By Melissa Heyboer

When you hear the words “meaningful use,” what comes to mind?

For most, it probably conjures up thoughts of confusion and unanswered questions.

The topic of meaningful use and electronic health records (EHR) has been buzzing ever since word of the Health Information Technology for Economic and Clinical Health (HITECH) Act took form in early 2009. According to the act, doctors of chiropractic would be eligible for up to $44,000 in incentives — beginning in 2011 — for meaningful use of a certified EHR.

It sounds simple, but if DCs were to apply today, none would actually qualify given their current health information software.

The Center for Medicare and Medicaid Services (CMS) recently released its “final rule” on the EHR incentive program and many DCs are more uncertain than ever about what’s expected.

So what should you do? How will this benefit chiropractors? When can you expect to get paid?

To answer these questions — and many more — Chiropractic Economics asked the industry’s most-knowledgeable experts to sound off on the important questions to help you become eligible for $44,000.

Change is in the air

As with any new program, there will be skeptics and believers. The HITECH Act, however, seems to be gaining support from the majority of professionals who it will affect the most.

“Chiropractors will gain substantial benefit from the HITECH Act,” says Tonio Cutrera, sales manager and marketing director for E-Z BIS, “not only because of the potential to receive up to $44,000 per provider in the form of enticement payments, but perhaps more importantly, due to the benefits of adopting the use of EHR software.

“Ultimately, patient care is improved by automating tedious tasks and by providing timely access to patient health information. Doctors can spend more time caring for patients and less time struggling with time-consuming paperwork.”

Steven J. Kraus, DC, DIBCN, CCSP, FASA, FICC, founder and CEO of Future Health, explains its benefits as a way to reduce expenses and increase productivity for individual chiropractors.

He says an EHR will promote professional documentation, which in turn, will help “justify the necessity of care according to the standards of modern-day rules.”

Kraus explains, however, that this program means big benefits for the profession as well.

“Mass EHR adoption by the profession will help establish chiropractic as a modern profession,” he says, “especially as we interact with third-party payers and other providers. It will show our willingness to collaborate with the healthcare community for improved patient care. DCs can participate in their state’s health information exchange and share patient data with other provider types.

“Specialists and general MDs are going to see the effectiveness of chiropractic care. We know chiropractic works, yet we struggle with a methodology to demonstrate outcomes. With an EHR, we have that methodology to gain more market share.”

Although the benefits are there, many experts want to make it clear that it won’t necessarily be an easy process from the get-go. Alex Niswander, owner of Midwest Software, says chiropractors need to “put aside the pipe dream” of just getting a check for $44,000. There’s much more to it than that.

“Once we understand all the federal rules and regulations and how they will be implemented and the adoption of the same or similar guidelines by all third-party carriers, benefits for the chiropractor and chiropractic assistant, and patient documentation will be seen by all,” says Kenneth Murkowski, president of MPC.

Others still, say those who apply for the $44,000 incentive won’t know if it’s beneficial until it’s actually implemented, at which time they can actually weigh the pros and cons themselves.

Roger Gooden, owner of Softworx Solutions, says “Many chiropractors may find this incentive to be more than they bargained for simply because they will be required to complete excess work they would otherwise be unaccustomed to doing.

“Does the chiropractor collect vitals (height, weight, blood pressure, etc.) on a consistent basis? How about recording current prescriptions or medication allergies?  These are some of the items that a chiropractic office will be required to perform to be considered for the collection of the $44,000. For some offices, the extra burden may not be worthwhile. It may require hiring an additional staff person that offsets any gains.”

Ken Schenley, vice president of Quick Notes Inc., agrees with Gooden, saying the program may not be beneficial for everyone.

“For some, it will be a winner, while for others, it might be unattainable,” says Schenley. “The chiropractor will have to meet meaningful use, and there are 15 core items and another five menu items that will be required. Many of these items fall outside the scope of practice for a chiropractor. The practice will have to purchase a certified EHR to be able to request the incentive, at a very high financial cost, even though many of the features will be essentially unused.

“If the result is improved patient care, then it will be beneficial in the long run. Just not sure everyone is ready to jump through so many hoops at this time.”

