Stage 2: The Delay Dilemma

In the last few weeks multiple professional organizations have called for some form of extension for  Stage 2 of the EHR Meaningful Use program. While the general theme is “delay,” the specific recommendations have varied:

MGMA – Requests that HHS extends the reporting period for Stage 2 incentives for a minimum of one year. MGMA also calls for a moratorium on penalties for providers that have completed Stage 1 requirements.

AAFP – Proposes three distinct “cohorts” of EPs, each with a different schedule depending on what year they first attested for MU. The timeline would require vendors to be ready for Stage 2 by January 1, 2014 but extend the implementation period from nine months to 21 months, depending on the cohort.

CHIME – Calls for a one year delay for implementation of Stage 2.

AMA/AHA – In a joint letter to HHS Secretary Kathleen Sebelius, the associations call for providers at Stage 1 to meet MU requirements for Stage 2 using either a 2011 or the 2014-certified EHR; the establishment of a 90-day reporting period for the first year of each new stage of MU; more flexibility in meeting Stage 2; and, an extension for each stage of no less than three years for all providers.

HIMSS – Recommends Stage 2 start as scheduled but that the attestation period  be extended through April 2015 for EHs and June 2015 for EPs. Providers would have 18 months to  attest to quarterly MU requirements.

One theme that is consistent from all the organizations is that the delay is necessary because vendors need more time to prepare and certify the required software upgrades and because providers need additional time to implement and optimize their EHR technology.

I must admit that when the various associations and industry leaders first began rumbling about a delay, my first thought was, “You’ve got to be kidding!” Lest anyone forget, HHS already extended the Stage 2 deadline once in November, 2011. By delaying again, HHS would be repeating its long history of telling vendors and providers that deadlines are made to be broken.

Regardless, there now seems to be a groundswell of sentiment in favor of a Stage 2 delay. No one at HHS, including Secretary Sebellius or the soon-to-be-departing Farzad Mostashari, has indicated that a postponement may happen, though my money is on policymakers agreeing to an extension for meeting and reporting on Stage 2 requirements and for delaying penalties for providers that have met Stage 1. I would hope that the January 1, 2014 start date remains intact.

Why? Maintaining the original start date means vendors must continue moving forward to ready their products. If the start date were also delayed, software release dates would undoubtedly be pushed and providers could again find themselves without adequate time to fully test, train, and implement the required updates and make any necessary changes to workflow. Keeping the original date also means early adopters would have the opportunity to attest early in 2014 and thus be paid their MU incentives.

Readers, I’d love to hear your thoughts on the possibility of a Stage 2 delay and how that delay might look.

Email Inga.

News 8/22/13

MGMA sends HHS a recommendation to immediately institute an indefinite moratorium on penalties for physicians that successfully complete Stage 1 MU requirements. The association is concerned that a lack of vendor readiness may hinder physicians ability to meet Stage 2 requirements and thus unfairly penalize physicians starting in 2015. MGMA also recommends extending the reporting periods for both Stage 1 and Stage 2 incentives.

Greenway Medical launches PrimePATIENT, a patient portal integrated with PrimeSUITE, giving patients the ability to request appointments, pre-register, pay bills, and maintain personal health records. Greenway also adds Seamless Medical Systems to its online Marketplace as a value-added partner.

Allscripts announces its Client Outcomes Excellence award winners, including Professional EHR customer Elmwood Health Center (NY) and Eastern Nephrology Associates’ (NC) IT administrator Kenneth Waters.

Allscripts also names Healthfinch the winner of its Open Apps Challenge for its automated prescription renewal request app. We interviewed Healthfinch’s CEO and co-founder Jonathan Baran on HIStalk Connect last year.

Medicare reimburses physicians up to five times more for performing procedures than for cognitive care, according to a  study published in JAMA Internal Medicine. Physicians make 368 percent more doing a colonoscopy and 486 percent more removing a cataract than a primary care physician generates providing cognitive care, meaning specialists can generate more revenue in one to two hours than a primary care physician makes in a day. Not great news for the recruitment of primary care physicians and highlights why specialists may resist efforts to transition from procedure-based  payment models.

Zirmed partners with Catch Data Systems to provide GE Centricity customers integration with ZirMed’s RCM, clinical communications, and analytics solutions.

The Air Force’s 62nd Air Division posts details of its Relay Health secure messaging program, which allows Airman  to securely message their primary care providers at the 62nd Medical Squadron’s Airmen’s Clinic. Patients of the Washington-based clinic are using the Relay Health service to schedule appointments, request medication refills, or communicate with physicians, even when off-based on temporary duty assignment or vacation.

