EHR VS EMR + HIPAA + HITECH ACT 09 = Office Subluxations

Published: 2010-12-22 07:58:04
Author: Dr. KSJ Murkowski

Not a week goes by that calls come in from MPC clients, former clients, MPC & Foot Leveler Seminar attendees who are confused & questioning “ How should they deal with the Dept. of HHS and CMS and the new requirements of “meaningful use” of EHR(Electronic Health Records) plus how do they get “That Government Money” (Stimulus).”
Everyone says ‘Show Me The Money’. The $44,000 Bonus or Reimbursement or Stimulus Funds from the HITECH Act 2009. (Health Information Technology For Economics and Clinical Health” Act of 2009 or For now, “EHR Office Subluxation”
The following opinions consist of the Dr. Murkowski Office Administration Adjustment to Reduce and Stabilize Your Office Subluxation of EHR – EMR. (Confusion)
1.) First your “Stimulus” (reimbursement) isn’t one lump check for buying software. For many practices, it will come in the form of grants or “bonuses” attached to future Medicare reimbursement payments.
2.) Depending on the year that your clinic starts this process, your reimbursement may be as much as $44,000 or as little as $25,000 to $35,000. Funds are available in areas with a shortage of health care providers and are also available for Medicaid, but are distributed by individual states.
3.) Payment comes for care rendered in the previous year. Payments starting in 2011 for 2010 care. Many software companies are encouraging D.C.’s to start their EHR-EMR adoption processes immediately. Electronic Health Record (software) Companies want you to be eligible for the maximum money bonus as it helps off-set, if not completely covers the cost of their software SOAP systems. BE VERY CAREFUL.
“RE-ADJUST” Your Office Subluxation thinking. Medicare gives as a reward for using an EHR/EMR properly, rather than reimbursement for purchasing a new software system.

How much you pay for a software system doesn’t determine how much money you’ll get from the government.

You don’t have to spend $44,000 to earn the $44,000. In all honestly your money is based on your “meaningful use” of the (EHR new technology). WHAT DOES THIS MEAN??? D.C’S will probably need to see five Medicare patients per day to achieve the maximum Government Reimbursement. However If you have more than one doctor in your clinic, “All D.C.’s” maybe eligible to receive more than just one reimbursement per clinic. The special Government Bonuses are supposed to come the same way that Medicare is already rewarding users for following acceptable treatment guidelines, diagnosis, documentation and care, etc. There is still the question of a percentage of increases in Medicare reimbursements or the proposed amount of reduction. (ie Chiropractic Manipulation) HR 3962 in 6/18/10 was voted on and passed, which delays the 21% Medicare fee decrease and allows a 2.2% Increase from 06/01/2010 to 11/30/2010.

Let’s “Adjust” this issue again. A “New” system of office software in your office doesn’t automatically equal a “Medicare Bonus”. Medicare says “Doctors” need to show they are using EHR-EMR in a way that saves money and improves quality. Medicare calls it “meaningful use” of “certified EHR”. Understanding “meaningful use” which is now your “Office Subluxation” (confusion Is the question) The definition of “certified EHR” wasn’t clear in 2009. As of February 2010, the official requirements are now somewhat defined, but not all of them necessarily apply to Doctor’s of Chiropractic. Medicare is still asking for feedback from everybody in the Health Care Industry.
The Government has published 25 general requirements to determine “meaningful use” (see enclosed). Each one has an objective; a statement that describes what your new software is and or supposed to do with code tasks that the clinic has to fulfill to meet the Federal objectives. Most requirements are easy to understand. Some of their requirements are specifically written with medicine in mind – (they only make sense for hospitals, M.D.’s, D.O’s and prescriptions, etc). What D.C.’s must do now to meet the minimum of these objectives is still up in the air today. (Confusion = Office-Subluxation)

What is The Role of EHR-EMR (Office Subluxation). D.C’s have to now show they are accomplishing some office “tasks”. All 25 requirements don’t have to be met all at once. There appears to be a period of transitions of the regulation process. The earlier doctors start showing their participation and compliance (2010) the more likely they are to get the Stimulus (Money). 

THE 25 OBJECTIVES OF MEANINGFUL USE
1.) Engage in Computerized Physician Order Entry (CPOE) to manage prescriptions, lab tests, imaging, referrals, and notes from patient visits, on 80% of patient visits.
2.) Track diagnosis codes (ICD-9CM, ICD-10 for office in effect or SNOWMED CT) using electronic documentation on 80% of patients.
3.) Electronically record patient demographics and Personal Health Information (PHI) on at least 80% of patients. (Remember HIPAA)
4.) Electronically record and track vital signs. BML and milestones on growth and development charts (age applicable)
5.) Electronically record smoking status for patients ages 13 and older in 80% of patients.
6.) Create at least one condition – based patient list to identify patient population by diagnosis. 
7.) Be able to electronically import lab results into patient’s electronic record at least 50% of patients. (Remember HIPAA Re: Email – Fax Etc)
8.) Send prescription medications electronically for 75% of patient population.
9.) Maintain an active medication list for each patient.
10.) Electronically record known allergies to prescription medication. (Possible other sources)
11.) Reconcile medication lists at important transitions in patient care.
12.) Electronically alert public health surveillance.
13.) Perform at least one test of sending in patient vaccine history to vaccine registries.
14.) Deliver an electronic copy of health information to 80% of patients. 
15.) Provide electronic access of health care records to 10% of patients.
16.) Protect patient data with encryption, passwords, multi-level access, automatic log outs, recording of record changes and deletions, etc 
17.) Electronically check insurance eligibility on 80% of patients.(Recommended get printouts)
18.) Electronically file claims. (Health Care-Rehab-P.T. Etc)
19.) Electronically connect to established health information exchanges to transmit health information on one patient file. 
20.) Remind patients age 50 or older of return office visits and preventive testing, at least 50% of unique patients visits. 
21.) Offer patients summaries of care after the patient visit on at least 80% of patients
22.) Use ambulatory measures of care quality and send them in with Medicare submissions.
23.) Use five clinical

support rules in determining how to care for and manage a patient, based on the doctor’s specialty and patient condition.
24.) For hospitals: offer patients electronic summaries of their discharge instructions on at least 80% of patients.
25.) For hospitals: electronically report significant lab findings of to public health officials when necessary.

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