Medical Group Practices and Meaningful Use

Even though Stage 1 meaningful use attestation wasn’t that difficult for Stephen G. Diamantoni, M.D. & Associates Family Practice, a five-office, 18-provider practice in Lancaster, Penn., it is moving forward on its next challenge—meeting Stage 2 requirements.

Diamantoni & Associates attested on June 21 for the Pennsylvania Medicaid EHR Incentive Program. The practice decided to attest via Medicaid, rather than Medicare because of higher incentive payments and lower requirements. Besides meeting Medicaid patient volume thresholds, the practice had to be “adopting, implementing, or upgrading (meaningfully using in future years) federally-certified EHR [electronic health record] systems.” The Pennsylvania Medicaid program allowed medical groups to attest as a group rather than individually for incentives, which made the process even more straightforward. Diamantoni & Associates received more than $300,000 in federal incentive payments in early July. The practice paid off its EHR system before meaningful use, but is using the incentive payments to buy new hardware with more RAM.

Despite the looser requirements for attestation, the practice exceeded many Stage 1 requirements, reaching 99 percent of orders entered into computer physician order entry (CPOE), 90 percent of prescriptions transmitted electronically using an EHR, 92 percent of patients have at least one entry in an active allergy list, and 65 percent of patients have demographics recorded.

EHR Implementation Journey
Long before meaningful use was even in the public lexicon, Diamantoni & Associates started on its technological journey by researching EHR vendors about eight years ago, but wasn’t satisfied with the technology available at the time. Three years later the practice invited vendors in for demonstrations, and eventually selected an integrated EHR (the Sage Intergy product from the Tampa-based Sage Healthcare). The most tech savvy partner, William Vollmar, M.D., then took on the de facto role of CIO and went about assuaging his colleague’s initial resistance to the technological changes.

Vollmar says his practice’s approach to implementing its EHR was to develop a cycling event for scanning in patient information into the EHR, while it implemented the system. “We didn’t wait till all the charts were already in because it’s too prolonged,” he says. “Then you’re just sitting there with all this capital that you’ve spent on it and then you can’t use it.”

His self-described management style as a “benign dictatorship” is less committee consensus, and more directed leadership. “It was easier to set some specific, albeit extensive goals, than it was to slowly try to accommodate and work with every single person because you’re never going to make everyone happy,” Vollmar says. “It’s good to have one or two cadre of people who are leaders in the group.”

Two years ago when meaningful use began taking shape, Diamantoni & Associates enlisted the help of a consultant Christine Kelly, with CMK Consulting (Baltimore, Md.) to help the practice with project management and quality reporting. Vollmar was feeling out of his expertise with the level of reporting meaningful use required and says the practice needed someone to be on top of it as information and requirements kept changing. When Kelly came on board she developed more robust reporting to help the practice to comply with Healthcare Effectiveness Data and Information Set (HEDIS) measures, and worked with the practice on a daily basis to administer practice management reporting and perform monthly audits.

Initial preparations for meaningful use Stage 1 commenced in early 2010 by reviewing the initial proposal and final rule and contacting the practice’s Regional Extension Center (REC) to update it with legislation changes and filter important information about incentives. Another area of Stage 1 preparation included setting forth a project plan, creating dashboards for key measures, and upgrading to the certified version of its EHR.

Physician EHR Adoption
Kelly reviews the practice analytics dashboard every week to get a quick picture on core and clinical meaningful use measures, comparing the required thresholds to current practice levels. The dashboard also allows for drilling down to an individual provider view to see compliance to particular measures. “As a data analyst and someone trying to drive this change, you always have to respect that you’re dealing with physicians caring for their patients,” says Kelly. “Regardless of what kind of information I need to capture in order to make their reporting numbers look good, they’ve been very open to change as long as the respect for what it is they’re doing always comes into play.”

Vollmar has taken a hard line when it comes to MU compliance and clinical documentation among his colleagues. “This is their job,” he says. “We encourage stuff like this when we’re looking at the ability of those people to put in the information that they’re supposed to, and that is going to be used in determining their raises this year.” Best practices are organically trickled down within the practice. If a particular physician isn’t up to par on a certain measure, Vollmar engages and educates the physician. Vollmar also likes that the EHR and clinical dashboard makes his practice more efficient.

“We can now look at all these markers and see if the receptionists are collecting this data as the patient comes into the office,” he says. “If they’re not, can the office manager at that site be enabled to get the receptionist to do that? So not only do we have information to supply CMS, we have information to supply our managers with to make our business flow more efficiently.”

Practice Portal Ahead
Even though Stage 1 wasn’t as difficult as Vollmar expected since it mostly just required an upgrade of the practice’s EHR, he and his colleagues are anticipating Stage 2 to prove more difficult as clinical requirements amp up and more patient participation in care will be involved. In the next two to three weeks, Diamantoni & Associates will be implementing one main piece of its Stage 2 strategy, its practice portal. Patients will be able to request refills, appointments, and see lab results. Eventually, they will be able to receive a summary of care record. Currently, the practice has begun collecting patient emails in order to send out an electronic blast with portal registration information, so patients can sign consent forms.

The practice will also be honing in on its smoking cessation program by engaging its automatic phone tree system to call patients for appointment reminders. Kelly says that the practice will be firming up its numbers on various measures and making sure all providers are within mandated thresholds, as well as performing a security audit on its EHR.

Vollmar recommends other practices striving to meet meaningful use practices get a CCHIT-approved EHR that is all inclusive with clinical, financial, and practice analytics as part of an integrated system. He says multi-system interfacing is not worth the headache.

Stay tuned for Healthcare Informatics’ October issue, which will address more strategic IT issues that medical group leaders are facing going forward on their meaningful use journeys.