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Attestation Takes Time

June 2, 2011
by Jennifer Prestigiacomo
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A small physician practice in Ohio offers attestation tips; No. 1, budget enough time

Springfield Center for Family Medicine Inc., a six-physician family medicine practice in Springfield, Ohio with a 25 percent Medicare population, was among the first providers to receive payment for demonstrating meaningful use under Stage 1 of the Medicare incentive program. Peter Muir, M.D., and five other physicians have all attested, and now only two are awaiting payment.

Springfield Center for Family Medicine Inc., a six-physician family medicine practice in Springfield, Ohio with a 25 percent Medicare population, was among the first providers to receive payment for demonstrating meaningful use under Stage 1 of the Medicare incentive program. Peter Muir, M.D., and five other physicians have all attested, and now only two are awaiting payment. Muir led Stage 1 efforts on the physician side, having been Springfield Center’s liaison with electronic health record (EMR) provider NextGen (Horsham, Penn.), helping with software updates and enhancements. Cindy Brewer, office manager, was instrumental in liaising with Muir and led the charge on the office side. She project managed the effort, making sure physicians adhered to deadlines, of which many were made 30 days before the actually deadline to ensure timeliness to attest. Brewer also completed the necessary documentation and reporting, and did all six attestations online. Brewer took time out to offer HCI Associate Editor Jennifer Prestigiacomo some tips for other providers on their road to attestation.

Tell me a little about your attestation experience.

On April 26 I attested for the first physician, and I did the rest on the 27th. I chose to do one on one day because it was a little overwhelming and panic [set in] with all the information coming at me on the website. I just wanted to take my time and avoid staff interruptions. By the second day it was a breeze to go through. The website itself is a little overwhelming because there are all kinds of helpful preview screens you can use, and there are 20 to 30 pages of instructions to help you get through it. I encourage everyone not to panic; just jump in, and start the attestation process. It’s very user-friendly, and it will guide you along the way. It was comforting that you can stop and start along the way, as long as you didn’t do the final step.


Springfield Center for Family Medicine

How long did it take you to complete each attestation?

The first one took two hours because I took my time and double-checked [everything]. By the second day I did all the other five physicians in 45 minutes apiece.

What made your practice decide to push ahead and attest at this early stage?

As far as meeting meaningful use, we’re pretty on top of it, being informed by CMS and NextGen by eNewsletters that keep us updated on what’s the newest out there and what’s required. We wanted to be ahead of things to avoid the CMS decrease in Medicare payments in 2015, and we also wanted to put our electronic products to good use. It just makes good healthcare sense for our patients as well.

Is it really worth it to attest, since the $18,000 payment per physician is dwarfed by the initial EMR investment?

It doesn’t cover the EMR investment, but it’s an incentive to be able to get the funding to update our medical record system. It’s helping us get updated equipment, computers, hardware to be able to keep up with the newest updates and [upgrade to] the newest version of Windows to keep our EMR up to date with the NextGen database.

Did you get a lot of help from NextGen?

The help that we got from NextGen was based on monthly emails and notices of where we’re at with meeting meaningful use. We’ve also attended webinars online to help us through the process.

And what were the biggest challenges?

[It was] probably getting our physicians and staff to cooperate in meeting the timeframe. Our registration [staff] was required to ask about race and ethnicity when they weren’t used to doing that. We had a lot of flak from them fearing what our patients were going to say, but we didn’t give them the option not to do it. If they weren’t doing it, we were able to run this report that showed our percentage of meeting [the goal]. It only took one or two times running that report to show them [and enforce it]. Being able to run reports and make your staff accountable helps them to be more comfortable in doing it. NextGen has an ethnicity box that you can’t move on out of your registration process until it’s filled in, and that was helpful.

On a scale of 1-10, with 10 being the most difficult, where did this fall on that scale in terms of difficulty?

Probably a seven because we already had our electronic medical record in place and our doctors were used to inputting [data into] the EMR; it just wasn’t enforced in some aspects. It’s now about changing their attitudes about implementing better documentation and putting [data] in the required area instead of making a general statement about it [in a note]. Lot of facilities already meet meaningful use, but they’re not recording it in the areas that can be reported on.

Do you have any advice for those organizations preparing to attest soon?

When you actually sit down to attest, really designate that quiet time to attest and make it clear to your staff that you’re not to be interrupted for around two hours depending on how many doctors you’re doing, but at least allow 45 minutes per doctor. Double check as you go along. One of the things about the Medicare site that may be frustrating is to want to print off certain parts of it—like towards the end I wanted to have paper proof that I filled out what I did. It’s probably something they need to fix with their website, but we tried many ways, and with Dr. Muir being as computer [savvy] as he was he couldn’t get it to print all the pages. So, we just hit the print screen button and brought up a WordPad and copied and pasted. The other thing, is when you go from your core measures to your quality measure questions, it changes the numerator/denominator order on you, and if you’re not paying attention, you can start filling out your figures wrong.

 


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