Several months before attesting for Stage 1 of CMS' meaningful use EHR incentive program, solo internal medicine physician Bob Fishman brought home armfuls of patient charts to enter data on the people he was seeing for the next two days.
"I would enter in their meds, their allergies, when their last colonoscopy was," recalls Fishman, who practices in South Hadley, Mass. "I did that for, like, three months."
The extra hours paid off in March 2012, when Fishman, who worked with a representative from the Massachusetts eHealth Collaborative (New Hampshire's regional extension center and an Implementation Optimization Organization for Massachusetts providers), received his first incentive check of $18,000 from CMS.
"It was a big, long, hard road for me, but I feel that I really accomplished something, and I really feel that I've earned my first installment of that $44,000," he says.
And although Fishman expects Stage 2 to go much more smoothly, as much of the burden of change will be on his EHR vendor, eClinicalWorks, chances are he'll have to put in some serious work before CMS hands him check number two.
"In Stage 2, they want you to send data electronically, and there's a subtle but real difference between data being faxed and data being sent in a digital domain," says Fishman. "We're now beginning to embark on the health information exchange and the patient portal."
As of December 2012, more than 82,000 eligible providers (EPs) have attested for Stage 1 and received the first check out of a potential total of $44,000 in Medicare incentive payments per provider (or out of a potential $63,750 for those who attested for the Medicaid program), according to an Office of the Inspector General (OIG) report. (To see a detailed timeline for the stages of meaningful use, visit http://bit.ly/meaningful_timeline).
But while the first stage only requires doctors to meet basic goals —demonstrate meaningful use of an EHR by satisfying 15 mandatory core measures, plus a choice of several clinical quality and other objectives — to prove use, Stage 2 will require a much more in-depth level of EHR use. That includes talking to vendors, changing work flow patterns, and taking an inventory of existing equipment to make sure it's up to par (and possibly purchasing new tech tools).
Not sure where to start? Follow this to-do list to get your practice ready to attest in 2014.
To do: Know your objectives
Though the earliest EPs can attest is in 2014, the changes a practice will have to make to be successful in Stage 2 could be monumental.
"Meaningful use Stage 1 was about getting the standardized processes and work flows in place," says Justin Barnes, chairman emeritus of the Healthcare Information and Management Systems Society (HIMSS) Electronic Health Record (EHR) Association, and vice president of marketing, industry affairs, and government affairs at Greenway Medical Technologies. "Meaningful use Stage 2 is about not just capturing the data but moving to improve the quality of care you provide to your patients."
The first thing a practice should do when it embarks on the road to attestation is to familiarize itself with the new objectives. (For details on the requirements, see our "Meaningful Use Stage 2 Crib Sheet," http://bit.ly/MU_cribsheet). Keep in mind, too, that states participating in the Medicaid incentive program may have attestation requirements that vary slightly, such as with submitting data to immunization registries, says regulatory expert Jason Fortin, a senior adviser for Naperville, Ill.-based Impact Advisors. Practices attesting for the Medicaid program, therefore, will want to check with their respective regional extension center (REC) or state Medicaid agency.