While Ochsner is eyeing some $50 million in incentive payments, the meaningful use program carries a little-discussed component: the payment penalties providers face beginning in 2015 if they are not qualified “meaningful users.” To Witherspoon, the penalties are as big a driving force as the incentives, particularly because they remain in effect indefinitely--unlike the incentive payments.
In that light, one of the biggest challenges, Witherspoon said, is qualifying certain specialists--such as radiologists and pathologists--under the program. These providers must meet the same criteria as do primary care physicians under the program. This “one size fits all” program is, in essence, driving a round peg into a square hole. “I am not sure what constitutes ‘seen by me’ for a pathologist,” he said, citing one of the many metrics required in compiling meaningful use thresholds.
But Ochsner is tailoring its workflows to help physicians qualify, he added. Witherspoon described how certain data, such as demographics and vital signs, need to be captured as part of the check-in, while providing a visit summary needs to be part of the check-out process. Physicians need to document in real time in essence, to keep the information flowing. To help communicate with patients and meet other criteria, Ochsner has launched a patient portal embedded in its Epic electronic health records system. Witherspoon described the portal as “wildly popular” with 30,000 patients signing up in two weeks.
Ochsner also maintains a scorecard of meaningful use criteria for individual physicians. But the I.T. behind it is sophisticated. The health system’s EHR feeds a transactional database, which in turn feeds a meaningful use reporting repository, from which meaningful use reports are extracted and then shared with physicians. “The reporting process is arduous,” Witherspoon said.
The qualification and reporting challenges pose a big obstacle to small practices attempting to qualify, he concluded. “Some people have not seen an EHR until CMS came along and said, “Doctor you have to use this and if you don’t we’re going to hit you with a big stick.’ ”