Are you prepared for meaningful use mandates?

New York - Among the most troublesome stage 2 requirements of the Medicare and Medicaid EHR Incentive Programs is the requirement that 5 percent of patients use the Internet to communicate with practices, an expert says.

Mark D. Kaufmann, M.D., says, “The most onerous change by far in stage 2 is that you’re no longer judged only on what you’re doing - your patients have to start participating with you in order for your practice to comply with stage 2.” Dr. Kaufmann is an associate clinical professor, department of dermatology, Icahn School of Medicine at Mount Sinai, New York. He spoke at the summer meeting of the American Academy of Dermatology.

“And this communication has to be something other than, ‘Can I make an appointment?’” Meeting this mark requires a patient to check a pathology report online, for example, and then request a callback to discuss it.

“That sticks in the throat of many physicians. It’s one thing to tell us what we have to do. It’s another thing to tell us we must convince our patients to do something they may not want to do. This will be a difficult obstacle people have to confront in stage 2,” and many of them don’t know it.

Fortunately, Dr. Kaufmann adds, acceptable solutions include installing a kiosk in one’s waiting room and asking patients on their way out to send a query via this technology.

“Additionally, there’s no rule against physicians initiating the contact. If a pathology report comes in, someone on your staff could go through the patient portal and say, ‘Mr. Jones, if you log into the portal, you’ll see your pathology report from last week. Please verify (online) that you’ve seen the report, and contact us if you have any questions,’” Dr. Kaufmann says.

Confusing subtleties

Requirements for stage 2 of meaningful EHR use also contain potentially confusing subtleties, Dr. Kaufmann says. For 2014, he explains, any practices that have done two years or more under stage 1 of the program automatically will be considered stage 2. And in a practice’s first year under stage 2, he says, the 90 days of meaningful use required to qualify for incentive payments must constitute a consecutive calendar quarter, which was not the case in stage 1.

Additionally, “A lot of what was optional in stage 1 becomes mandatory in stage 2.” More specifically, the number of required measures remains 20, as in stage 1. But in stage 2, the number of mandatory core measurements rises from 15 to 17. The percentage targets that practices must hit in these areas also increase, as do the number of quality measures required (from six of 64 in stage 1, to nine in stage 2).

Overall, Dr. Kaufmann says that with the amount of blowback from physicians, vendors and others that these changes have generated, “There’s still a chance we won’t see full stage 2 implementation on time.” It’s already been delayed once, he adds.

Changes to watch for

Other key stage 1 changes include alterations to requirements for recording patients’ vital signs. Most relevant to dermatologists, Dr. Kaufmann says, is the provision that physicians can skip height and weight documentation if they believe these data are irrelevant to their practices. “Many dermatologists - especially surgical dermatologists - take blood pressure on many patients, but never height and weight.”

Previously, Dr. Kaufmann says, physicians who failed to provide height and weight along with blood pressure (for at least half their patients) would have failed the vital sign requirement.

“For 2013 and beyond, the Centers for Medicare and Medicaid Services (CMS) have allowed specialists to parse out which vital signs are relevant to their practice and which are not,” he says.

Regarding recent CMS data, Dr. Kaufmann says he finds it shocking that 17 percent of practices that qualified for meaningful use incentives in 2011 dropped out of the program in 2012.

“That doesn’t bode well for stage 2, as it is a major leap from stage 1,” he says. As more practices reach stage 2, he adds, the dropout rate likely will surge.

Meanwhile, Dr. Kaufmann advises caution in attesting to Medicare’s physician quality system (PQRS), as well. CMS data show that in 2011, 22 percent of dermatologists met these goals, earning average bonuses of nearly $4,000 - among the highest for any specialty. However, “The intent of the PQRS program was not to make dermatologists richer. Be aware that these numbers are going to be on CMS’ radar screen, and measures may be adjusted,” especially if the number of participating dermatologists increases and their average bonus remains relatively high.

Disclosures: Dr. Kaufmann is a medical advisory board member for Modernizing Medicine Inc.