The details

For those chiropractors who will likely take advantage of this program, you may be wondering what exactly is required of you and how much money it will cost. Although the minute details of CMS’ final rule are extensive, the most important requirements are not.

“Chiropractors must use a certified EHR solution, manage Medicare payments, and complete an application for the incentive with CMS,” says Mark Firmin, senior vice president for ACOM Health.

“An EHR solution must be certified by a testing agency that has, itself, been accredited by the government. We understand that two such entities are in the review process at this time. We expect these testing agencies to begin testing and certifying EHR solutions in late summer and early fall.”

Paul B. Bindell, DC, president of Life Systems Software goes on to say, “To qualify for the maximum stimulus income, you must have certified EHR software in place by the end of 2010.”

Claude Cote, founder and president of Platinum System C. R. Corp., cautions doctors of chiropractic to take care before launching into purchasing expensive new software in hopes of obtaining $44,000 from the U.S. government.

Before making the decision to apply for the government stimulus, Neil Skene, vice chairman for MedAffinity Corporation, says it’s important for chiropractors to talk to their staffs.

“Let the staff know that this is not about cutting staff. Tell them your goal is creating time for more important things, and making their jobs better," says Skene. "Ask about the things they get satisfaction from, and what frustrates them. Don’t just think about yourself. It needs to support your staff. That’s why the selection needs to be a team consideration.”

Skene, as well as others, want to make sure chiropractors are aware of both the cost in terms of money, but also time.

Mike Norworth, president of MPN Software Systems Inc., says that as far as outward cost, “Unless there’s a cost for individual certification as an eligible provider, the answer for most computerized practices should be ‘nothing!’”

However, while there may not be a cost to actually apply for the program itself, Firmin and others want to make it clear that it will cost money to upgrade software and get your practice compliant with the requisites.

“Costs are going to depend a great deal on what software they already have in their office,” says Derek Greenwood, founder and CEO of EON Systems. “If they are lucky, they will simply be able to update what they currently have and then just add document storage or documentation.”

As for time, Greenwood says it could take three to six months to incorporate a full digital solution from scratch. 

Ron Short, DC, MCS-P, certified insurance consultant, certified peer-review specialist, and certified medical compliance specialist with Heartland Consulting Group Ltd., says “the cost will vary according to the cost of the software and any hardware that will be necessary. The important consideration is the time; because if the doctor does not take the time to set up the program correctly, it will be ineffective at best.”

Will you fit in?

So, at this point, maybe you’re eager to jump on the incentive bandwagon, but are all chiropractic practices guaranteed to qualify?

According to Gooden, the quick answer is no!

“Unfortunately, not all chiropractic offices will qualify for the incentive program. If your office is a cash-only office and you do not accept Medicare patients, then you would not qualify for the program under the guidelines,” says Gooden. “The incentive program payments are only available through Medicare and Medicaid programs; however, chiropractors only fall under the Medicare portion.

“The payments are actually a bonus based on the billings that you do for these types of patients. To collect the full amount, a chiropractic office must bill a minimum of $24,000 to Medicare to reach the maximum potential incentive money.”

Kraus says that more than three out of four chiropractors will likely apply, saying that as long as chiropractors submit permissible charges to Medicare, meet the meaningful use criteria, and use a certified EHR, they will qualify.

“The reason a DC must accept Medicare to qualify is because the amount a DC receives is based on 75 percent of their Medicare-allowed charges for a given period of time,” says Kraus. “The maximum cap is $18,000 for 2011, followed by $12,000 for 2012, and continuing to decrease each of the following years. The total maximum amount available over five years is $44,000.”

Both Norworth and Short, however, say cash-based practices may not totally be left out.

“By law, ‘cash’ practices must still submit Medicare claims for patients with Medicare (to ensure those patients are reimbursed),” says Norworth. “Thus, with regard to this program, there’s little difference between a practice that bills payers and one that bills patients.”

Short agrees, saying “there is no provision that a chiropractor must be a participating provider to register for the EHR incentive program. As such, the cash practice that is treating Medicare beneficiaries on a nonparticipating basis should qualify.”

Valuable questions

It’s important for interested chiropractors to not only read, but to educate themselves on CMS’ requirements and its final rule.

With that, however, questions may be raised that only your software or insurance provider can answer.

While most agree that nothing