Email Inga.

News 8/20/13

The AHRQ examines the findings from more than 20 studies that were funded by the agency’s Ambulatory Safety and Quality program and concludes that the use of HIT in ambulatory care settings has a positive impact on evidence-based preventive and chronic care delivery, chronic disease control, provider satisfaction, and health outcomes.

Southern New England Ear, Nose, Throat and Facial Plastic Surgery Group (CT) selects ChartLogic’s EHR suite for its 11 physician practice.

More companies are purchasing cyber insurance to cover potential losses and fines in the event of a cyber security breach. About 32 percent of healthcare organizations now have some sort of cyber insurance policy in place and an additional 41 percent are considering purchasing coverage. Industry experts note that in the last six to nine months more smaller practices are expressing an interest in coverage, especially as more data breaches are being publicized and fines are accessed.

The 11-provider Orthopaedic Associates of Augusta (GA) selects SRS EHR.

Physicians across all organizations can expect an average salary increase of 2.4 percent in 2014, which is on par with last year. Physicians in group practices can expect the largest pay increases at 3.7 percent; hospital-based physicians will see increases of only about 2.2 percent.

The most useful patient record strikes a good balance between structured data and a physician’s narrative according Lesley Kadlec, director of AHIMA’s HIM Practice Excellence. Kadlec notes that EHR templates are a great tool but don’t always support good documentation, so she recommends the smarter use of free text and/or the use of speech recognition technology.

Email Inga.

News 8/15/13

The AAFP urges CMS to modify the Stage 2 MU timeline because of concerns that the program’s requirements will “outstrip the capacity of many certified electronic health technology vendors and ambulatory family medicine practices.” The AAFP offers a proposal that does not delay the implementation of Stage 2 but adds a 12 month extension to the timeframe for Stage 2 compliance.

MGMA-ACMPE announces that HCA Physician Services, which employs more than 500 practice managers, is the association’s newest large group member.

Aprima reports having over 600 participants at annual user group conference earlier this month in Dallas.

Greenway Medical joins Humana’s EHR Rewards program, which subsidizes 85 percent of the purchase of select EHRs for physicians practicing in the Humana network.

Frost & Sullivan awards Kareo its 2013 North American Physician Practice Management Customer Value Enhancement Award for demonstrating excellence in implementing strategies that create value for its customers.

Mercy Health System (ME) selects Allscripts RCM Services for its physician practices.

Bogdan Rau of the UCLA Center for Health Policy Research creates an interesting table depicting the top EHR vendors based on the percentage of MU attestations. While Epic and Allscripts have dominated the top spots since 2011, it’s interesting to see how the vendor mix has shifted for the vendors in the 3rd, 4th, and 5th place spots. Obviously the number users by vendor has a big impact on the rankings.

Email Inga.

News 8/13/13

Less than 12 percent of providers are planning to replace or purchase an EMR and only 8.6 percent plan to do so within the year, according to physicians participating in an athenahealth/Epocrates survey . While not apples to apples, I find athena’s replace/purchase numbers more realistic than Black Book’s recent estimate that up to 17 percent of practices with an existing EMR will replace their software by the end of the year.  Other key findings from the Physician Sentiment Survey:

• The majority of physicians believe EMRs have at least some positive impact on patient care, though 17 percent believe they worsen care.
• Most physicians don’t believe the financial benefits of an EMR outweigh the costs, though most believe the patient care benefits of EMRs outweigh the costs.
• Seventy-six percent of physicians report having purchased an EMR.

Emdeon reports Q2 adjusted earnings of $77.2 million, down 3.7 percent from a year ago. Revenues were up almost six percent to $311 million.

Emdeon also announces that the Chain Drug Consortium has renewed its agreement to utilize the Emdeon Clinical Exchange eRx Network.

The folks at Greenway Medical sent me a note bragging about Jason Dufner and his 2013 PGA Championship victory, his first major title since Greenway beginning sponsoring him. I actually watched a bit of the tournament Sunday and mildly impressed my fellow couch potatoes when I mentioned  that  the logo on Dufner’s shirt came from one of the same companies that sponsors HIStalk and HIStalk Practice.

Allscripts Enterprise 11.4.1 and Professional 13.0 EHRs receive 2014 ONC HIT Certification from the Drummond Group. Interestingly both products earned two complete ambulatory certifications, one with Allscripts FollowMyHealth (formerly Jardogs) and one with Allscripts Patient Portal by Intuit. I interpret that to mean that despite its recent acquisition of Jardogs, Allscripts does not have immediate plans to force customers to migrate off the Intuit platform.

Email Inga.