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The 'haves' and 'have nots'

October 5, 2011
by Dennis Grantham, Editor-in-Chief
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While many providers struggle with limited IT capabilities, others see EHR systems as “mission critical”
Michael lardiere, the national council's vice president for health information technology and strategic development
Michael Lardiere, the National Council's Vice President for Health Information Technology and Strategic Development

Amid continued efforts by many to help behavioral health providers to adopt new information technology, the fact remains that a significant number of 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.”

Youth Villages sees its EHR system as “mission critical,” so it went ahead with upgrades regardless of its eligibility for EHR incentives.

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 many providers have a long way to go until they can proficiently-let alone meaningfully-use healthcare IT in their organizations.

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 sidebar).

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 question arose-would the Medicaid patient populations seen by Youth Villages eligible providers meet the minimum threshold for participation in the Medicaid EHR incentive program? According to Johnson, many of Youth Villages patients are funded with non-Medicaid state dollars, so meeting the threshold level seemed like it could be “a reach.”

Ultimately, Youth Villages passed on participating in the MU incentives program. But the exercise of consideration helped him and his colleagues realize two important things. First, that the Medicaid EHR incentives program was “more a means to incentivize an EHR purchase, rather than a reward for those, like our organization, that have already become very comfortable with health IT.”

Second, that Youth Villages-now implementing its third generation of EHR technology-has long seen its EHR system as “mission critical” and was “ready to go ahead with the system with or whether or not we got government help.”

“We've got a large research component. We track two-year outcomes, looking at components of care andplacement factors for each child,” says Johnson. The approach enables Youth Villages “to see what we did for the successful kids and what we didn't do for those that were not successful.”

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.