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BY STANLEY U. NORTH AND PATRICK J. HURD
COMMENTARY
The prospect of the U.S. healthcare system moving from paper to electronic medical records (EMR) has given rise to a host of thorny questions on matters of privacy, security, logistics and more. Irrespective of those questions, the time to start making the switch is now – in part because the federal government will soon finalize important new guidelines on what healthcare providers need to do in order to "go digital."
At this time, approximately $35 billion in EMR incentives are available through the federal Centers for Medicare & Medicaid Services (CMS). However, healthcare providers – who are required by law to make "meaningful use" of EMR in order to receive $44,000 EMR-implementation grants-have been waiting for the government to clarify the meaning of this term before investing in new systems.
Healthcare providers need not sit on the sidelines any longer. The government published its preliminary EMR guidelines in the Federal Register on Dec. 28, its meaningful use regulations January 13, 2010, and is now in the process of finalizing them. Although new requirements might be added, the benchmarks are unlikely to change dramatically.
Consequently, much of the uncertainty about EMR-implementation has been removed.Medical practices, hospitals and other healthcare providers also should be cognizant of the manifold other reasons to act now on EMR. For example, the legislation that created the current EMR incentives program temporarily relaxed certain regulations that can make it much harder for hospitals to collaborate with local physicians on EMR. With those more stringent regulations set to kick in again after a phase-out period, it only makes sense to act now.
Meanwhile, the beginning of this year brought the inauguration of an aggressive new auditing program created by Congress to ferret out improper Medicaid payments. The auditors, who are paid a bonus based on the amount of money they recoup, have earned a reputation for demanding clear documentation of medical necessity.
If they are unable to read a document because of illegible handwriting, or if the physician's signature is missing on an order, the auditors will likely determine that the procedure in question "never happened." This will likely result in the government payment for that procedure being labeled an "overpayment" and either disgorged by the practice or subtracted from its next reimbursement check.
By contrast, EMR systems, so long as they are properly implemented and effectively used, generate thorough and legible records that can be ideal to support reimbursement claims. EMR also means that, when you are audited and the auditors ask for 20 records, you are not forced to go through boxes of files and take up staff time making photocopies. You have an electronic record that can easily be printed, converted to a PDF file and easily submitted for review.
Healthcare providers taking the EMR plunge need not start with a total conversion of all their operations, as the new federal guidelines allow them to make the transition in three stages. In the first stage, medical practices can self-certify their compliance. In the second, CMS confirms a practice's compliance with its EMR-implementation guidelines.
The third stage requires healthcare providers to integrate their electronic records with the public health system. You have to be "meaningfully using" EMR at the third stage by 2015 or you jump right into a one percent reduction of your general reimbursement revenues in 2015 that grows to a three percent reduction by 2017 and each year thereafter.
Against this backdrop, we recommend that medical practices first consider implementing e-prescription programs, which can cost as little as $2,000. Electronic prescription programs are already widely used by the nation's chain drugstores and will increasingly become a necessity for physicians in any case. They represent a great way for medical practices to get their feet wet prior to diving into the deep end of the pool with a conversion of their records to EMR.
