Electronic Medical Records

Feds Extend Meaningful Use Attestation Deadline By One Month

Posted in Electronic health records, Electronic Medical Records on February 10th, 2014 by MMS – Comments Off on Feds Extend Meaningful Use Attestation Deadline By One Month

data 2The Centers for Medicare and Medicaid Services announced last week that it is extending the deadline for attesting to meaningful use for the 2013 reporting year by one month, to March 31, 2014, at 11:59 p.m. ET. The previous deadline was Feb. 28.

The criteria must still have been met by Dec. 31, 2013, the end of the reporting period for incentive payments.

The extension does not apply to the Medicaid portion of the EHR inventive payment program.

The President’s Podium: Mass. Medicine, After Cost Control

Posted in Board of Medicine, Electronic health records, Electronic Medical Records, Global Payments, Health IT, Health Policy, Health Reform, Regulation, Uncategorized on December 9th, 2013 by MMS Communications – 1 Comment

By Ronald Dunlap, M.D., President, Massachusetts Medical Society  

Massachusetts entered its second phase of reform with the 2012 passage of DSC_0003 Dunlap 4x6 color 300 ppi_editedChapter 224, cost control legislation officially titled “An Act Improving the Quality of Health Care and Reducing Costs Through Increased Transparency, Efficiency and Innovation.”

While the first phase, Chapter 54 passed in 2006, was indeed landmark legislation and served as the model for the Affordable Care Act, Chapter 224 alters the state’s health care industry perhaps like no other law.

The changes this law brings are vast, from payment reform to giving the Attorney General new powers in the health care marketplace. Although 224 does include some benefits for physicians (medical malpractice reform for one), other provisions pose significant challenges, particularly for physicians in small practices. Here are two that raise concern.

Health Information Technology (HIT) One of the biggest challenges presented by Chapter 224 is its embrace of health information technology. Physicians will be required – as a condition of licensure – to demonstrate proficiency in all aspects of health information technology by January 1, 2015.

While MMS supports HIT and recognizes its intent to improve patient care, this provision of the law could severely disrupt medical care. Because the statutory language creating the requirement is tied to Federal standards of “meaningful use” (which in turn is tied to participation in Medicare and Medicaid), it raises concerns that strict interpretation of this provision would lead to denial of license renewals for some 26,000 physicians.  Our state has a high certification rate for meaningful use, with more than 14,000 physicians having met stage 1 requirements, but nearly 40,000 physicians have a Massachusetts license, and most are not included in the population targeted for meaningful use certification.

Additionally, the costs of establishing HIT can be huge. The outlay for such items as implementation, maintenance, software and hardware upgrades, conversion to Federal ICD-10 codes, training, and data conversion could approach well over half a million dollars for some practices while not including the “opportunity loss of income” from decreased productivity.  While the law allows for assistance to providers for HIT, the level of help is unknown, and the financial burden can be crippling to small practices.

The law further requires all providers to implement fully interoperable electronic health records that connect to the statewide health information exchange by January 1, 2017 (a goal not in sight) and imposes penalties for noncompliance. These technologies are not only critical for physicians to practice medicine, but also to participate in quality measurement programs.  The specter of this kind of commitment to HIT, however, with its financial outlay, is certain to make physicians pause and think, especially those close to retirement.

MMS has had lengthy discussions with the Board of Registration in Medicine (responsible for implementing the HIT requirement) and has testified in support of legislation to delay this requirement and provide relief to physicians. Our voice has been heard, and we are hopeful such relief will be forthcoming.

Data Collection and Reporting Chapter 224 is equally enthusiastic about data collection and reporting.  It creates a “provider organization registration program,” requiring organizations to provide detailed information about their operations: costs, financial performance, utilization, total medical expenses, and patient referral practices, among other information.  This data is hard to extract from many EMR systems.

