multiple EHR systems to sit under one umbrella, with a single look and feel. But they’re the exception, he said, especially among those HCOs that have deployed Epic systems: “Because of the size of investment they’ve made and the benefits the account’s been sold on, there’s a strong bias in that direction to go with Epic exclusively. There is a very significant value of the single patient record between hospital and doctor for which Epic is very good at gaining C-suite acceptance. ”
In non-Epic settings, Mytych said he has worked on integrating strategies for as many as 10 different EHR systems at one time. “It’s not easy, it’s expensive, but it can be done.” He’s asking HCOs contemplating consolidation to consider whether it would be effective to “rip and replace” now, or whether it might be more advantageous to look at newer technologies that would allow multiple systems to co-exist, providing access to “virtual health records.”
Moving forward, Mytych said practices are gearing up for Stage 2 of meaningful use in 2014, saying that practices are shifting away from a “do-more, bill more” model, toward the implementation of value–based medicine models for the delivery of care. Accountable care organizations, he said, will play a major role in this scenario. “In order to function effectively, doctors will have to have the effective use of analytical tools to judge where they’re at with patient care, and manage episodes and communicate across multiple practices and locations, so that we’re all working off the same set of patient information. Everyone will be doing their best to be judged well on quality.”
Money, he said, will no longer be the deciding factor. “You’re the orchestra leader,” Mytych commented. “Everyone must be on same page, and in sync. It will take coordination and sharing of information and good assessments, so that doctors can say, ‘did we do well, and if not, where do we improve?’” MedAxiom, he said, has emerged as a leader in this sector continually working with its members to adapt to an ever-changing value landscape.
Mytych summed up 2013 activity, saying practices will see three major areas of activity: an ongoing effort in refinement of EHR systems to produce the analytical information needed for quality measurement; patient portals, giving patients access to their own medical records (new HIPAA regulations will take effect later this year, requiring doctors to provide patients with electronic copies of their records within 30 days of a request); and the continued evolution and utilization of health information exchanges, enabling doctors to be better stewards of how their services are being utilized and reimbursed.