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AAOS Now

Published 7/1/2015
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Douglas W. Lundy, MD, MBA

Meeting Meaningful Use: One Practice’s Experiences

Meeting the criteria required for Stage 2 of Meaningful Use (MU) isn’t easy—as our experience at Resurgens Orthopaedics, a multispecialty orthopaedic practice with 21 locations and more than 100 physicians, proves. Although Resurgens was an early adopter of electronic health record (EHR) technology and successfully attested for MU Stage 1, Stage 2 has been a significant challenge. (See “Meeting the Challenges of Meaningful Use Stage 2.”)

Orthopaedic surgeons across the country have developed innovative methods to successfully meet the attestation requirements of Meaningful Use. This article may help AAOS Now readers better prepare for meeting these requirements.

What is meaningful use?
The Health Information Technology for Economic and Clinical Health Act (HITECH) was intended to encourage physicians not just to adopt EHRs, but to use them in what the federal government described as a “meaningful” way. According to the federal government, EHRs should be used by physicians to meet the following goals:

  • improve quality, safety, and efficiency
  • reduce health disparities
  • engage patients and their families
  • improve care coordination and population and public health
  • maintain privacy and security of patient health information.

Ultimately, the government hoped that MU would result in better clinical outcomes, improved population health outcomes, increased transparency and efficiency, empowered individuals, and more robust research data on health systems.

MU Stage 1 vs MU Stage 2
MU Stage 1 was introduced as an incentive program, with the first payments available in 2011. Physicians who satisfactorily attest to meeting the MU requirements are eligible to receive up to $43,720 in incentive payments through 2015. After the incentive phase expires, the Centers for Medicare & Medicaid Services (CMS) will introduce penalties for physicians who do not satisfactorily meet the requirements.

In 2014, physicians were still able to attest to MU Stage 1. Successful attestation meant that physicians had to meet 13 required core requirements and five menu requirements. The intent of MU Stage1 is for physicians to demonstrate to CMS that their EHR can successfully capture and share data with other EHR systems. Stage 2 attestation will require physicians to demonstrate that their EHR system will “advance clinical processes,” while Stage 3 attestation will require that the system shows how it improves patient outcomes.

MU Stage 1 was challenging, but all Resurgens physicians successfully attested. MU Stage 2 is a much different program with much more stringent requirements, and this has proven to be exceptionally difficult. In 2015, the penalty phase for MU began.

Physicians who do the math will realize that when a percentage of Medicare dollars will not be paid into the practice, they may actually have to spend some money to get more money. Failure to attest in 2015 will result in a 1 percent penalty. The penalty increases to 2 percent in 2016 and to 3 percent in 2017.

MU Stage 2 requirements
MU Stage 2 demands successful completion of 17 core objectives and 3 menu objectives. These objectives have higher thresholds and more difficult requirements than Stage 1. The seventeen Stage 2 core objectives are listed in
Table 1. The core measures that are most difficult for Resurgens are 1, 13, and 17.

Measure 1 is a challenge to physicians who cannot e-prescribe the minimum threshold of 60 percent, such as trauma surgeons and other physicians who prescribe a high level of narcotics but few other prescriptions. Neither Georgia state law nor our EHR allow printing scheduled prescriptions on blank white paper, so the practice purchased special printers to enable these physicians to satisfactorily meet this measure. That kind of innovative thinking may be required for practices to successfully meet MU Stage 2.

Measure 13 requires the physician to “Use certified EHR technology to identify patient-specific education resources.” This measure can be satisfied by providing diagnosis- and/or treatment-related information to the patient through a patient portal or a printed Clinical Summary from the EHR at the end of the office visit.

At least 10 percent of all of the physicians’ patients must receive this information during that attestation period. Resurgens met this requirement by providing drug education materials on medications prescribed or condition-specific material based on the patient’s diagnosis. We used the AAOS patient education website, OrthoInfo.org, for condition-specific material.

The portal hurdle
Measure 17 may be the most difficult to meet. It requires that at least 5 percent of a physician’s patients meaningfully interact with the physician through the patient portal. This is more challenging than it seems. First, patients must be convinced that it is in their best interest to go through the trouble of signing up for access through the portal. Then, patients must actually use the portal to communicate with the physician. Patients may sign up for access to the portal, but unless it contains meaningful content, their interest quickly wanes.

Some orthopaedic offices with spacious waiting rooms can justify the cost of hiring an employee to help patients sign up for the portal and initiate communication with the physician. With 21 offices in the metro Atlanta area, Resurgens could not effectively justify such an expense. Other offices send messages to patients asking about the weather or welcoming them to the practice. Whether these are appropriate communications mandated by the measure, however, is debatable.

We have found that patients who communicate through the portal actually believe that it is more convenient than calling the office and leaving a voice mail. We strongly encourage all patients to communicate with their physician teams through the portal. We have placed as much meaningful content as we can on the portal—including a bill payment option—so that patients will use the portal.

By far, the number one driver to the portal is physician endorsement and encouragement. In our experience, nothing increases patient involvement more than a specific discussion between patient and physician about accessing the portal. We have even printed a small card (Fig. 1) that the physician can use, asking patients to notify him or her about their conditions through the portal. This tactic has significantly increased our ability to meet the requirements of Core Measure 17.

Douglas W. Lundy, MD, MBA, is president of Resurgens Orthopaedics in Atlanta and a member of the AAOS Now editorial board.

Additional Information
http://www.healthit.gov/providers-professionals/ehr-incentives-certification

Meaningful Use Final Rule

Stage 1

Stage 2