Regional Extension Centers Help Small Practices Achieve Meaningful Use

April 26, 2011

For small practices, implementing an EHR and achieving meaningful use is a whole lot easier with a helping hand. Newly created regional extension centers are there to provide it. Here’s how to make the best of them.

Peggy Smith, an office manager at a Harlan, Ky.-based practice, and her husband, Carl Smith, a pediatrician, had long since gotten used to using the EHR their practice had in place since 2003. Then, in 2010, CMS shook everything up, launching the now-quite-familiar program that calls on practices to use their EHR system in a "meaningful" way.

Upon closer look at the changes they'd have to make - such as e-prescribing and submitting clinical quality measures to the federal government - the Smiths realized they could use a bit of help.

Enter the state of Kentucky's Regional Extension Center (REC), which dispatched an in-house expert to assist the Smiths so quickly that by press time they were counting the days till they received a substantial Medicaid incentive check.

"She's just done an excellent job," says Peggy Smith, referring to a consultant hired by the University of Kentucky Foundation, the organization that is now the state's official REC. "She's walked us through the steps we needed to go through. I probably wouldn't have been as far along without her."

The consultant employed by the REC helped the Smiths navigate online applications and assessments for the "meaningful use" incentive program, upgrade their EHR software, and bring their practice up to speed with CMS' meaningful use measures. Such one-on-one help usually runs $3,000 to $15,000, depending on who you ask. The Smiths paid just $250.

"They've been invaluable as far as I'm concerned," Smith says. "They've helped us talk with our EHR people to set up what upgrades we needed to be compliant with incentives."

Many small practices like the Smiths' can benefit from similar assistance at a nominal cost by working with one of 62 federal RECs, operations put in place by the Department of Health and Human Services, with help from the Office of the National Coordinator (ONC) for Health Information Technology, and other collaborating organizations.

We can think of a few good reasons your practice, especially if it's a small practice, might want to take a closer look at these local resources.

REC 101

Under direction of the HITECH Act, ONC, in partnership with CMS and other agencies, has funded 62 Regional Extension Centers to help more than 100,000 primary-care providers achieve meaningful use and receive Medicare and Medicaid EHR program incentive payments.

Because small and rural practices have fewer financial and personal resources than their bigger counterparts, HHS states that RECs are focused on giving free and low-cost services to primary-care providers (such as family practitioners, pediatricians, OB-GYNs, and internal medicine).

If you're a specialist, you aren't likely to be eligible for free or low-cost services, notes Bruce Kleaveland, a healthcare IT consultant.

"CMS is only providing financial rewards for primary-care providers in groups under 10 that RECs help achieve meaningful use. There is an allocation of money for the regional extension centers. CMS does not yet reimburse RECs for helping specialists," says Kleaveland. "The government basically said, 'If we just put [meaningful use rules] out there, and don't provide some help, it's possible that the small provider offices, because they're not experienced in healthcare IT, wouldn't be able to take advantage of this program.'"

All RECs are staffed by well-versed healthcare professionals (such as doctors, administrators, and educators) and overseen by established healthcare organizations. For example, the Chicago Health Information Technology Regional Extension Center is a partnership among Northwestern University, the Alliance of Chicago Community Health Services, and more than 40 local and national collaborators focused on health IT adoption within the city of Chicago.

But although all RECs share the same goals of education and assistance, at press time only a handful of states could say they have practices already receiving Medicaid incentive checks.

What to expect

"Am I going to see my incentive payments?" "How much is this going to cost?" "How long is this going to take?"

Those are some of the most common questions Daniel Wilt, program director of the Maryland REC, Chesapeake Regional Information System for Our Patients, says he gets from practices.

Providers from all regions of the country are asking RECs similar questions. That's why every REC's first goal is education on EHRs, CMS' meaningful use measures, state and federal incentives, and similar topics.

In Maryland, Wilt says providers who sign up with the state's REC are encouraged to attend an eight-hour "soup to nuts" seminar on how to select an EHR system that suits the needs of their practice. In Kentucky, practices from nearby rural communities often meet in central locations for group education and question-and-answer sessions, says Carol Steltenkamp, the primary grant investigator for the Kentucky Regional Extension Center.

While there are some slight stylistic differences, the motivation - to help providers navigate a changing, more computerized world - is the same across the board.

"You get the advantage of a pretty smart person holding your hand through a process that most small practices don't have experience with," says Kleaveland.

And just because the REC in your state works with a select number of EHR vendors doesn't mean your practice has to adopt a particular vendor's solution.

"If a physician works with a REC, he or she is not required to go with one of our preferred vendors," says Cathy Costello, the REC coordinator with the Ohio Health Information Partnership (OHIP). "But the benefits are that all vendors that are on a given REC's 'preferred' list have likely met the same set of rigorous criteria to obtain that status, including a lengthy RFP process."

Next steps

Ready to look into working with your state's REC? If your answer is yes, you better be ready to set aside some serious time.

It can take 40 or more hours to attend educational sessions, and work with a REC consultant onsite. But if you don't work with a REC, achieving meaningful use could take a lot longer, and end up being costlier for your practice.

In Ohio, for example, once a practice sets up an appointment to meet with a REC, it’s usually given a practice assessment tool that includes a questionnaire to help their assigned consultant identify what kind of EHR system would fit their needs, says Andrea Perry, a project manager of REC and health information exchange (HIE) services for OHIP.

"That tool would cost about $15,000 if you were to purchase it privately," Perry says, adding that the cost of working with a consultant to help a practice set up an EHR can range from $500 to $3,000.

After an initial assessment, the REC representative will determine the next steps based on the practice needs, which may include assigning a consultant to work one on one. Most practices will need some sort of help from a consultant on an individual basis - some may need a lot of help sketching out their path to achieve meaningful use, others simply need help adjusting various fields in their existing EHR software, and/or converting to a paperless work flow.

"The biggest challenge is the change," says Steltenkamp. "You're going to have to change how you practice, and that's big for every one of us."

Marisa Torrieri is an associate editor at Physicians Practice. She can be reached at marisa.torrieri@ubm.com.

This article originally appeared in the May 2011 issue of Physicians Practice.