Resource Centers:(News, information, and tools to support your practice)
September 2010
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The $44,000 question: industry insider responses (Roger Gooden)
This is in reference to Melissa Heyboer’s article, “The $44,000 question,” which appeared in Issue 13, 2010. The following is Roger Gooden’s responses in their entirety.
Question 1: How will this affect the chiropractic office? i.e., do you think this program is beneficial?
A: The chiropractic office will change because everything will become electronic. There will be no more need for paper folders that hold the ever growing patient documentation and notes. There will be no reason for chiropractors to be behind in their note for any patient or not have access information with the click of a button. However, many chiropractors may find this incentive to be more than they bargained for simply because they will be required to complete excess work that 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. Whether or not the program will actually be beneficial remains to be seen in the day-to-day practice of medicine. I believe the sharing of information between providers to better serve the patient will be the most beneficial part.
Question 2: What do chiropractor’s need to take advantage of this incentive? How much will it cost, as far as time and money, to implement?
A: To take advantage of the incentive program, a Chiropractic office needs to be using a certified Electronic Health Records (EHR) system as defined by government. Once using a certified system, the chiropractors must use the system in what has been determined as "Meaningful Use" by the Centers for Medicare and Medicaid Services (CMS) and the U.S. Department of Health and Human Services (HHS). At this time, there are NO certified systems as the government is still working to setup the certification bodies. Certified systems will appear later in the year and next year. There is no doubt that a Chiropractic office looking to take advantage of the incentive payments will have more to do in terms of time. The "Meaningful Use" items are geared towards collecting more information from the patient as well as doing more tests with the patient.
Chiropractors will need a software system that is tailored to their specific needs. It cannot be a system designed for the MD in mind because their practice is a lot different than that of a chiropractor. Depending on the software system the chiropractor chooses, the computer hardware they purchase to run the software and the time it will take them to learn the software and get comfortable using it on a daily basis, it could cost the doctor anywhere from $6,000 and up. Other articles project this number to be $12,000 and up.
Question 3: Will all chiropractic offices qualify? Can cash-based practices benefit?
A: 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. 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.
Question 4: When can chiropractors expect to receive payments?
A: Chiropractors could begin to see incentive payments as early as May of next year, however, to receive payments certain criteria has to be met and filed with the federal government. First, you must register with the EHR Incentive Program website and be enrolled in the Medicare, Fee-for-service (FFS) or Medicare Advantage programs. You must have a National Provider Identifier (NPI) for your registration and using a certified EHR technology to demonstrate meaningful use. Finally, attestation of Clinical Quality Measures has to be completed beginning in 2011. Beginning in 2012, electronic submission of aggregate information from the chiropractor through their EHR software would be required to continue receiving incentive payments.
Question 5: What questions should chiropractors ask their providers (insurance and software) to ensure they are being compliant?
A: As the new rules come into effect next year, Chiropractors want to first off be sure they software they use or plan to use will support the new "Meaningful Use" measures. If a system is certified, then it then falls on the doctor to perform the actions necessary to meet the measures. As the new rules come into effect next year, Chiropractors want to first off be sure they software they use or plan to use will support the new "Meaningful Use" measures. If a system is certified, then it then falls on the doctor to perform the actions necessary to meet the measures. Questions you should ask you EHR vendor should be How customizable are the work flows? Your EHR should allow you to make certain changes in the workflow so that your standard process is not interrupted. How does your EHR interface with other applications, and how expensive are the interfaces? Your EHR system should integrate with your billing system to provide you with some continuity. The information should be easily manageable. How often do you upgrade your product? This is a big question because advancement is the key to making things better. Will the EHR take your suggestions to better the product? How do I get historical data into the system? This is a big question. If the EHR will allow you to scan older information into the patient file it will be beneficial to you. In an age where digital everything speeds things up having that capability will help you in the long run.
Question 6: What new products or services do you think will come out of this incentive?
A: We feel there will be new consulting opportunities. Doctors will be unsure of all the criteria they must meet to be deemed "Meaningful Use" users and will accept consulting advice. We also feel there will be new companies that provide Links or Exchanges that allow patient information to be passed from one office to another. These will be developed over the next few years as the standards and technology improve. New products and services may include something to link all the information together, possibly new security formats and of course new ideas to improve healthcare IT.
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