In my family practice these days I am not only busy taking care of numerous patients with complicated chronic diseases but also coming to grips with the necessary tasks to qualify for the Centers for Medicare and Medicaid Services (CMS) Incentive Program for my Electronic Medical Records (EMR) system. “Meaningful Use" (MU) of the EMR system must be demonstrated in order to receive the reimbursement.
According to CMS, “The American Recovery and Reinvestment Act (ARRA) of 2009 specifies three main components of Meaningful Use (MU):
- The use of a certified EHR in a meaningful manner, such as e-prescribing.
- The use of certified EHR technology for electronic exchange of health information to improve quality of health care.
- The use of certified EHR technology to submit clinical quality and other measures.”
Here is a summary of MU Stage 1 Requirements that I am using to guide me through this process. The overarching purpose of Meaningful Use is to improve quality and reduce the cost of healthcare. This is accomplished in part by increasing efficiency, reducing duplicated testing with its associated costs and reducing medical errors. Improved patient satisfaction is also an important goal.
It is quite a challenge to successfully accomplish this goal in 2011. My EMR company over the last few months has been in a frenzy modifying their software application to comply with the final rules of MU that were released only late 2010. 2011 is important for Stage 1 qualification of the program, since only 90 consecutive days of Meaningful Use need to be demonstrated in this year. Starting Stage 1 qualification in 2012 will require an all year demonstration of Meaningful Use. Performing correctly the necessary patient care steps (workflows) to meet the objectives requires additional effort, but I think that it is worthwhile.
Treatment and complications of heart disease and stroke cost this country nearly half a billion dollars and half a million lives a year. In general, optimum control of blood pressure and low density lipoprotein cholesterol (LDL) is seriously lacking, despite the billions of dollars a year spent in the US healthcare industry. Physicians can greatly reduce the cost of healthcare even by just optimizing the treatment of hypertension and hypercholesterolemia. Stage 1 MU requirements include mandatory selection of several Clinical Quality Measures (CQMs). Here are examples of how 2 out of many CQMs that I am working on that may help reduce costs, morbidity and mortality.
Effective management of blood pressure in patients with hypertension can help prevent cardiovascular events, including myocardial infarction, stroke, and the development of heart failure.
Clinical Recommendation Statement:
“Treating SBP and DBP to targets that are <140/90 mm Hg is associated with a decrease in CVD risk complications. In patients with hypertension and diabetes or renal disease, the BP goal is <130/80 mm Hg. (JNC VII, 2004).”
Studies have demonstrated that active treatment with lipid lowering therapy is associated with stabilization and regression of coronary atherosclerotic plaques and decreased incidence of clinical events. Recent clinical trials have further documented that LDL lowering agents can decrease the risk of adverse ischemic events in patients with established CAD.
Clinical Recommendation Statement:
The LDL C treatment goal is <100 mg/dl. Persons with established coronary heart disease (CHD) who have a baseline LDL C 130 mg/dl should be started on a cholesterol lowering drug simultaneously with therapeutic lifestyle changes and control of nonlipid risk factors (National Cholesterol Education Program [NCEP]).
I take advantage of my EMR application’s impressive programming capability to prompt me during patient office visits when blood pressure and LDL measurements are outside the optimum parameters, and also to guide me through the appropriate steps to achieve the range that I am looking for. This often includes printing pertinent patient education material, requesting appropriate lab testing and prescription changes.
This $20 billion incentive program has thousands of physicians each chasing an approximately $50,000 rebate. In the process, they may very well reduce trillions of dollars in health care expenditure over the next several years, while improving quality and patient satisfaction.