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Early Attestation In a Solo Physician Practice in California

August 23, 2011
by root
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Patrick Golden, M.D. is board-certified in internal medicine, with specialties in cardiology and bariatrics. He is a solo practitioner in Fresno, California, with an office staff of seven full-time and three part-time staff members. His practice uses the Sage Intergy EHR from the Tampa-based Sage Healthcare, as its core electronic health record (The practice went live with Sage’s EHR in December 2009; it had gone live with the company’s demographics and billing system in September 2009). In practice since 1987, Dr. Golden made the decision to go for early attestation under meaningful use. He and his practice manager and wife, Eloise Golden, spoke recently with HCI Editor-in-Chief Mark Hagland regarding their practice’s path towards early attestation. Below are excerpts from that interview.

What made you decide to attest early?

Patrick Golden: Well, because I had gone live with an EHR in 2009, before meaningful use was finalized, I was already meaningfully using my system, or at least I thought I was; so as soon as the information was disseminated through CMS [the federal Centers for Medicare and Medicaid Services], I figured I would attest as soon as possible. Plus, if you attest during this calendar year, you only have to attest over three months; whereas next year, you’ll have to attest across 12 months.
Patrick Golden, M.D.

When did you attest?

On June 13. So we would have attested for the period of March, April, and May. I could even have attested earlier, but it took a while to get our practice analytics software from Sage. Because you can’t count the numerator and denominator manually, it has to be machine-derived; so we had to wait for that software to know what our figures were.

How difficult was it to prepare for attestation?

For us, the rate-limiting step was acquiring the software we needed; so once we received the practice analytics software and looked at it for the first time, I was actually already compliant with 23 of the 25 core criteria. We only had to make two changes. First, under demographics, they wanted race plus ethnicity. And we had been gathering information for race, but not ethnicity. So we had to figure that out and go back into our patient population and add the ethnicity. And the definitions of ethnicity came through the census department.

And what was the other criterion?

The only other one I wasn’t compliant with was handing out the sheets (encounter summaries) at the end of each encounter. I was not handing a summary sheet out to each of the patients. So I had to do that for 100 percent of my patients for 60 days in order to meet that 50-percent requirement.

So you had to hand out the encounter summary for two months before you entered your period of attestation?

That’s correct. If it hadn’t been for that, I could have attested as early as March. So other than for those two criteria, I could have attested two months early. And I think the criteria are important; those are things we ought to be doing anyway. It’s all common-sense stuff—active problem list, active medications list, use of electronic prescribing, and sharing of data and medical records, as appropriate.

So you really didn’t have any major problems?

No, it was really pretty easy, I have to admit. And again, it took about two months to meet out the handing out the summaries to patients, but other than that, we were easily above the requirements for the other measures. So that made us feel good. I felt lucky that we were with Sage, though, because I don’t know what other companies’ systems would have been like.

What would your advice be for other solo practitioners?

You know, I’m lucky because I started before the meaningful use criteria were finalized. So right now for a solo practitioner, I would go ahead and get an electronic system; and I would look at using a system where the data servers are maintained at a location remote from my office—through a cloud-based or hosted solution. Because I wish we didn’t have the big servers in my office. And I would make sure that a solo practitioner’s vendor product was certified.

Are you thinking of going to a cloud-based or hosted solution?

I don’t need to now, because I don’t need to. But in retrospect, it would have been nice to have that service; and Sage does offer those services.

Are you feeling pretty sanguine about stages 2 and 3?

I’m going to have a big problem, in that in order to attest, we have to use what’s called a meaningful use template. And before MU appeared, Sage had a wonderful system set up where we have this light bulb icon in the upper right hand corner of our desktop; and clicking on it shows us all the things we should be doing for longitudinal patient management. It makes sure that you do all of those things; and those are the kinds of things asked of me in stages 2 and 3.

The problem is that when I satisfy those requirements by clicking the light bulb, the template doesn’t know I’ve done it. So I’ve got to find a geek within Sage that makes the light bulb talk to the template. But if I have to go back through and click and template with respect to something I’ve already done through the light bulb icon, that’s tough. But I think Sage will be very helpful.

Eloise Golden: One thing is that the doctor has to be 100-percent committed, and can’t be waylaid by his staff. I’ve seen staffs that complain; and it is a challenge. And Dr. Golden would never, ever go back to paper; but there’s work involved. And sometimes, it’s easy for a doctor let his staff do what they need to do to get information to him. But wishy-washy-ness will lead to failure.

Patrick Golden: And you have to use the templates if you’re going to get the meaningful use money.

Anything to add?

Patrick Golden: If somebody this late in the year purchases a new system, I don’t think it’s realistic for them to be able to attest before next year; it just takes that long to get all of your patient information scanned. There isn’t enough time to get all your information together if you haven’t yet started.

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