Monday, September 30, 2013

My nephrology practice is pushing for meaningful use.

When the economic stimulus package passed and the basic blue print for meaningful use started to be hammered together, my practice committed to making the jump from paper to an EMR. Through blood sweat and tears (mostly tears) we implemented an EMR program in the first year that funds were available and we successfully qualified for meaningful use. We threw off the shackles of our paper chart and embraced the shackles of our EMR system, Allscripts (in case you wanted to follow us down this boondoggle).

It is hard work moving a large, multi-site practice across this chasm and the federal money really helped because it was expensive, more expensive and more complex than just about anything else our practice has accomplished, i.e. we did a heart transplant on our out-patient practice without taking taking a day off work.

After qualifying for Meaningful Use Part One for two years we were well on our way to qualifying for meaningful use Part Two when we hit a massive speed bump.

I maintain the medical records on the patients I see in clinic. I contribute to but do not maintain the medical records of the patients I see in the hospital. Those are maintained by the hospital. It makes sense for the hospital to take charge of the medical record and because I am only one of many doctors taking care of each patient. In addition to doctors there are pharmacists, nurses, physical therapists, etc that all share the medical record. So when meaningful use tracks how compliant I have been in using my EMR, they wisely don't include the patients I see in the hospital as part of the denominator:

I also see a lot of my patients in the dialysis unit. Part of the reason so many of the visits are in the dialysis unit is that the federally implemented a payment structure encourages four visits a month. So I strive to go four times a month. These dialysis visits represent a large proportion of my monthly non-hospital-based patient encounters. Dialysis is truly the third leg that supports our practice.

Note: the feds look like they are right on this one with improved outcomes seen with longer time spent with the patient.

Just like in the hospital, I contribute to the medical record in the dialysis unit but I do not control it. It is a shared resource used by the nurses, dietitians, social workers and technicians, who all contribute to patient care and the medical record. This medical record is newly electronic. I work in Davita facilities
and I have been blown away by the simplicity, speed, and ease of use of their Falcon EMR. (I was not paid to say that, though I jointly own a dialysis unit with Davita.)

Unfortunately, that EMR is not certified for Meaningful Use, so not only do I not get credit for using it, all of those patient encounters are counted in my denominator against my office use of the EMR dragging me down so even with 100% compliance in the clinic I am unable to qualify for Meaningful Use. I not only forfit the incentive money but I will start to be penalized for not adopting an EMR. I will be punished despite, investing in and using an EMR for all of the outpatient visits in my clinic. The only outpatient visits that I don't use the EMR for, are the dialysis visits, and even in that situation I use an EMR.

This feels incredibly stupid, mean spirited and counter productive. Please Davita, get Falcon approved for Meaningful Use ASAP so this mindless punnishment does not befall all neprhologists. Please CMS grant nephrologists hardship exemptions so that dialysis unit visits are excluded from the denominator calculation just like hospital and emergency room encounters are.

BTW: I have been told that Fresenius's in-house EMR is likewise not approved for meaningful use. Lunacy.
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