May 2008 — Vol. 3, No. 5
In This Issue
- An Editorial Perspective:
EMR Implementation for Small Medical Practices
James Morrow, MD - Quality Measures, Incentives, and Certification of Health IT
Mark Leavitt, MD, PhD
Chair, Certification Commission for Healthcare Information Technology - What's Ahead - Pay for Performance
Karen Bell, MD, MMS - Pay for Performance and Strategies for Success
François de Brantes, MS, MBA
CEO, Bridges to Excellence - Already There…Implemented Health IT
Connecting P4P and the EMR - Already There…Implemented Health IT
P4P Guidelines Becomes Part of the Routine - CCHIT Approves Updated Ambulatory EHR Criteria
- Updated CPHIMS Exam Set to Release June 1
- Davies Application Due Dates and New CHO Award Announced
- Be A HIMSS Member
- HIMSS EMR ROI Calculator
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Davies Application Due Dates and New CHO Award
The 2008 Davies Awards are currently accepting applications for several honors. Visit the recently redesigned Davies Web site to download the pre-requisites and the application. Join the healthcare elite and be recognized for your success in deriving value from your EHR system.
Following are the awards and the respective application submission deadlines:
- HIMSS Davies Community Health Organizations Award—May 30
The HIMSS Davies Community Health Organization Award is a new honor, launched at HIMSS08, and it was designed to extend recognition to community health organizations. HIMSS decided to establish a separate Davies Award for CHOs based on the awareness of the unique characteristics of CHOs and the populations they serve.
For more information, e-mail David Collins, Senior Manager, Davies Awards, or call 703-562-8817.
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HIMSS Healthcare Information Systems Initiative
Patricia Wise, RN, MSN, MA
Colonel, USA Ret'd
Vice President, Healthcare Information Systems, HIMSS
For information on the HIMSS Davies Awards or the Ambulatory Care Initiative
David Collins, MHA, CPHIMS, CPHQ
Senior Manager, Davies Award Program, HIMSS
dcollins@himss.org/703-562-8817
For information on The Digital Office
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Senior Manager, Corporate Communications, HIMSS
jlofstrom@himss.org/312.915.9237
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Special edition: Pay for Performance
The Digital Office looks at Pay for Performance, an initiative introduced in 2005 by the Centers for Medicare and Medicaid to improve patient care and lower healthcare costs.
This issue begins with James Morrow, MD, a 2004 HIMSS Ambulatory Davies Award of Excellence recipient and 2006 HIMSS Physician IT Leader of the Year, calling on his fellow physicians to be part of the CMS electronic health record demonstration project for small medical practices.
Mark Leavitt, MD, PhD, chair, of the Certification Commission for Healthcare Information Technology (CCHIT), shares his thoughts on quality measures, incentives and the implementation of health IT.
Two question-and-answer interviews with P4P leaders provide an update on the progress of this initiative and discussion on how to move forward. The interviews are with:
- Karen Bell, MD, MMS, director, Office of Health IT Adoption in the Office of the National Coordinator
- François de Brantes, MS, MBA, national coordinator, Bridges to Excellence
The Already There…Implemented Health IT column offers a physician perspective on P4P. Read more about the reasons behind and success of this P4P decision.
An Editorial Perspective
EMR Implementation for Small Medical Practices
James Morrow, MD
Vice President/CIO
North Fulton Family Medicine
Atlanta, Ga.
Physicians across America enjoy the use of the most advanced medical and scientific technology in the world in their mission to diagnose and treat patients. They depend on that technology to make decisions that affect entire lives. Yet, when confronted with the decision to implement life-saving health information technology in their own offices, they hold back when it counts. The primary reasons for this lack of HIT adoption are environmental change and money.
Until now, there has been no relief for the financial crunch that these practitioners experience. However, HHS Secretary Michael Leavitt recently announced a CMS electronic medical record demonstration project that will seek out physicians in small practices who are willing to take the plunge into HIT and, into some degree of debt, some degree of risk. These practices will be eligible for significant incentive funding from CMS.
