Bookmark and Share PrintE-mail
  The Health Record Review
by Patty Enrado


Payers may add meaningful use criteria to physician contracts

Posted on Thu, Jul 08, 2010 - 12:23 am

They say as the Centers for Medicare & Medicaid Services goes, so goes the rest of the payer industry. CMS is close to releasing the final meaningful use criteria. There are rumblings out in the marketplace that commercial payers are putting meaningful use criteria in their physician contracts.

Trying to get physicians to adopt EMRs has been attempted before. The most visible effort is the Massachusetts healthcare reform legislation of 2008. Lawmakers are requiring all physicians in the commonwealth to use EMRs by 2015. According to the president of the Massachusetts Medical Society, general fear and the belief that EMRs didn't fit their workflow were the main barriers to adoption.

In the case of commercial payers, the push for EHR adoption was presented as a requirement for their pay-for-performance (P4) programs. While I don't know the aggregate results of having such a criterion for P4P, the incentives likely were not big enough to justify the cost.

In a few short years, however, things have changed dramatically. In fact, two things have made a significant difference in the industry: The federal stimulus funds that will be administered by CMS and the aggressive move to develop industry standards for EMRs. While the $44,000 amount may be pennies for some of the larger healthcare organizations, it's much larger than previous incentives.

America's Health Insurance Plans (AHIP) says it's not aware of the movement for commercial payers to include an EMR requirement in their physician contracts. Maybe it's not a movement now, but it sounds like there are some that are running with it. Have any physician groups or healthcare systems seen the requirement in their contracts?

Is it a good idea for commercial payers to make it a requirement? If you believe health IT can improve the quality of care and patient safety, and make healthcare delivery more efficient, then yes, it makes sense for all payers to make it a requirement. CMS has a big chunk of the payer market, but it can't successfully move the industry to health IT adoption by itself.

Photo by joostj.bakkerIJMuiden obtained via Creative Commons license.


Comments

Posted by vswamy on Mon, Aug 02, 2010 - 04:34 pm.

I completely agree with you that just federal reforms are not going to be enough in large scale adoption of IT in the healthcare industry.

Also I think by the introduction of commercial payer, things can get more murky. Already today medical practitioners are looking to avail of this federal incentive by trying to comply with the definition of meaningful use but at the same time EHR providers are looking at their own set of profits.
This misunderstanding is mostly I believe as a result of wrong interpretation of the federal guidelines. The EHR providers need to look at these guidelines from the prospective of the practitioners who deal with different specialties.
Each specialty EHR has its own set of challenges or requirements which I believe is overlooked by in most EHR vendors in an effort to merely follows federal guidelines. This is resulting in low usability to the practitioners, thus less ROI, finally redundancy of the EHR solution in place.
I think ROI is very important factor that should be duly considered when look achieve a 'meaning use' out of a EHR solution. Though one may get vendors providing 'meaning use' at a lower cost, their ROI / savings through the use of their EHR might be pretty low when compared to costlier initial investment. Found a pretty useful ROI tool that is pretty customizable and easy to use. It also accounts for the different specialty EHR's too.

Also the introduction of REC’s through the HITECH act. is a great way to avail of quality EHR solutions at competitive prices. The stiff competition among not only these REC’s but also among EHR vendors ( to become a preferred vendor of a given REC) will result in lot of positives to medical practioners.
Looking the funding provided to the REC’s, the staggered grant allocation system also promises to be an unbiased way of allocating funds. It will also help in the concept of REC’s helping out each with their own unique business models.