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CMS' Weems Talks Ambulatory EHRs

December 12, 2007
by Stacey Kramer
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On Oct. 30, Centers for Medicare and Medicaid Services (CMS) announced it was developing a new demonstration initiative to reward physicians financial for the use of EHRs. The initiative expands upon the Medicare Care Management Performance (MCMP) Demonstration. According to CMS, the goal of the new five-year demonstration is “to foster the implementation and adoption of EHRs and health information technology more broadly as effective vehicles, not only to improve the quality of care provided, but also to transform the way medicine is practiced and delivered.”

HCI Managing Editor Stacey Kramer recently caught up with CMS Acting Administrator Kerry Weems to talk about the new plan.

Tell me about your new project.

It’s a new Medicare demonstration project, and our goal is to go into 12 different communities and recruit in each one of those communities 100 physician practices. And these practices will be in the small-to-medium range, with about three to five physicians per practice. So we think that by the time we finish the 12 communities, the 100 practices per community, and then the three to five doctors with this demonstration, we may touch as many as 3.5 million Americans.

How does the project incentivize physicians?

The project provides incentive bonuses to physicians for using an EHR in their practice, especially to manage patients and to practice along certain quality measures that they’re going to report on. I think we may look back at this and say this was the day that everything changed.

Why do you feel the effect is going to be so dramatic?

Because we are going to demonstrate that an EHR can save a practice money. So how does it do that? It saves costs by reducing adverse events. Just take e-prescribing — making sure that people don’t have medicines that conflict with one another. By managing patients better, we believe that it will reduce hospitalization, they’ll be fewer duplicate tests, and fewer emergency room visits.

Have you chosen the 1,200 practices yet?

We have not chosen yet, we’ll be recruiting. We’re finishing our research design right now. In the late Winter/early Spring, we expect to have identified the 12 communities and start recruiting physicians.

What’s the criteria upon which the selection will be based?

The first thing we are going to do is choose the 12 communities, and then choose physicians from there. Our research design is still underway. The reason we’re announcing it now is to get people interested, and maybe get them to raise their hands and say, “You really should come to our community.” One of the other really exciting aspects of this is that we expect the private sector, private payers, to participate with us. So, you can imagine then the power of this. Say Medicare patients are, let’s choose a number, 30 percent of a physician practice, and they’re going to earn a bonus based on their recording of quality measures. Well, if one of the private sector companies decides to join, we hope they’ll pay a similar bonus, so suddenly rather than a bonus on 30 percent of the practice, we’re talking about a bonus on 60-70 percent of the practice. That is a real game changer.

How long will the demonstration last?

We’re contemplating a five-year program. That may change based on the final design, but right now we’re contemplating a five-year program.

Do you then plan on moving all Medicare patients to EHRs and, if so, what’s the time frame for this?

Well, we’re going to look at the demonstration — that’s the purpose of a demonstration, and it’s going to tell us things. The research questions that we’re trying to answer here are: what are the savings, and how are those savings stratified by physician practice? What’s the effect on quality? Are we achieving better outcomes with patients? What does the business model look like for physician practices, what’s the adoption incentive here? And then there’s some other questions like: how does this change the workflow in a physician’s office, and what’s the degree of functionality that physicians use, how quickly do they move up the functionality chain in an EHR? Those are some important questions that we need answered by this demonstration.

What do you think CIOs need to know about this project?

If I were the CIO of a healthcare provider, I would read anything that CMS says on this and position myself in the market where I might be able to take advantage of this very quickly. I would look at the 12 communities being recruited. I would look at those physician practices. This, I think, presents a real opportunity to be an early adopter in a marketplace that can improve patient care and reduce costs in the health system.

The demonstration is focused on smaller practices, correct?

It’s three to five doctors. That’s what we’re looking at, that’s our general parameter. The reason is that’s sort of the sweet spot right now where adoption’s fairly low.

What’s the take-home message that people need to get, that our readers need to get from this?

The take home message is that EHRs can improve the quality of patients’ lives, can improve outcomes, and the time to do it is now. Like I said, this is a day that we’ll look back on and say, “This is the day when everything changed.”