The announcement of this project marks the first time that physicians will have the chance to invest in this technology with some hope of recouping a portion of that capital. This marks a shift in thought process that will certainly move us all to fewer mistakes and deaths due to the current paper chase.
As I sat in the press conference with Secretary Leavitt in Atlanta, it was clear to me that he and his staff are very committed to this project and to this enormous change. In 2004, when North Fulton Family Medicine won the Davies Award for EMR implementation, we had no such opportunity…and I highly encourage all small practices to take advantage of this unique opportunity.
So, now the decision to move forward is in the hands of those who can do the most good with the technology. By lowering the barrier of money, it is now up to the providers to do the right thing. There will never be a time when a practice can implement HIT without cost. There will always be risk. But the time to act is here. Our patients deserve this.
Find out more about this demonstration project at http://www.tennesseeanytime.org/ehealth/documents/EHR-2-20-08.pdf
Quality Measures, Incentives, and Certification of Health IT
Mark Leavitt, MD, PhD
Chair, Certification Commission for Healthcare Information Technology
The newly released report, “Evidence on the Costs and Benefits of Health Information Technology” by the Congressional Budget Office (CBO),1 raised the question: is the simple adoption of health IT sufficient to guarantee the desired outcomes: improvements in quality and savings in costs?
I think most of us in health IT would agree on the same answer the CBO arrived at: while adoption of health IT is necessary for achieving those improvements, it is not by itself sufficient unless there are significant drivers for change. Whether it’s ‘carrots’ – such as financial bonuses – or ‘sticks’ – such as legal mandates – there must be incentives to employ new health IT tools in a way that achieves those better outcomes. This certainly isn’t news for the many healthcare purchasers and payers that have instituted pay-for-performance programs, but I think a more exciting recent development is the recognition that health IT adoption is a logical first step on the way to measuring and rewarding those improved outcomes. Building on pioneering efforts such as the Bridges to Excellence program in the private sector, we now have the highly visible Medicare EHR Demonstration project in the public sector that provides incentives first for adopting certified EHRs, and then for using them to improve quality.
From a health IT certification perspective, the ability of an EHR system to collect and report the data necessary to participate in pay-for-performance incentive programs is a highly desirable feature. Since our first year, functionality in support of this has been part of the CCHIT criteria. But there have still been too many different pay-for-performance programs, with disparate quality measures, and no nationwide standard for data and reporting formats.
Just as HITSP helped resolve issues of conflicting interoperability standards, we are now seeing efforts to reach consensus on standardized quality measures and message formats. If these efforts are successful, CCHIT will be able to ensure that all certified EHR products support those standards. Eventually, periodic quality reporting (and, dare we hope, reimbursement too?) should be as easy as online shopping– a task requiring just a few clicks, with the details accurately and securely handled between your computer system and the merchant, using encrypted transmissions over the Internet.
1Available at http://www.cbo.gov/ftpdocs/91xx/doc9168/05-20-HealthIT.pdf
What's Ahead - Pay for Performance
Karen Bell, MD, MMS
Director, Office of Health IT Adoption
Office of the National Coordinator of Health Information Technology
Department of Health and Human Services
Karen Bell, MD, MMS, provides her thoughts about the CMS demonstration projects, electronic medical records and Pay for Performance.
Q. Is the CMS taking a serious look at Pay for Performance, via electronic medical records, per its four demonstration projects, as it searches a long-term solution?
A. CMS has been directed by Congress to consider Pay for Performance in a budget-neutral environment with the goal of improving quality of care while maintaining budget neutrality. CMS is attempting to meet this challenge with respect to physicians through piloting and evaluation of four different approaches to P4P.
The first of these became operational in 2005 under the authority of the Benefits Improvement and Protection Act of 2000 (BIPA). It was designed to support improved infrastructure and care processes in large (200+) group practices by rewarding physicians for improved health outcomes on a number of consensus-driven quality measures, primarily attributable to primary care. To date, some, but not all, of the practices have been able to reap some of the benefit of associated with cost savings.
The Medicare Care Management Performance Demonstration is a three-year
P-4-P program launched in 2006 that targets small- to medium-sized primary care practices in four states: California, Utah, Arkansas, and Massachusetts. In addition to bonus payments for the same quality measures used in the large group practice P4P demonstration project, these physicians receive an added bonus if health information technologies contribute to the quality improvement effort.
