Early Attestation in a Solo Physician Practice
Julie Childs (second from right, above) and her colleagues in the Childs Medical Clinic in Samson, Alabama, seized the opportunity to attest to stage 1 meaningful use within the first week that attestation was possible.What’s Dr. Childs’ feeling about having gone through this?Well, there are some areas where we felt we were very good, and some areas where we feel it’s just a matter of accounting for what we were already doing. He wanted to do this, and has learned anything that needed to be learned. And some physicians really don’t want to do that, and they can protest and protest, but eventually, if they’re not on electronic records, it will hurt them.On a scale of 1-10, with 10 being the most difficult, where did this fall on that scale in terms of difficulty?I’d give it a 3. [chuckles] Some things were a little bit difficult, and some were very easy. But every time I’d have a problem, I’d call the Greenway people, and they’d help me figure it out. I think a system’s only as good as its customer support, and theirs is very good.But it does require a little bit of perseverance and a little bit of flexibility, right?Oh, yes, and the whole office had to get involved. Let me give you one example of a little glitch that had to be fixed through engaging everyone. In the area of the clinical summary, one requirement is to have the “preferred physician” line filled out within the demographic information for each patient. Well, I hadn’t been putting down the preferred provider, as there’s only one eligible provider here! So I had never thought to do anything with that; but once I found out that that was the stumbling block, I made it a required field, so that the front office wouldn’t skip that click.So a lot of it has to do with adjusting little process things?Right. One requirement has to do with noting the ethnicity of each patient, which isn’t related to patient care, as far as I can tell—so it’s an added step among others that had to be done under meaningful use.So the front office really had to be trained for this, too?Right, everybody had to be trained for their part. For example, tobacco assessment had to be included; and it had to be done in a certain way—you have to click on “tobacco,” and select “current,” “former,” “never,” etc. And most of our patients are not smokers, but some are. And you had to put in there how many packs a day, etc. But if I left it as “non-smoker,” it would not pick up on the assessment. So the nurse had to make sure the proper link on “social history” was clicked. It was things like that.How do you all feel now that it’s done for stage 1?We’re still working on doing these things [completing required tasks] with our new patients. And this is an ongoing process; and once you do things for this year, you have to prepare for the next level.When will the first payment come to you?I think [the Centers for Medicare and Medicaid Services (CMS) EHR Incentive Program Web Portal] indicated four to six weeks. There’s a place on the website where we attested, for status. And we can look that up; it does show timeframe and all that.What will be this year’s payout?It’s $18,000. And I know what we’re going to do with it; we need a new floor in our building! And everybody will get a bonus.I’m guessing that that still represents only a portion of your initial EHR investment?That’s right; our first loan was for around $100,000, for the very first system, though that also included the necessary hardware, plus a monthly fee. Since then, by the way, we’ve added a website, and we have a patient portal, which I love; they can get prescriptions refilled and can schedule an appointment. Right now, about 25 percent of our patients have computers; but some of the adult children of patients have computers, and can handle the elderly patients who are not going to have computers, so their children can send requests for refills or schedule appointments.In any case, the bottom line is that we are here to help our community; it’s a mission. We all firmly believe in it, and we do what we can to make it work.And there are certainly elements in all this that can’t be directly quantified, correct? Yes, that’s right. How much is Dr. Childs’ time worth, or how important is a person’s medical record? If someone needs to be sent immediately to another physician, we can click on it on the computer and immediately zeta-fax it to that doctor. How much is that worth? The whole point of this is to make medicine better for the patient; and that’s great for the patient. The growing pains are hard. So the incentive makes people who wouldn’t pursue this immediately, do so.
