While the timing of Stage 2 of meaningful use has been a hot topic lately, there are tools and technology to help providers automate meaningful use so that practices of all sizes are ready for this huge next step. As provider organizations advance beyond the earliest phases of meaningful use reporting, they quickly realize how tough it can be to track the details in a process that is constantly changing.
Like countless of physician organizations across the country, one health system that has faced these challenges is the Washington, D.C.-based The GW Medical Faculty Associates, the largest multi-specialty physician practice in the D.C. area, delivering care through 51 medical and surgical specialties, while using the Allscripts Enterprise EHR.
The leaders of The GW Medical Faculty Associates have chosen SA Ignite, a Chicago-based provider of software solutions that streamlines, automates, and tracks the achievement of meaningful use of electronic health records (EHRs), for its reporting needs. The company’s MU Assistant product is a cloud-based solution that relives provider organizations of duties such as keeping track of eligibility, payment year, meaningful use stage, and program type—tasks that can undoubtedly amount to a full-time job.
Attestation is the part of the process to secure the Centers for Medicare & Medicaid Services (CMS) EHR Incentive Program reimbursements that requires providers to prove that they are meaningfully using a certified EHR. Physicians who show meaningful use of a certified EHR for Medicaid are eligible for up to approximately $64,000 in extra payments from CMS and beginning in 2015, while providers who do not attest to meaningful use are subject to financial penalties.
SA Ignite started out by working with regional extension centers out of the Office of the National Coordinator for Health Information technology (ONC), and when it became known that achieving meaningful use would be a very manual process with a lot of steps involved—including the threat of audits—the company expanded, now partnering with more than 50 organizations on 16 different EHRs, said SA Ignite CEO and founder Tom Lee.
The GW Medical Faculty Associates' CIO Praveen Toteja recently spoke with Healthcare Informatics Assistant Editor Rajiv Leventhal about the benefits of working with SA Ignite, the complexities of meaningful use attestation, how provider organizations can automate their data to help them feel more prepared to handle Stage 2, and other challenges associated with the meaningful use process. Below are excerpts from that interview.
How specifically does your meaningful use tracking vendor help with monitoring and attestation? How does it confront the complexities of meaningful use data management?
In 2012, as our providers wavered in and out of compliance for any given meaningful use measure and rumors of a slow CMS attestation site were buzzing around the ambulatory community, I knew that if we were going to maximize our incentive dollars and not lose $5,000 per physician for missing meaningful use, we needed help. We had a goal of attesting for 100 providers for the 2012 payment year. So I challenged the SA Ignite team: at a minimum, I want to meet the goal, but what can you do to help us beat it?
There are a few key benefits that we experience in working with SA Ignite. First, we needed a view into every future and past 90-day period since upgrading to the certified system. By back-loading data for the entire last quarter of 2012, The GW Medical Faculty Associates' managers were able to see daily 90-day windows and pinpoint compliant providers who were only compliant for minimal compliant periods. Second, it gave us the capability of submitting final results to CMS by click of a button. Initially, we had to do everything manually with the first provider we worked on. That took days actually, and another one took 40 minutes to submit all the numbers. With SA Ignite, we were quickly able to click a button and transmit data for hundreds of providers at a time.
By early 2013, we doubled our goal and attested for 201 providers. Exceeding the goal did not create additional work, and with the streamlined attestation process, we had most of our providers attested prior to the end of the calendar year. We earned $1.8 million in unexpected incentives, $500,000 of which would have vanished based on the structure of the meaningful use program, and $1.3 million of which would have hopefully been captured in 2013. Factor in staff time savings, and we calculated a return on investment (ROI) in excess of 450 percent (according to a case study done with SA Ignite). That means the investment paid itself back in roughly two months. That doesn’t even factor in benefits on the audit side or accelerating the $1.3 million to 2012.
Prior to using this software, how did you manage to work through all of this?
The biggest issue was the frequency of running reports for each provider, managing them on spreadsheets, figuring out who qualified at what point, or where they lacked. All that become very transparent with SA Ignite—they would have the numbers that would tell us what we needed to know. Don’t take this the wrong way, though— we are trying to get all of our providers to do everything, but with more than 900 of them, it’s hard to get everyone to make all the changes that meaningful use requires. The key thing was to find out when they qualified. We never said, “You are already qualified, so you can stop doing this or that.” That never happened.
As far as the complexities that go along with Stage 1 and Stage 2, some people think it’s complicated and a lot of work. The way I see it, it’s better patient care. Yes, there is more responsibility on the clinicians, but when you discuss with them that the end result is better patient care, they subscribe.
What are other challenges providers face when it comes to achieving meaningful use?
From my perspective, it’s mostly about the additional work put on the provider to capture everything. All of this really makes a lot of sense, but there is additional work which they have to do. For what providers could do in three minutes now takes seven. There is a difference between 20 patients a day and 40. People think the EHR and meaningful use should have reduced work, and I understand that. We try to give them easier ways of doing it, and we tell them that that it gets easier the next time they do it. Building their confidence is a big part of all this. I do feel bad though that they do have to spend more time on it. Other systems have nurses do a lot of the work, so they don’t feel the pain as much, but here, providers do everything.
Also, there is often a limited staff that has to do everything. There is not just meaningful use, but ICD-10, patient-centered medical homes (PCMH), and other initiatives. There is a shortage of 50,000 health IT workers in the country, so really good talent is hard to find. And once you launch something major like meaningful use, you will have your best people allocated to it. But those people also have to move on to other things like ICD-10. So how do you put this ongoing massive project into more of an auto pilot mode? Organizations wrestle with that all the time.
What can organizations do to better handle Stage 2?
We know what we’re doing wrong, and we try to fix everything we can. But there is a limitation on how much you can push. Eventually, this is going to have great results for patients and providers, but it is a painful process right now. As long as our providers are aware of that, it’s ok. I have yet to found a provider who doesn’t do it or doesn’t want to do it—the only real issue/complaint is the time it takes. And it’s not just one EHR; completely different systems have the same problems.
There has been plenty of recent negative reaction when it comes to timing issues within meaningful use, from industry associations as well as politicians. What are your thoughts on that?
I try to ignore a lot of it, unless it becomes a rule or law. Frankly, it doesn’t concern me. If you sit down and look at the [program], most of it comes back to the basic notion of better patient care, albeit at the expense of clinicians doing extra work. These same discussions took place about Stage 1. I have not followed these discussions, and personally, I think we need to move on. As far as delaying it or pushing forward, my stance is neutral. I’m sure lots of hospitals aren’t ready, and that might be a good enough reason to delay it. In my eyes, improved patient care needs to happen, and it doesn’t matter if it’s 2014, 2015, or 2016. But it has to happen.