A physician might qualify for $44,000 in government incentives for meaningful use of an electronic health record – but "if you have a system that's a disaster, who cares?"
That's the opinion of Rosemarie Nelson, a principal of the Medical Group Management Association's Health Care Consulting Group, who spoke to a roomful of physician practice administrators and managers Tuesday at the MGMA's annual convention in Denver.
Nelson partnered with lawyer David Schoolcraft to help the audience navigate the ins and outs of government incentives for using EHRs. They focused on planning and on negotiating contracts with vendors.
Schoolcraft advised healthcare providers to get a commitment from the vendor that the system is going to enable meaningful use now as well as in subsequent years, when the eligibility bar is higher. The system, he said, has to evolve.
"Vendors that are in the space right now are going to have to step it up," he said.
The incentive payments from Medicare, provided over five years under the American Recovery and Reinvestment Act, require physicians to show meaningful use of healthcare IT. Though "meaningful use" does not yet have a final definition, government officials say the bar will be raised each year.
Nelson, who helps physician practices across the country convert from paper to digital records and find the right technology, said planning is critical, and "it has to start with understanding what it is you want to solve."
Nelson's advice includes:
- Understand what you need early on. "Look at how you use the chart in your practice," she said. "Understand where you are going to get the biggest bang in operations for your buck."
- Talk to peers who have already rolled out an EHR – not for product endorsements, but to understand what they went through with their workflow.
- Create a test to assess the practice's readiness for change, coding the factors red, yellow or green. "You should not go like hell, if you're yellow," she said.
- Take it slow. "Big bang approaches are called that because people get shot and they die," she said.
- Create a multi-disciplinary planning team. Don't forget someone from the billing department.
- Set appointments with vendors close together, and think creatively about how to do this without disrupting operations – perhaps by scheduling them on Saturdays and Sundays.
Nelson and Schoolcraft both recommend developing a request-for-proposal from vendors of no more than four or five pages.
Identify three to 10 things that are really critical, Schoolcraft said, and when it's time for rollout, withhold "a meaningful amount" of the contract price until the vendor has met the acceptance criteria. In addition, he said, make sure the vendor response to the RFP is included in the contract.
"It's far easier to deal with those issues when you're holding on to the money," Schoolcraft said.
Nelson recommends hiring a lawyer to help review and negotiate the contract, regardless of the size of the practice. "You wouldn't do other deals without that kind of assistance," she said.
It changes the leverage," Schoolcraft added.
