MGMA 09: Confusion reigns over EMR stimulus, HIPAA, Medicare SGR

It's a good thing the federal EMR stimulus program doesn't start for another 15 months, and an even better thing that HHS likely will give doctors until 2014 to meet the so-called 2011 standards for meaningful use of health IT, because there's a lot of education that needs to be done.

"I think everybody sort of gets the gist of it," NextGen Healthcare Information Systems Senior VP Scott Decker said at the Medical Group Management Association annual conference in Denver earlier this week. The government is handing out a boatload of cash for physicians and hospitals to adopt EMRs. However, Decker has heard a number of "interesting interpretations" of this idea.

He is not alone. MGMA senior consultant and health IT workflow expert Cindy Dunn said that she's heard from numerous clients wondering when Uncle Sam was going to write them a check so they could go out and buy an EMR. Uh, it doesn't quite work that way. You have to install the technology and prove that you're using it in a meaningful way--based on rules HHS won't finalize until the second quarter of 2010. Then you get your money.

"The stimulus isn't there to help you purchase an EMR/EHR," Dunn said. "It's there to help you provide better-quality care."

Meantime, the physician market remains stuck in neutral. Dr. Bill Jessee, MGMA's CEO, said his organization's membership breaks down into two camps when it comes to clinical IT. About one-quarter have some form of electronic record, though likely not a full-blown system. "They're trying to figure out what the rules will be," according to Jessee. Then they will work with their vendors to make the necessary adjustments to qualify for their share of the Medicare or Medicaid bonuses.

The rest? Well, they're in a similar position, only they haven't purchased a system yet. "My sense is that most of them are sitting on the sidelines waiting for clarification on rules," Jessee said.

And these are but two factors that, in the words of MGMA's Washington-based senior policy advisor, Rob Tennant, have "paralyzed investments in HIT." Understanding the new HIPAA requirements on breach notification also are proving to be a challenge. But the biggest factor--surprise--is the uncertainty over the direction of health-insurance reform. Practices, Tennant said, are having a hard time forecasting revenue because they're uncertain about the future of the Medicare sustainable growth rate.

And I've been saying for months that the noisy healthcare debate this summer and fall has excluded health IT. Now it's starting to make sense. Sorta. - Neil