Some 18 months ago, industry groups and providers far and wide were quick to point out the challenges they saw in the requirements to which they'd have to attest to earn the EHR “meaningful use” incentive funds provided in the HITECH section of ARRA, the American Recovery and Reinvestment Act.
More recently, however, a growing number of providers have become more optimistic, says Amy Machtay, a HIMSS certified professional in health information management, or CPHIMS. A consultant with Boughton and Orndorf Consultants (Orange Beach, Fla.), Machtay visits behavioral health organizations to conduct “readiness assessments” that get them started on the path toward meeting meaningful use requirements.
For providers who still utilize paper-based systems-still a sizable number-Machtay's engagement often starts with an earlier step-fact-finding that helps an organization to evaluate and select a certified EHR. For those who already have and use EHRs (typically these are “non certified” and therefore in need of upgrade or replacement), she says that the readiness assessment can begin immediately.
Oklahoma-based Grand Lakes is first CMHC to get EHR incentive funds
Grand Lake Mental Health, Inc. (Nowata, Okla.) serves behavioral health needs in seven counties of northeastern Oklahoma, with regional offices supported by an administrative center. About 10 years ago, Grand Lake adopted an electronic health records system, trained up its staff, and has made numerous expansions and changes along the way.
Because of that experience, Grand Lake's CIO, Steve LaFleur, felt optimistic about the organization's prospects for earning EHR “meaningful use” incentive funds as soon as he heard the details of Oklahoma's program last fall.
“We learned from a representative of the state that Oklahoma would be ready to begin the EHR incentive program and disburse funds in January 2011,” he recalls. In fact, Oklahoma has been a leader in implementing health information technology initiatives. It was one of the first states to win CMS approval for its state EHR incentives program and is the recipient of a $50 million grant to develop health information exchange (HIE) technology that could be shared with other states.
Once LaFleur reviewed the requirements for the Medicaid EHR incentive program, he knew Grand Lake could do it. Qualifying for the first year's incentive-which provides one-third of the total incentive offered-required Grand Lake to certify its “eligible providers” and “adopt, implement, or upgrade” to a certified EHR software package.
Because Grand Lake already used an EHR system, qualifying its eligible providers-two psychiatrists and a nurse practitioner-was straightforward. The state required that Grand Lake submit 90 days of records to demonstrate that a minimum of 30 percent of provider encounters were taking place with Medicaid patients.
With provider eligibility established, “all that was really needed [for first-year eligibility] was a promise that we would implement and begin using a certified record,” he says. After learning from The Echo Group that it expected to complete product certification in early 2011 for its product (Clinician's Desktop, version 8.13), he “communicated a number of times with the state to make sure that we were doing things right.”
“Once Echo got their software certified in February, we were ready to go,” says LaFleur, who sent in Grand Lake's application in on April 1. “Right now, we're on version 8.0 of Clinician's Desktop and we'll upgrade to version 8.13-the certified version-just as soon as we've tested all the pieces according to our local configuration. We're required to be using it by yearend,” he says, noting that they expect to be up and running this summer.
To qualify for second-year incentive funds totaling $8,500 per eligible provider, Grand Lake is now obligated to attest that, for any 90-day period of 2012, it meets 10 “core” and 5 “optional” meaningful use measures, as well as any quality improvement measures required by Medicaid or the state of Oklahoma program.
The prompt arrival of the first year's incentive payment the week of April 18 came as a pleasant surprise to LaFleur and the Grand Lake team. “Last week, our billing department saw that our doctors' deposits were much higher than usual. But when I saw the amounts, I told them, ‘I know what that is.’ The state funneled the EHR incentives into the flow of the other payments for our Medicaid services.”
In all, Grand Lake's three providers were paid incentives of $21,250 each, bringing their total first year EHR incentive to $63,750. By meeting meaningful use requirements for five more years, these eligible provider incentives will total the maximum of $63,750 each, or $191,250 in all. The incentives are initially paid to the providers, who then use an agreement to transfer the funds to the CMHC.
So, a natural question: What is Grand Lakes going to do with the money? LaFleur notes that a lot of the meaningful use requirements revolve around medical and physical health components. And, while he says that “we haven't yet chosen our core/optional measures, we're excited about bringing in the medical side to our facilities, so our clients can have both medical and behavioral health needs met.” He adds that Grand Lakes is looking at options to expand integration with federally qualified health centers, as well as facility redesigns that would add medical examination rooms.