by Maged Mikhail
If you read Part I of this article which appeared in the Fall 2010 issue, you probably understand a little bit more about how the stimulus program affects phlebologists. The article gave advice about how to properly evaluate and implement an electronic medical record (EMR), discussed what meaningful use actually is and how to maximize your incentive. While most physicians dictate and some of you are still using pen and paper for documentation, the stimulus package has been designed to motivate you to switch to an EMR as early as 2011, but no later than 2012 if you want to get the maximum allowed incentives.
OK, Great!, I can wait!
If your first reaction is, “Great, I can wait until the last quarter of 2012”, I would tell you the tentative answer is yes, but let’s be clear about what you mean by “wait”. If you mean that you can wait until the last quarter of 2012 to start
proving “Meaningful Use”, it is possible. However, there is a big “but” to this affirmation. How long will it take for you and your staff to select an EMR? More importantly, how long will it take to install, get trained, and implement an EMR so you can actually demonstrate “meaningful use”? Keep in mind that it will take time to adapt to a paperless system, and the productivity of your office could suffer during this transition. And at the heart of it, integration and transition to an EMR are critical elements of proving meaning fuluse. Finally, the government has designed the stimulus incentive so that you must make an investment in an EMR before you can qualify for reimbursement and then must show meaningful use to receive reimbursement. You will need to make the commitment first, and prove it, and then you will get the incentive money.
Based on our experience with the entire process from passive interest to full use of EMRs, here is a typical timeline and phased approach for you to consider:
• Get organized in your EMR evaluation by designating someone to be the point person to help you with your evaluation process. Planning/setting up goals will take approximately 1 month.
• EMR evaluations should take about 3-9 months, depending on how selective you are.
• Inventory and possibly update your current computer system and network infrastructure (if any.) This can happen concurrently with the above steps, but plan for it to take 2-4 months.
• After selecting a finalist in your EMR search, check out their references, negotiate the details of your contract, the schedule of payments and deliverables – plan for at least 1-2 months on this step.
• Does the EMR interface with current billing software? Depending on your current system, writing an interface, testing and then proper linking could take 1- 2 months.
• If you decide to change your billing/practice management system, tack on another 6-12 months for this evaluation and implementation.
• Set up a liaison that will help you with your implementation. That person will be crucial to your success. However, it is key is that you, the doctor, must be closely involved for a successful implementation.
• Start your training and implementation process. Typical start-to-finish implementation could take between 2-4 months. You can expect a much longer time frame for larger facilities that have a lot of paper. The more organized you are before the implementation, the faster it will go. If your practice is chaotic and disorganized to begin with, the implementation could take 4- 6 months.
• Plan to re-evaluate your training and continue with additional retraining towards the end in order to
make sure proper use of system happens in the future.
You need to move forward soon in order to be ready for receiving the incentives. Adding up all the above, the
shortest time from “I am curious” to a full-fledged power user of an EMR is a minimum of 7 months; the longest time could be up to 26 months. To be able to move from “I am curious” to “I have demonstrated meaningful use” will take 7-12 months for most practices.
You do not want to make a mistake in this first step, make sure you evaluate wisely and purchase a phlebology-specific EMR or you will find yourself with a non-operable system, or a system that must be highly customized to meet your requirements, which will take additional time and money in programming and implementation. Because of the time to evaluate and implement, you need to move quickly in order take advantages of the incentive plans.
The Government’s Economic Stimulus package called the American Recovery and Reinvestment Act (ARRA) of 2009 is landmark legislation that will change the way you practice medicine. Starting in 2011, you will be able to qualify for over $ 44,000 of reimbursement incentives towards computerizing your medical records with an EMR. However, you should not wait until the end of 2011. Doing so will put you in a time crunch and you might lose some or all of the incentive money. Even worse, you might make an ill-informed decision about what is the best EMR for you and your practice. You will need to have a fully implemented EMR and be able to demonstrate “meaningful use” of your EMR in order to qualify. There are diminishing incentive payments until 2015. In 2015, a Medicare disincentive of 1% each year until 2017 will be in effect thus with the incentives and possible reduction in Medicare payments, you could stand to lose or gain over $ 70,000.
Phlebologists need to be very careful when purchasing EMRs that are not written specifically for phlebology but were developed for primary care, or some other specialty. Phlebologists, unlike primary care doctors, see patients for a condition or a set of conditions over time. Isolated templates do not work for phlebologists. Your documentation of the patient’s pathology, treatment(s), and response to those treatments need to be consistent, logical and well documented throughout the patient’s lifetime with your practice. You also do not have the time to create screens and content, which is what you will have to do if you select an EMR that is not phlebology-specific. To develop screens and content that will support your clinical workflow without frustrating it takes years of research and development, and most physicians simply will not have time to do this. Proper evaluation of EMR systems that fit your practice will lead to acquiring an EMR system that will ultimately increase your practice’s productivity. Proper training and implementation will verify proof of meaningful use and ensure that you may reap the benefits the government is providing rather than be caught with reductions in your income, or worse, face a costly audit.