This information will be collected by the Center for Health Information and Analysis (CHIA), a new independent state agency created by 224 that takes over most of the responsibilities of the Division of Health Care Finance and Policy, which was abolished by the law. Physician groups are now required – for the first time – to submit such data. The law contains language focusing on the reporting on risk-bearing groups while exempting smaller groups, but the applicability of this language has not been fully tested yet, so it isn’t clear how reporting requirements will be enforced and upon whom.

On a promising note, CHIA Executive Director Aron Boros told our House of Delegates at the Interim Meeting on December 6 that CHIA’s goal is to gather “reliable and meaningful” information through an “engaged transparent operation.”  He believes his agency must be “transparent, open, and collaborative” to build credibility.

The law also stipulates that by January 1, providers must disclose to patients within two working days of their request, how much a proposed procedure or service costs and what the health plan offers as payment.

I am not optimistic that physicians will be prepared within a month’s time to inform patients about specific or estimated costs for all procedures. We are encouraging legislators and the Health Policy Commission to implement the law incrementally, by considering the most expensive procedures first.

HIT and data collection/reporting requirements are but two areas that Chapter 224 dramatically changes. These changes, coupled with constant concerns over Medicare reimbursements as well as added requirements such as those imposed by ICD-10 codes, continue to strain physician practices.

What policymakers and regulators must keep in mind is that, even in a highly sophisticated medical environment like Massachusetts, no less than 64 percent of our physicians are in practices with fewer than 25 physicians. Policies and regulations that burden these practices and reduce their viability will not only affect the quality of care but will also reduce health care access for Massachusetts residents.

The President’s Podium appears regularly on the MMS Blog, offering Dr. Dunlap’s commentary on a range of issues in health and medicine. For a section by section analysis of Chapter 224, click here.  


Key Similarities and Differences Between the House and Senate Payment Reform Bills

Posted in Accountable Care Organizations, Defensive medicine, Electronic health records, Electronic Medical Records, Health IT, Health Reform, Malpractice, Mass. Legislature, medical liability reform, Payment Reform on June 8th, 2012 by MMS – 1 Comment

After two years of discussion and debate, the Massachusetts Legislature must now deal with two huge pieces of payment reform and cost control legislation.

Earlier this week, the House passed its legislation by a wide margin, following eight hours of deciding which of 275 amendments it would accept. The Senate passed a separate bill on May 17.

During the House debate this week, the MMS sought to protect most small and medium physician groups from the House’s very rigorous reporting requirements. The original House bill exempted groups with fewer than 10 physicians. Due to MMS advocacy, the House agreed to increase the exemption to 25, which we will try to increase further during the conference committee’s deliberations.

When the members of the conference committee are appointed, they will have until adjournment on July 31 to agree on a single bill and get it passed by both chambers.

Despite their many similarities, reconciliation and consolidation of the bills is not expected to be an easy task.

Key Similarities

  • Cost containment: Each bill states that overall health care costs should rise in concert with the growth in the state’s economy. (Differences noted below.)
  • State oversight: Each creates a new state agency to certify provider groups, and collect volumes of information on quality measures and costs. The House agency is placed inside the executive branch, under the Executive Office of Health and Human Services. The Senate agency is an independent entity.
  • Market power: Both bills require payers to negotiate separate contracts for each hospital facility, with some exceptions.
  • Alternative payment models: The bills define ACOs and their requirements. They provide a 2 percent bonus in Medicaid payments to providers starting in July 2013, if they move to alternative payment methodologies.
  • Electronic Health Records: Each requires physicians to be proficient in the use of electronic medical records. (Differences noted below.)
  • Medical liability: Both mandate waiting periods for civil suits brought against health care providers. They require disclosure of case information to patients and providers; protect statements of apology from being admissible as evidence; provide for early payments to patients without prejudice. They reduce the prejudgment interest rate in malpractice cases from 4 percent to 2 percent. No contract may prohibit a physician from serving as an expert witness.
  • Determination of Need: They expand the Determination of Need process to include more new technologies, transfers of ownership and site expansions.
  • Administrative simplification: Both bills require standards forms for utilization review.
  • Peer review: Both bills expand the peer review statute. The House specifically provides ACOs with peer review protection; the Senate provides such protections to any provider group that conducts peer review activities.
  • Charitable immunity: They raise the charitable immunity cap from $20,000 to $100,000 (affects most hospitals in Massachusetts).
  • Physician assistants and nurse practitioners: Each bill provides more independence to physician assistants and nurse practitioners.
  • Limited service clinics: Both bills eliminate some existing regulations for the operation limited service clinics, such as those located in pharmacies; however their approaches differ.

