Wondering About EMR Meaningful Use and How to Get Paid?

I recently received a request to help decipher this thing called "Meaningful Use", which has the health care community all abuzz. It's an incentive program that has been laid out by the federal government to promote the transition from paper medical records to electronic medical records and will pay either $44,000 or $63,750 over a five year period to those who meet certain requirements.

EMR has long been touted as the holy grail of cost containment and was a big part of the federal health care reform debate. Now it's just being touted because going electronic is always better! And after a little research I came across this short description of how quality measures need to be reported from an EMR system (one of several requirement to meet Meaningful Use requirements and get paid). The blurb below is how the Centers for Medicare and Medicare (CMS), who is coordinating the national health IT movement, describes the endeavor. 

Good luck deciphering this one and good luck to all the future 'meaningful users' out there!

Eligible Professional Clinical Quality Measures

Instructions for Reporting Numerators, Denominators & Exclusions

Each clinical quality measure includes specifications for the numerator, denominator and also indicates if there are any exclusions for the measure as described in the measure specifications. Each measure requires reporting one or more numerators and one or more denominators. Although the denominator population may not change for a measure, when there is more than 1 numerator, it is required to report the denominator each time. Conversely, when the denominator population is stratified but there is only 1 numerator in the measure, the numerator must be repeated for each subset of the denominator population. See attached table which depicts the number of numerators and denominators required for reporting. This table also identifies if exclusions may be reported and the field type required for each numerator, denominator and exclusion, if applicable.

The following measures require reporting more than one numerator (NQF Numbers 0064, 0027, 0421, 0024, 0033, 0036, 0038, 0075, 0004, and 0105). If a measure has more than one numerator, than all numerators must be reported and there must also be a denominator reported for each numerator (even if the denominator population remains the same for the measure). Therefore the number of numerators reported will always equal the number of denominators needed for reporting regardless of whether the denominator remains the same for a measure or it changes (e.g., denominator population is stratified by age) and results in more than one denominator for the measure.

(Table not included, but not useful anyway.)

Put Doctors on Salary, Survey (by Commonwealth Fund) Says

Here's an interesting article that will surprise few that follow the Commonwealth Fund's work. For the unfamiliar, the Fund does extensive health policy research and is regularly commissioned by the states to support their policy development efforts. Familiar or unfamiliar, the article is worth reading since it gives a glimpse into an idea that, for better or worse, is gaining steam: End the independent physician practice and put everyone on salary.

The NY Times ran a story which mirrors this theme earlier this year and highlighted that "an increasing share of young physicians, burdened by medical school debts and seeking regular hours, are deciding against opening private practices. Instead, they are accepting salaries at hospitalsand health systems. And a growing number of older doctors — facing rising costs and fearing they will not be able to recruit junior partners — are selling their practices and moving into salaried jobs, too."

Apparently, the Commonwealth Fund decided to put some numbers behind the anecdotes. Note they do not list independent physicians on their list of groups surveyed. Makes you wonder...

Put Doctors on Salary, Survey Says
October 26, 2010

The healthcare system would be much improved if physicians were all on salary, according to results from a survey by the Commonwealth Fund.

"The way we currently pay for healthcare leads to unnecessary confusion and wide variation, and sometimes borders on chaotic," said Commonwealth Fund president Karen Davis, PhD.

"Experts agree that if private payers and public programs could come together and agree to pay the same way, and the same amount, we can improve the efficiency of our healthcare system, eliminate administrative waste, and create better experiences for patients," Davis said.

The Commonwealth Fund, a left-leaning think tank, and Modern Healthcare magazine commissioned Harris Interactive to survey healthcare academics and researchers; leaders in healthcare delivery, business, insurance, and other health industries; and key players in government, labor, and advocacy groups.

A total of 190 experts participated in the survey, which was conducted between Sept. 7 and Oct. 6. The results were summarized in a brief written by Kristof Stremikis, MPP, Stuart Guterman, MA, and Davis. All three authors work for the fund.

When asked whether they supported salaried medical practice with "appropriate rewards for quality and prudent use of resources," only 11% said they did not.

Nearly three-quarters (73%) said they supported salaried practice with rewards for both quality and resource use. The remaining 16% supported salaried practice with rewards for quality, "but not connected to prudent use of resources," the authors noted.

Nearly half of respondents (49%) agreed that it was "important or very important" for patients to choose services and providers on the basis of cost.

Respondents also agreed that the reimbursement system needs to be simplified.

"Currently, public and private health insurers engage in a complex and continuous process of negotiations with multiple healthcare providers to establish reimbursement rates for services," the authors noted. "This increases administrative expenses among payers and providers and leads to wide variation in prices."

Related to that, 56% of survey respondents said they supported replacing the current system with either all- payer payment rate setting or a single system of payment rate negotiation on behalf of all payers.

Another 23% of respondents supported letting each provider set its own prices, where insurers would pay the lowest price and patients would pay the difference in cost for seeing higher-priced providers.

Just 9% of respondents supported keeping the current system.

Survey respondents also supported several other changes to the reimbursement system, including "value- based benefit design," in which cost- sharing for individual services varies based on the established effectiveness and potential benefit of the treatment or service; and "reference pricing," in which insurers and public programs pay for a drug, device, or service based on the lowest price of equally effective treatments.

Just over half of respondents (53%) of also supported using tiered networks, in which premiums for enrollees would vary based on the level of spending by the hospitals, physicians, and other providers they used.

The survey also asked respondents about transparency in healthcare pricing. Nine out of 10 respondents agreed that it was important for the public to have information on clinical quality, prices, and patient experiences.

"Such information could be used to encourage physicians to meet local and regional benchmarks, allow public and private payers to become more prudent purchasers of care, and to empower patients to identify and receive care from high quality providers," according to a statement from the Commonwealth Fund, which also noted that the new healthcare reform law, the Affordable Care Act, contains provisions aimed at increasing transparency.

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