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Thursday, January 29, 2009

CMS makes e-prescribing simple

When was the last time the Centers for Medicare & Medicaid Services (CMS) made anything simple? Good question. Well, now they have published a document called "2009 Electronic Prescribing (E-Prescribing) Incentive Program Made Simple." It's just four pages, three questions, two tables and three steps, two of which you have to repeat a few hundred times. Simple, huh?

All you have to do is bill one of 33 CPT and G codes plus one of another set of three G codes for at least 50 percent of your patients, hope that CMS corrects the problems associated with the Physician Quality Reporting Initiative (PQRI) last year and rake in the incentive payments.

OK. I recognize that, even as simple as that sounds, it may not tempt you. But that doesn't make e-prescribing a bad deal in itself, as Kenneth Adler's article in our current issue argues. If you're not already doing e-prescribing, it's at least worth a look. And once you're up and running with it, you can decide whether you want to simplify your life by going for the Medicare incentive.

Friday, January 23, 2009

Spend $20 billion on health care IT? Yes, we can!

One of President Obama's first health-care-related moves in office is likely to be the approval of some $20 billion for health care information technology (IT) as part of the proposed $800 billion economic stimulus package. While IT alone is unlikely to transform health care (because "IT use in health care will reflect the system it's put into, rather than transform it," to quote Matthew Holt), this historic investment is sure to bring some benefit to physicians and their patients – if the money is spent right.

The leading idea for how to spend the $20 billion is to let every doctor in the country buy an electronic health record (EHR). But technology experts David Kibbe, MD, and Brian Klepper, PhD, say not so fast:

"The new Administration and Congress are about to throw a lot of money at the health IT problem, and the conventional thinking is to buy everyone an EHR of his/her choosing. While we enthusiastically applaud the vision that this represents, a more measured approach would create a smoother and more productive transition. At the same time, it would signal the EHR industry that, for national deployment, they need to come to terms with issues they have avoided so far."

The issues they cite are:

1. EHRs are too expensive, upwards of $40,000 per physician in a medium-sized practice. Of course, the stimulus package would help everyone forget about the costs for now, much to the delight of EHR vendors.

2. EHR implementation can be difficult, disrupting practice operations and revenue for months.

3. There is no conclusive evidence that using EHRs actually improves quality of care.

4. EHRs are still not interoperable, which means providers cannot easily exchange data with one another if they use different systems, which they surely will.

So what's a better way to spend the $20 billion? According to Kibbe and Klepper, the IT solutions that have "more bang, with less turmoil, for the buck" are e-prescribing, e-referring, patient communication technologies (e.g., secure e-mail and Web applications that allow patients to schedule appointments online, pay bills online and view lab results online) and broadband access to the Internet for every medical practice and every home in America.

Monday, January 12, 2009

Are you ready for the medical home?

It’s been a year since the National Committee for Quality Assurance (NCQA) launched its patient-centered medical home designation program. Through December, the organization had received applications from approximately 120 practices, according to Eric Williams, NCQA product development manager. One of these was from Joseph Mambu, MD, of Lower Gwynned, Pa. Mambu learned last month that his three-physician family medicine practice had earned the highest level of recognition possible, tier 3, from NCQA. The Centers for Medicare & Medicaid Services (CMS) has yet to announce the regions where its medical home demonstration project will be carried out, but Mambu is hoping to be able to participate in this and other pilot projects in his area. According to a recent AAFP survey, 74 percent of the family physicians who responded were very or somewhat interested in having their practice recognized as a patient-centered medical home, but Mambu must be among the first to have completed the process.

We’re hoping to publish an article about Dr. Mambu’s group’s experience in an upcoming issue of FPM. In the meantime, look for “Building the Case for the Patient-Centered Medical Home” in our January/February issue. The article examines developments surrounding the patient-centered medical home initiative and perceptions from family physicians about where it might lead. Not everyone is ready to pay NCQA’s PCMH application fee of $450 per physician (for a practice of up to six physicians), much less make the investment in electronic medical records that tier 2 or 3 recognition requires. Are you?

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