Key Differences

Cost Containment

  • The House’s benchmark is 3.6 percent for 2012 and 2013. In 2014 and 2015, it would be equal to the growth rate projected in the Governor’s budget submissions. From 2016 to 2026, it would be equal to a half percentage point below the Gross State Product (GSP) from 2016 to 2026, and equal to one point above GSP after 2027.
  • The Senate’s cost benchmark is a half point above GSP through 2015, and equal to GSP from 2016 to 2026.
  • The House imposes a penalty on providers who costs are 20 percent higher than the benchmark. It establishes rate setting for governmental units. The House gives the state the ability to force providers to reopen contracts that it considers contributing to excessive spending. The House gives the attorney general to block unreasonable increases in rates, and block changes that adversely affect patient access and the quality of care. In the Senate bill, groups that exceed the benchmark must file improvement plans.

Market power

  • The House subjects provider groups of 10 or more physicians to a market impact review.
  •  The Senate gives the attorney general the power to prevent excess consolidation and collusion.


  • The House requires any physician group with 25 or more physicians to be certified by the Department of Public Health.
  • The Senate requires certification for all providers entering into alternative contracts. It exempts groups with less than $500,000 in annual net patient service revenue and fewer than five affiliated physicians, if the group does not accept risk.

Electronic Health Records

  • The House requires providers to adopt EHRs that are fully interoperable and connect to the statewide health information exchange.
  • The Senate updates existing the requirement for EHR proficiency by 2015 by requiring physicians must demonstrate the skills to comply with the federal government’s meaningful use requirements. It creates an institute to facilitate the implementation of interoperable records statewide, and promote the use of other health information technologies.

CMS to Delay ICD-10 Implementation

Posted in Electronic Medical Records, Health IT on February 14th, 2012 by Erica Noonan – 6 Comments

The acting administrator of the Centers for Medicare and Medicaid Services said today  her agency may delay adoption of a complex new insurance coding system.

Speaking at a conference of the American Medical Association on Tuesday, Marilyn Tavenner (right) said CMS is considering giving the nation’s doctors more time to switch to the ICD-10 systems.  Currently, the law requires implementation by October 2013.

(UPDATE: On Feb. 16, the CMS formally announced an indefinite postponement of the deadline to comply with the ICD-10 system.)

“I’m committing today to work with you to reexamine the pace at which we implement ICD-10,” Tavenner said to loud applause from hundreds of physicians. “I want to work together to ensure that we implement ICD-10 in a way that (meets its) goals while recognizing your concerns.”

Proponents say the switch from ICD-9 to ICD-10 will bring the U.S. medical system in line with much of the rest of the world, while allowing health officials to better track the nation’s health and monitor diseases.  The new system has some 68,000 codes, five times the amount under the current system.

The AMA and other physician groups say switching to ICD-10 coding will cost medical practices anywhere between $83,290 and more than $2.7 million, and that the pressure is too much while physicians are also coping with complex new electronic health record requirement mandates.

Lynda Young, M.D., president of the Massachusetts Medical Society, praised Tavenner’s openness to delaying ICD-10 implementation.

“This is a good thing, and it will give us more time to get ready,” said Dr. Young. “There are serious time and cost issues for practices trying to implement all of these changes at once.  We want to give people a chance to take care of the other changes first.”

Tavenner said her office would formally announce its intention to craft new regulations within the next few days.

