Pop quiz. Can you list all of your male patients who have PSA levels greater than four, who are between the ages of 50 and 75 and have not had a urology consult?
What about your diabetic patients with hemoglobin A1c levels over nine who are due for a foot exam? Or your female patients overdue for a mammogram?
It’s data like this that your practice must have at the ready for pay-for-performance program reporting. Medicare and private payers are increasingly developing programs to reward physicians based on clinical benchmarks, marking a move away from visit-based service delivery to one of population management. As more payers embrace this approach, practices are looking to technology to help them manage the complex reporting requirements.
Imagine the time and energy it would take to comb through hundreds of paper charts, flipping through each one looking for test results and visit details, and then calling each patient for appointments.
“It’s virtually impossible to readily comply with a P4P program without technology,” says management consultant Bruce Kleaveland. “It’s very, very difficult to get your arms around the parameters and manage it.”
Most EHRs can be configured to run such reports, as long as you have the system fully implemented and are prepared to tailor your work flow accordingly.
But some practices are finding the standard EHRs limiting. Practices and vendors are taking the technology to the next level, adding additional management tools and databases — one doc dubbed the approach “EMR 2.0” — to meet the requirements and become P4P champs.
First stop: EHRs
At Valley Medical Associates in Springfield, Mass., the four physicians and three nurse practitioners are using the practice’s Allscripts EHR to meet the requirements of the Medicare Care Management Performance (MCMP) demonstration, a pilot program for reporting on different measures for Medicare patients.
They are able to run reports based on the program’s requirements, generating lists and reminders.
“We are using our electronic record to be able to document when things are being done and then pull reports off and contact patients to make sure they get [the procedures] done,” says family practitioner P.J. Helmuth.
EHRs allow practices to take an otherwise essentially impossible task — one that would involve endless hours weeding through paper records — and convert it into a two- or three-hour job. “It allows you to take a more proactive disease management and preventive care management approach to the delivery of healthcare,” Kleaveland says.
EHRs can help practices in two major ways, according to Kleaveland. The first is in setting a basic metric by which to track patients’ progress, such as blood sugar levels for diabetics. An EHR can generate reminders and notifications for the physician while the patient is in the office. (Mrs. Jones, have you had your foot exam?)
Second, physicians can tailor the EHR’s templates based on the particular pay-for-performance program. This modification is necessary, considering that each program has different requirements and the metrics continue to evolve. Most CCHIT-certified systems will allow practices to tailor the templates for the program’s criteria, Kleaveland says. He adds “A given provider might have relationships with multiple insurance companies, and the multiple insurance companies don’t always have the same P4P programs. One very legitimate challenge for doctors in complying is their ability to understand the specifics of each program.”
At Helmuth’s office, they’ve had to add a few extra steps to be able to generate reports. Much patient care happens outside of their office — mammograms and colonoscopies, for starters — so his staff has to enter those results into the system (rather than scan them in) so they can become reportable, Helmuth explains. “We have made some changes to work flow to improve numbers and accommodate that,” he says. For the most part, their EHR accommodates their needs, or they can create work-arounds to get the job done.
Another option: registries
Clearly, some practices are finding that EHRs aren’t without their limitations.
EHR systems tend to be more focused on visit documentation, Helmuth says, rather than reporting and disease management functions. “It’s not just being able to run a report; it’s also disease management, and how easy it is to find out which diabetic has not had an eye exam and how to communicate with patients,” he says.
