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Behavioral health IT: The 'haves' and the 'have nots'

August 12, 2011
by Dennis Grantham, Editor-in-Chief
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As many providers yearn for IT help, one early adopter says its EHR system is “mission critical"

Amid continued efforts by many to help behavioral health providers who are struggling to adopt new information technology, the sad fact is that most providers are not “haves” but “have nots.” That’s the word from Michael Lardiere, the National Council’s recently named vice president for health information technology and strategic development.

Lardiere, who joined the National Council in April, says that of the National Council’s 1,900 member organizations, “less than 50 percent—or—I’ve heard as low as 25 percent—of those have some health information technology.” Even, he notes, “if you accept the 50 percent figure, which in my experience seems very high, that’s still about 1,000 members who really don’t have much.”
He adds that while the number of providers using practice management systems continues to rise, “some providers, particularly in the area of substance-use disorder treatment providers, don’t even have those.”

Among behavioral health providers with IT capabilities, Lardiere says that at present, “we can’t really say where many of them are relative to meaningful use.” To get the facts on member IT capabilities, he says that the Council is planning a health information technology survey of its members in the near future. Yet, no matter what that survey finds, it’s clear that most providers have a long way to go until they can proficiently—let alone meaningfully—use healthcare IT in their organizations.

More on EHR incentives

In the first year of eligibility in the Medicaid segment of the HITECH EHR incentives program, eligible providers—physicians and nurse practitioners—can receive $21,000 for committing to purchase and implement qualifying EHR technology, or by attesting to completion of Stage 1 Meaningful Use requirements. But behavioral health organizations don’t qualify for organizational funds the way that, for example, acute-care hospitals do. These organizations often ask their “eligible providers” to complete contracts or other agreements that legally transfer the EHR incentive funds they’re receiving to their employer—the behavioral health organization.
For more details about EHR incentive programs, see ... "Five key questions about EHR incentive funds."

While many providers are still learning how to begin, there are also stories of the very first eligible providers—and their provider organizations—qualifying for and receiving electronic health record incentive funding (see the sidebar to your right).
And, there are also those rare organizations who are so far along in the adoption and use of their EHR systems that the potential for EHR incentive funding can be considered a form of “icing on the cake—an option that’s attractive, but not necessarily urgent or even required.

Youth Villages (Memphis, Tenn.) is one of those rare providers. Although they’re adept in using health information technology, they’re not striving to achieve “meaningful use” and its related incentives. In fact, the organization—whose 2,500 employees serve 3,000 young people (ages up to 25) daily from 63 locations in eleven states and the District of Columbia—has ruled out going for Medicaid meaningful use incentives as it implements its third generation of EHR technology. But it did so only after a lot of consideration, says Hughes Johnson, Youth Villages’ Director of Performance Improvement.

“We never could find an easy way in [to the program] except through working with our doctors—working with them to get the incentives money,” Johnson explains. While Youth Villages, which employs four full-time physicians and a nurse-practitioner, considered that arrangement, he began reviewing the meaningful use requirements.

“It struck me that these requirements were really set up for a physician doing medical care. Yet, we’re a behavioral health organization and I wondered, ‘Is this really going to be worth the effort? How much do we really want to put into this?’” He also realized that the decision could be unpopular internally. “Would we be signing on to a situation where there’s someone else telling us what to do?” he wondered, realizing that “that’s not a situation that always works well in our organization.”

Then, another concern arose—a threshold requirement for the Medicaid incentive program that required each eligible practitioner’s practice to include (directly or by formula) 30 percent Medicaid patients. “Many of our patients are funded with non-Medicaid state dollars,” says Johnson, “so that 30 percent threshold was a reach.”

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