More on the CMS announcement:

Erica Noonan

David Szabo: Due Diligence Needed to Protect Patient Information

Posted in Electronic health records, Electronic Medical Records on January 18th, 2011 by MMS Communications – Comments Off on David Szabo: Due Diligence Needed to Protect Patient Information

Legal issues continue to loom ever larger in the world of medicine. The establishment of accountable care organizations is presenting new challenges for physicians, and now, the implementation of the federal HITECH (Health Information Technology for Economic and Clinical Health) Act – the law enacted last year to promote the adoption and meaningful use of health information technology – should and must prompt them to give more due diligence to the privacy and security of patient information. 

That was the clear message from David S. Szabo, a health care attorney with Edwards Angell Palmer & Dodge, one of the featured speakers at the MMS’s January 14 CME session on Health Reform and Health IT.

Mr. Szabo took attendees through what amounted to a “legal lightening round” of issues to consider for users of electronic medical records, touching on privacy and security, obligations to notify when a data breach occurs, and best practices and risk management.

“The HITECH Act substantially increased the civil penalties to violations of the HIPAA privacy and security regulations,” said Mr. Szabo. Fines from $100 to $50,000 can now be levied on violators, depending on level of neglect and speed of correction.  

Some key elements of his presentation included the distinction between privacy and security, user requirements for electronic health information, the categories of safeguarding information, and the three steps of security requirements.

Mr. Szabo was quick to point out that state laws as well as federal laws apply to the safeguarding of information, and that violations of state law can result in civil penalties, damages, or licensure sanctions. Massachusetts, for example, is one of only two states to have an information security rule protecting “personal information.” Those who hold information about state residents must adopt a written information security policy and follow reasonable security practices to protect that information.

Among his suggestions for best practices: setting clear policies and procedures, intensive training, and privacy, security and data breach insurance. Additional details of his presentation are available here.

New England CMS Director Says Physicians Must Adapt

Posted in Electronic health records, Electronic Medical Records, Health IT on January 17th, 2011 by MMS – 1 Comment

The “dizzying” pace of change in our health care system requires physicians to adapt quickly to this new world, says chief medical office of CMS’ New England Region, Dr. William Kassler.

Speaking at the Massachusetts Medical Society’s health IT conference on Friday, Dr. Kassler began his remarks by outlining the impressive breadth of innovation occurring at the national level.

He then told physicians in the audience that the only way to take advantage of these innovations is to embrace information technology.

Later, in response to a question about whether physicians should wait to adopt EHRs until interoperable health information exchanges become a reality, Dr. Kassler said, “I reject the idea that you need a fully functional EHR to get the benefits.” He said the benefits from the decision-support tools in a freestanding EHR is “reason enough to invest.”

David Blumenthal: Physician Professionalism and Health IT

Posted in Electronic health records, Electronic Medical Records, Health IT on January 14th, 2011 by MMS – 1 Comment

Dr. David Blumenthal, the leader of the federal government’s health IT initiative, keynoted the MMS’ health IT conference with remarks today asserting that adoption of health IT is a professional imperative for physicians.

“Information and its management is a core competency for the profession,” he said. “Can we be technically competent if we don’t manage information using the most capable and available technology?”

Dr. Blumenthal also extolled explosion of innovation in the EHR industry, and that every major electronics company is trying to build a better EHR. He said a “tidal wave of change” is coming, and predicted there won’t be another opportunity in our lifetime to have the government subsidize the implementation of EHRs.

AMA Releases Comprehensive Physicians’ How-To Guide on ACOs

Posted in Accountable Care Organizations, Electronic health records, Electronic Medical Records, Global Payments, Payment Reform on January 10th, 2011 by MMS – Comments Off on AMA Releases Comprehensive Physicians’ How-To Guide on ACOs

Photo by MyTudut via FlickrThe American Medical Association has released one of the most comprehensive resources produced so far to help physicians evaluate their options for practice integration, accountable care organizations, and other issues, following the passage of federal health reform last year.

The resource may also be helpful to Massachusetts physicians who are thinking about what statewide payment reform and ACOs could mean to them.

