Reviewing Meaningful Use

Presenters: Steven E. Waldren, MD, Director, Center for Health IT at the AAFP; David Kibbe, MD, Senior Advisor, Center for Health IT at the AAFP; Jason Mitchell, MD, Assistant Director, Center for Health IT at the AAFP

This session reviewed the background of meaningful use, eligibility, measures, the path forward, and the regional extension program.

In his opening remarks on meaningful use, David Kibbe, MD, said, “This program is changing the design and future of EHRs.” Through meaningful use, EHRs are now certified, being designed better, and price points are being established.

Steven Waldren, MD, walked the audience through the lecture starting with eligibility. He explained that eligible professionals have the option of choosing to implement meaningful use through Medicare or Medicaid, and highly recommending that physicians choose Medicaid. However, it is important to note that in order for a physician to use Medicaid, he/she is required to have 30% of patients on Medicaid in order to be eligible. Although physicians have to choose one option, they do have the opportunity to switch once during the process.

Choosing Medicare

If a physician decides to go with Medicare, they have a chance to receive a maximum of $44,000 for meaningful use, so long as the process has started the meaningful use process in 2011-2012. Starting the process after 2012, the maximum incentive is no longer available. The Medicare program is going to be operated by the federal government—CMS—which might sway physicians from choosing this option.

Choosing Medicaid

Physicians who start the meaningful use process will receive $21,000 of the $65,000 maximum incentive upfront. Waldren explained that the rational for why Medicaid is a better option is because it’s considered to more of a social good. Another benefit is that it will be operated by individual states versus the federal government; however, some states may opt-out of the program. That being said, physicians need to keep regular tabs on their state’s decision.

An attendee asked why physicians cannot participate in both Medicare and Medicaid. Waldren commented, “I think they do not want to give you all of that money,” which garnered a laugh from the audience. He explained that there was a certain amount set aside, so physicians can only choose one or the other.

Waldren said they are confident that the majority of physicians will start in 2011-2012. When he asked how many of the physicians in the room would start implementing meaningful use in 2011, an overwhelming majority of the physicians raised their hands. When asked how many would not start in 2011, maybe five hands went up. Perhaps this is because they want to avoid having to pay the penalty fees that will start in 2015.

Criteria for meaningful use

There are two criteria groups that physicians will use as a guideline to implement meaningful use: Core group and Menu Group. The Core group is a list of requirements that physicians must accomplish all aspects, whereas the Menu group only requires physicians to do five. Waldren said it’s their belief that the Menu group will become the Core group for Stage 2.

Examples of the Core Group Requirements

• Must have 30% of unique patients with at least one medication on the list entered into CPOE.
• If a patient requests an electronic copy of health, physicians are required to send 50% of them electronically.
• ePrescribing — 40% of prescriptions are to be sent electronically

Examples of the Menu Group Options

• Medication reconciliation needs to happen 50% of the time
• Drug formulary check needs to be turned on
• Generated patient lists which will allow physicians to identify individual patients based on disease state
• Establishing patient reminders
• Providing patient education

Moving forward

It is important for the physician to make the decision based on what’s right for his/her practice and patients.

The HITECH bill also authorized funds for developing regional extension centers. There will be 60 centers that will offer resources and assistance to rural practices, small practices, and primary care physicians on implementing meaningful use.

For physicians who are ready to take the next step in meaningful use, Waldren and the Center for Health IT team recommends that they contact the regional extension center, watch for updates on state decisions regarding Medicaid, explore the official CMS website, and determine patient volume—do you have 30% Medicaid patients?

What was probably the most educational and interesting part of this session was the Q&A. There were some great questions asked and comments made by attendees. The comment that really hit home was when an attendee said, “I need a reason other than money to do this.” How many physicians have asked themselves this very question? How about this question, “What is the government going to do with all of this data?” Part of meaningful use requires physicians to report the performance and quality on all patients to the government.

Docs: What do you think about meaningful use? Will it be beneficial to your practice or a hindrance? Please share your comments.