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Smaller practices offered assistance in implementing EMR systems
CMS Web-based program offers technical support, will include lessons on patient management of chronic disease. Part 5 of a series.
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The technical support that is critical to helping solo, small- and mid-sized practices get off the ground with electronic medical record systems could become a reality.
The Centers for Medicare and Medicaid Services recently implemented a Web-based educational program to help practices implement electronic medical records (EMRs).
The Doctors’ Office Quality Information Technology University (DOQ-IT U) is designed for solo and small- to medium-sized practices, a CMS news release said.
In 2004, President Bush called for a majority of physicians in the United States to implement EMRs by 2014. Various federal initiatives are designed to promote the safety, security and interoperability of EMR systems and certify EMRs for use in primary care and specialty practices.
DOQ-IT U is a component of the Physician Focused Quality Initiative. The initiative is designed to assess care quality and clinical conditions for Medicare patients, support appropriate treatment, prevent avoidable medical problems and explore the concept of pay-for-performance (P4P), the CMS release said.
 John B. Pinto |
The new program offers a broad curriculum that includes office workflow redesign, culture shifting and communication needed for successful EMR adoption. The program will also include lessons on patient management of chronic disease and will eventually offer continuing medical education and continuing education units, the release said.
“CMS is pleased to launch DOQ-IT University, the first of its kind e-learning platform, to provide assistance to physicians across the United States in the adoption and implementation of electronic heal records and care management processes,” Leslie V. Norwalk, acting CMS administrator, said in a press release. “DOQ-IT U’s interactive platform, self-paced curriculum and associated tools provide physicians with easy access to the resources they need to help ensure that patients receive the highest quality of care at all times.”
A recent Commonwealth Fund study highlighted small practices’ lower rates of EMR use. According to study data, only 13% of groups with one physician “routinely” or “occasionally” used EMRs. Larger groups used EMRs more often. For example, 23% of groups of two to nine physicians, 35% of groups with 10 to 49 physicians and 57% of groups with 50 or more physicians used EMRs regularly or on occasion, the data showed.
Health IT as a performance measure
The use of health IT is the fastest growing measurement in P4P initiatives, according to a National P4P Study conducted by Med-Vantage, a medical management consulting firm. Study results showed that the number of programs including health IT as a measurement grew almost 40% between 2003 and 2004.
The study included 57 performance-based bonus plans sponsored by commercial health plans, 12 Medicare plans and other plans.
The Integrated Healthcare Association manages a large P4P initiative that started “live” measurement in 2003 and currently comprises seven major health plans and 225 physician organizations serving more than 12 million enrolled patients.
In a recent press release about P4P results for 2006, the Integrated Healthcare Association announced significant increases in the use of clinical IT capabilities by participating physician groups to support both patient population management and treatment at the point of care. Furthermore, program results demonstrated that groups achieving maximum scores in clinical IT measures also had higher scores for clinical measures. On average, clinical performance measure scores were 19% higher for groups with the highest level of clinical IT scores as compared with groups that had the lowest clinical IT scores.
The Integrated Healthcare Association’s P4P measurement set comprises three domains: clinical, patient experience and IT investment. The latter domain accounts for 20% of participants’ performance scores, according to an article by executive director of the Integrated Healthcare Association Tom Williams and colleagues published i n the Journal of Medical Practice Management.
CMS has implemented several P4P demonstrations, such as the Premier Hospital Quality Incentive Demonstration, Physician Group Practice Demonstration and Care Management Performance Demonstration. The latter initiative was implemented in Arkansas, California, Massachusetts and Utah. It was designed to be a pay-for-reporting initiative in 2007, its first year, and shift to P4P in ensuing years, according to CMS.
Health IT is particularly useful for performance measurement, the hallmark of P4P, Mr. Williams said.
“The availability of electronic medical records makes clinical performance measurement much easier, more robust and potentially less expensive,” he said. “There appears to be a parallel track between improved performance and the development of electronic capabilities to support patient care and management. To what extent this improvement is the result of better care vs. better data collection is an open question; however, it appears to be a function of both. The notion of paying direct incentives for groups that implement electronic medical records and other clinical IT, I think there’s a place for it.”
‘Modest’ benefits, potential pitfalls
OSN Practice Management Section Editor John B. Pinto was less optimistic about health IT as a payment incentive. He said pay-for-reporting yields “modest” benefits, only a few thousand dollars per physician annually.
“If you look at the work that you would have to go through if you don’t have an EMR system, in order to track that data, the labor probably wouldn’t be compensated by these modest payments at this point,” Mr. Pinto said. “If you already have an EMR system, then obviously it makes sense to be reporting. If you don’t have an EMR system … getting paid for reporting is not in and of itself a sufficient driver to shift to EMR.”
Currently, physician quality and care pathways are evaluated on a peer-reviewed basis, Mr. Pinto said. He echoed some providers’ concerns that in the future, when reporting and transparency are mandatory, a “kind of creeping Big Brother-ism” will subject practices to undue scrutiny.
“When pay-for-performance is mandatory and when EMR is universal, it’s going to be like every provider having their board exams re-scored every month,” Mr. Pinto said. “In a way that is not present in any other professional domain, there will be absolute transparency in what you are doing.”
Automation will make “micromanagement” and complete transparency possible, Mr. Pinto said.
“That kind of micromanagement doesn’t happen today because it would take a human reviewer,” he said. “It will happen in an almost cost-free manner in the future when computer software is written that allows the algorithms to look at every doctor’s care pathways.”
For more information:
- John B. Pinto can be reached at J. Pinto & Associates Inc., 1576 Willow St., San Diego, CA 92106; 619-223-2233; fax: 619-223-2253; e-mail: pintoinc@aol.com.
- Tom Williams, executive director of the Integrated Healthcare Association, can be reached at the IHA, 334 Thomas L. Berkley Way, Suite 350, Oakland, CA 94612; 510-208-1740; fax: 510-444-5842; e-mail: twilliams@iha.org.
References:
- The Centers for Medicare and Medicaid Services news releases are available at: www.cms.hhs.gov.
- The Med-Vantage National P4P Study is available at: www.medvantage.com.
- Williams TR, Raube K, Damberg CL, Mardon RE. Pay for performance: its influence on the use of IT in physician organizations. J Med Pract Manage. 2006;21:301-306.
- Matt Hasson is an OSN Staff Writer who covers all aspects of ophthalmology. He focuses on regulatory, legislative and practice management topics.