Here are some of the topics:

  • ACO governance issues
  • Partnering with hospitals
  • Partnering with health plans
  • CO-OPs and accountable care
  • Electronic health records and federal incentive payments
  • Managing anti-trust risk

The document is available from the AMA at no cost.

Download the document here. (.pdf, 112 pages, 781 kb)

State Steps Up EHR Support Services for Physicians

Posted in Electronic health records, Electronic Medical Records, Health IT, meaningful use on September 9th, 2010 by MMS – Comments Off on State Steps Up EHR Support Services for Physicians

The state agency charged with helping physicians and hospitals implement electronic health records has released its list of 18 certified “implementation organizations” to act as consultants to practices during the implementation process.

They range from hospitals and health care systems, to private consulting firms, to even a few EHR vendors themselves.

The state also unveiled a list of 10 certified vendors of EHR software, and said that it’s made arrangements through Webster Bank to provide loans to physicians to help them purchase and install the software.

In addition, Dr. JudyAnn Bigby (pictured), secretary of the state Executive Office of Health and Human Services, issued an open letter today to all physicians inviting them to take advantage of the state’s support services. (.pdf)

She wrote, “As a physician, I understand that making the transition to electronic health records is challenging, but the Patrick Administration and the team of professionals at the Regional Extension Center will help you every step of the way.”

She invited physicians to become members of the state’s Regional Extension Center, which will provide direct support services to practices worth $4,500, upon payment of a registration fee up $600 to $800. The application form is available here. (.pdf)

General information about EHRs from the Massachusetts eHealth Institute is available to anyone, regardless of whether they’ve joined the Regional Extension Center.

Feds Release Revised EHR Rules – Flexible Enough?

Posted in Electronic health records, Electronic Medical Records on July 13th, 2010 by MMS – 1 Comment

photo by Geopilia, via flickrThe federal government today released its revised and final “meaningful use” regulations that define how physicians can qualify for Medicare or Medicare bonuses after installing electronic health records.

The rules don’t change the timeline for demonstrating the meaningful use of EHRs, but relax some of the standards that physicians and hospitals must achieve.

No doubt, the experts will have a hearty debate over whether the rules have been relaxed enough to address concerns that the draft rules were too difficult for doctors to meet, and not flexible enough.

(The MMS, the AMA and others have commented that the draft rules were a case of “too much, too soon.”)

In general, the feds have implemented a two-track strategy. There’s a core set of standards that must be met – 15 for physicians (and other “eligible providers”) and 14 for hospitals. Then there’s a separate set of 10 standards, of which physicians and hospitals must meet five to qualify.

At least some of standards are relaxed. For example, the draft rules said that physicians must order 75 percent of their prescriptions to qualify. Under the final rule, it’s 40 percent. Another example: The number rules relating to clinical decision support have been reduced from five to one. Physicians must meet standards for measuring six quality measure, and hospitals must meet 15, out of a total of 44.

Dr. David Blumenthal, who leads the government’s health IT program, said the feds received more than 2,000 comments on the draft rules, and took the comments seriously. He said, “We very much want well-intentioned providers to become meaningful users. [The goals] are ambitious but achievable.”

He added, “If you try, you can get there, and get the incentives.”

Blumenthal summarized the rules in an article published today by the New England Journal of Medicine.

The Journal also published a commentary by Dr. Regina Benjamin, the US Surgeon General. She wrote about how she implemented an EHR after her Gulf Coast practice in Alabama was afflicted by multiple disasters, including two hurricanes and a fire.

She wrote, “Whereas I had previously decided against installing an EHR system because I couldn’t afford one, I now realized I could not afford not to have one.”

The news conference was highlighted by the passionate – and heartbreaking – comments of Regina Holliday, the widow of a recently deceased cancer patient. She shared how her inability to promptly obtain her husband’s medical records during the course of his illness compounded the agony of their ordeal. Easily accessible health records, she said, would have made a world of difference.

Here’s  a recording of her brief remarks. The audio quality isn’t perfect because it’s recorded off a computer speaker, but it’s certainly good enough to understand her point. (Length – 4:02)