Most recent in this group is the EHR Demonstration Project, about to be launched in June 2008, under the direction of Secretary (Michael) Leavitt. This differs from the earlier projects in that it recognizes the importance of certified EHRs as a critical infrastructure for sustained improvement in quality measurement results and bonuses physicians at the start for reporting on the use of various functionalities of certified EHRS. The bonus structure migrates to reward reporting on quality measures, then to improved outcomes on these measures. The quality measures themselves are similar to those of the predecessor projects, and the target audience is small- to medium-sized physician offices.
Last, but not least, is the Physician Quality Reporting Initiative. PQRI was developed under the authority of the 2006 Tax Relief and Health Care Act. Its 119 quality measures cover a broad range of physician specialists in addition to primary care and include two "structural" measures: use of e-prescribing and use of an electronic health record. The bonus can be up to 1.5 percent of an individual physician's total allowed charges for a given calendar year.
Read more.
Pay for Performance and Strategies for Success
François de Brantes, MS, MBA
CEO, Bridges to Excellence
Here is another look at P4P from François de Brantes.
Q. Is the CMS taking a serious look at Pay for Performance, via electronic medical records, per its four demonstration projects, as it searches a long-term solution?
A. CMS is taking a very serious look at P4P and transparency, and not just through its demos. I think that the opening up of registries and other medical record data "infomediaries" as reporters of PQRI measures is a huge step in creating the practice-based performance feedback mechanisms that have been absent in health care. The demos are really designed to show proof of concept that transformed practices provide more effective and efficient care. Bridges to Excellence will publish a paper in September supporting this concept, so I'm pretty confident that the demos will yield good results. But beyond that, the message of PQRI measure reporting through EHRs sends the signal that practices that have these systems can leverage them for P4P efforts.
Q. How will vendor consolidation impact the industry? Will it result in standardized reporting mechanisms?
A. Vendor consolidation was an inevitable step in the maturing of the industry. Every sector of the economy has gone through consolidation as part of its maturity, and HIT is not different. Over time, it might help in standardizing reporting functions and mechanisms, but remember that vendor consolidation is only one part of that equation. The other part has to be some standardization in what measures are used, such as hemoglobin A1C control for people with diabetes. What criteria are applied for a standard that calls for an A1C that is “less than 7 for at least 40 percent of diabetics”? How would this and other criteria be weighted in an overall performance assessment program? That second part of the equation will take quite some time to be standardized, and it might never be. So my continued recommendation on this issue is for the vendors to standardize the input and storage of key data elements so that the exportation of those data can be standardized and then the rest of the measurement process can do its thing.
Already There…Implemented Health IT
Connecting P4P and the EMR
Valley Medical Associates
Springfield, Mass
Valley Medical Associates is an urban primary care medical practice serving patients in western Massachusetts since 1996. Five physicians established the practice after completing their residency training in internal medicine and pediatrics at Baystate Medical Center. Located in Springfield, the third largest city in Massachusetts, Valley Medical Associates serves a culturally and socio-economically diverse patient population.
In 2005, one of the physician owners observed that managed care organizations pursued contract renewals with pay-for-performance incentives rather than rate increases. He recognized this trend while serving as a member of the contract review committee for the local physician hospital organization, Baycare Health Partners. The practice’s physician owners agreed that investing in improved office technology made sense and set out to implement an electronic health record (EHR) to improve disease management tasks among other goals.
Without a functioning EHR, practices face great challenges in achieving P4P goals. For example, many managed care organizations include breast cancer screening as a target for quality care measurement and provide incentives for increasing mammography rates. It would be time- and cost- prohibitive to report and document up-to-date breast cancer screening for the practice’s entire population of female patients over age 40.
Read more.
Already There…Implemented Health IT
P4P Guidelines Becomes Part of the Routine
Gail Cetto, RN
Office Manager
Grove Medical Associates
Worcester, Mass.
