But they moved ahead and spent 3 years selecting, buying, and implementing an EHR system that they could all use, said Dr. Brull, who practices in Plainview. She took out a loan for $50,000 to buy the equipment; her colleagues contributed to the software and other costs.
Because they practice in a rural area, there was no possibility of using a web-based model, so Dr. Brull has a server onsite at her office, and recently purchased a second server for $3,000. The net cost so far has been about $30,000 per physician, Dr. Brull said.
The first 6 months were a challenge, she said. “Anytime you do something that's a complete paradigm shift, it's hard. It's hard mentally to think about all those changes, hard physically because you're investing more time and effort, and hard emotionally because your staff gets freaked out.”
In addition to allowing the practice to meet meaningful use criteria, the system also has a patient portal. The physicians are preparing to be able to participate in the state's health information exchange.
Dr. Brull said that she disagrees with physicians who say that adopting an EHR interrupts the workflow or comes between the physician and patient.
“This whole project has resulted in dramatic quality improvement for my practice,” Dr. Brull added. Another example: She implemented a quality measure on breast cancer screening. Just by having a flag in the EHR, she went from screening 50% of patients to almost 100%. “Having the data at your fingertips makes you aware of where you do a good job and where you don't,” Dr. Brull said.
Vitals
Source Elsevier Global Medical News
Meaningful Use: How, Where, When
The ONC provides the central leadership for the Medicare and Medicaid EHR incentive programs. The HITECH (Health Information Technology for Economic and Clinical Health) Act directly appropriated $2 billion to the ONC to spend on incentives and administration of the program.
The federal regulation governing the incentive program (some 800 pages) was issued in July 2010.
This year – 2011 – is the first year in which physicians can participate; they have until Oct. 1 to attest that they are meaningful users. To be eligible for incentive payments, physicians have to meet the meaningful use criteria for 90 consecutive days.
The criteria are being introduced in stages over the next 4-5 years. Stage 1 outlines what is expected in 2011 and 2012.
Stage 2 was expected to be put into place in 2013, but in June, the Health IT Policy Committee of the Centers for Medicare and Medicaid Services voted to delay implementation until 2014, but only for physicians who were already participating.
Physicians who wait until 2012 or later would still be expected to meet stage 2 criteria in 2013.
Physicians who want to participate have to choose between the Medicare or Medicaid incentive program. Those who take part in the Medicare program are eligible to receive incentive payments of $44,000 over 5 years. However, the payments will be made only through 2016.
Physicians who wait until 2012 to start would still earn the $44,000 maximum; those who start later would receive prorated payments.
Physicians who practice in designated Health Professional Shortage Areas may be eligible for an additional 10% in each year's incentive payment.
Importantly, Medicare begins to penalize nonparticipating physicians starting in 2016.
The Medicaid incentives are more generous: A total of $63,750 can be paid out over 6 years. And there's a longer time frame. Eligible professionals can wait until 2016 to start participating and still receive the maximum payout over a 6-year period.
In late May, the CMS announced that $75 million in Medicare incentives had been awarded to physicians and hospitals in the first 2 weeks of the program. Some states began paying out Medicaid incentives in January.