Pay for Performance participation and health information technology use have resulted in significant revenue increases to Grove Medical Associates or GMA. The increase in insurance claim reimbursements and P4P has resulted in a revenue increase of 15 percent in 2005, 18 percent in 2006, and 23 percent in 2007.
Another less tangible result of P4P has been a heightened focus on preventative measures. This further illustrates the link between healthcare IT and P4P.
For example, with patients who were flagged as needing a colorectal screening, the patient participation in completing the colonoscopy exam was approximately 50 percent, before implementing our EMR. The practice was recently informed that our Massachusetts Health Quality Partners rating was 72 percent completion of colorectal screenings for 2007 (post EMR). The eClinicalWorks EMR system makes it easier for the GMA staff to provide patient education and consistently follow-up on each encounter, which I resulted in the increased compliance to this important preventative procedure.
GMA provides P4P data directly from our EMR system. The report cards provided by the Medicare Care Management Performance (MCMP) demonstration project provide an accurate and helpful tool for improving the quality of care. Physician providers and staff all contributed to this project and all review the report cards.
The improvements in revenue and patient care definitely have made P4P worth the time investment. It took about 60 minutes as a group to discuss and agree upon what preventative measures needed to be mapped into the EMR. These measures are consistent with the National Committee for Quality Assurance (NCQA) standards, in most cases. The actual task of configuring the alerts took another 30 minutes.
Adhering to P4P methods is routine now. The implementation of both P4P and an EMR helps us to be highly accurate and to adhere to an efficient and systematic approach.
CCHIT Approves Updated Ambulatory EHR Criteria
CCHIT has finalized its updated requirements for ambulatory (office-based) electronic health records (EHRs). Products that comply with 100 percent of these criteria will receive the CCHIT Certified® 08 Ambulatory EHR designation. The final criteria, test scripts, and associated documents have been posted to the Certification Commission's Web site at www.cchit.org/certify/ambulatory. The first round of applications for certification under the Ambulatory EHR 08 criteria will be accepted from July 1 to July 14, with results announced in October, followed by additional application windows later in the year. Additional information for vendors, including a certification handbook and other information on how to apply, will be published in the next few days. Read the complete news release.
Updated CPHIMS Exam Set to Release June 1
HIMSS has updated its Certified Professional in Healthcare Information and Management Systems (CPHIMS) exam, available June 1, to reflect current professional practice and incorporate a global healthcare information and management systems perspective. The CPHIMS program grants the premier credential in the industry.
Content in the updated CPHIMS exam focuses on the following topics: General Healthcare and Technology Environments; Systems Analysis; Design; Selection, Implementation, Support and Maintenance; Testing and Evaluation; and Privacy and Security; and Administration Leadership and Management.
The CPHIMS exam is administered at AMP Assessment Centers throughout the world; organizations, healthcare facilities, HIMSS chapters and other groups may schedule a special onsite group administration of the exam. HIMSS is offering the updated exam in conjunction with the HIMSS Summit08, June 9-10 at the Renaissance Washington, DC Hotel; exam registration is open through May 28. Please note: candidates are not required to register for the Summit08 in order to take the CPHIMS exam on June 9 or 10.
Click here for additional CPHIMS information, including the CPHIMS Candidate Handbook
New CPHIMS Study Tools Now Available
In conjunction with the new CPHIMS exam, HIMSS has developed three updated study companions to maximize candidates’ exam preparation and optimize exam success. All three updated tools were developed using the content outline for the new CPHIMS exam.
The CPHIMS Self-Assessment Exam (SAE), an online tool, helps simulate the CPHIMS exam in format and content. The SAE offers useful feedback to future test-takers and includes a rationale for correct and incorrect responses. Feedback reports identify test takers’ strengths and improvement areas. Click here to purchase the SAE or see the free SAE demo.
Preparing for Success in Healthcare Information and Management Systems: The CPHIMS Review, available in both book and CD ROM, is the perfect study partner, withsample multiple choice questions and a glossary of acronyms, and the most current and comprehensive overview in healthcare information and management systems today. Choose either the book or CD ROM format to meet your learning needs
The CPHIMS review book and CD be purchased online or by calling 312-664-4467.