This is our last Meaningful Use Dashboard Update for 2011 and we are happy to show a healthy uptick in the final weeks of the year.

We’ll have one or two more updates in January 2012 to catch those last few providers who cross the attestation finish line. And stay tuned for a more complete summary of our performance and lessons learned, coming up around the time the Centers for Medicare & Medicaid Services (CMS) announce the final 2011 Meaningful Use (MU) numbers.

But first, our data:

• 77% of our Medicare MU providers have attested; as of Dec. 3, 66% of our Medicare MU providers had attested

That’s an 11 point bump in our attestation rate over two weeks, after a few weeks of single-digit increases. The percentage of providers who have satisfied all but two core measures has decreased slightly from 25% to 17%; we expect this number to shift downward as more and more providers attest.

• 95.2% of our Medicare MU providers are currently satisfying the Clinical Summary measure; as of Dec. 3, 92.2% had satisfied this measure
• 97.9% of our Medicare MU providers have met 5 of 10 menu measures; as of Dec. 3, 96.9% had done so

So, the story for this week’s Meaningful Use update is that the numbers keep going up! 

Looking back briefly, we only began showing our numbers in September with a post by Jonathan Bush about transparency. He lived up to the pledge and during the Medical Group Management Association (MGMA) convention week in Las Vegas, he challenged the industry to be just as open about their Meaningful Use performance. Has anyone else stepped out with their data? If there is anyone else publishing Meaningful Use data for all to see, please share.

Until then, we’re happy to know that our clients in the Meaningful Use program pushed through some early challenges and made steady progress toward successful attestation throughout the year. We’re also ready for 2012: full-year Stage 1 Medicare MU, Year 2 Medicaid MU and a whole new set of providers who will begin their journey to Meaningful Use.

How have you fared in your journey to Meaningful Use?

People who don’t regularly find themselves in houses of worship will often turn to prayer when facing dire circumstances like, say, jungle combat or the inside of a jail cell.

Now a recent article in Modern Healthcare references a study by KLAS on preparation among medical providers for the looming January 1 conversion to ANSI 5010—and it turns out some of those providers have lately found religion.

The KLAS survey of 800 office-based providers found not only that a majority has not bothered to prepare but that providers are putting their faith in claims clearinghouses to do all the work required for the transition. The report found what a substance abuse counselor might describe as instances of “denial” among caregivers.

According to one such provider quoted in the piece, “I’m honestly trying to pretend that 5010 changes are not going to occur… I pray that (our clearinghouse) will be able to deal with the changes. Because of what they are telling me, I think they will. I hope they have been telling me the truth.”

It’s not like ANSI 5010 should be a surprise. The Centers for Medicare & Medicaid (CMS) have been diligent about waving the warning flags. Just last week, the agency released a notice that “The compliance deadline for the transition to Version 5010 is only two weeks away!” It was accompanied by a reminder that there’s now an “enforcement discretionary period” out to April 1, as well as links to updated fact sheets, webpages and other resources.

And then on Dec. 19, the Medical Group Management Association (MGMA) acknowledged all this and asked for a six-month contingency plan so that medical practices are not negatively impacted in early 2012. They used some strong language backed up with hard facts.

So what’s the point?

If you’re an athenahealth client, a lot of this is irrelevant because we’ve got you covered. You may recall a blog post from October about how “… thanks to our cloud-based model, 100% of our clients are already using a 5010-compliant version of our practice management services that we updated at no additional cost.”

So since the praying contingent among our clients can reserve their spiritual energies for causes other than ANSI 5010, we thought now might be a good time to share some fun facts we’ve gathered in the course of our work on the transition.

 For our top 100 payers:

• Only 32% of our claim volume was available for 5010 conversion prior to Q4, due to lagging payer and vendor timelines. Despite this delay, we’re now at over 60% 5010 claim submission and expect to close the year above 85%.
• Production testing is available for 73% of this volume. This is the gold standard of testing—sending real claims for real adjudication before flipping all volume live. By sending small volumes of production 5010 claims before converting it all, we’ve found and resolved production issues with many payers prior to go-live. This spares our providers literally tens of thousands of claim rejections and denials.
• While the CMS grace period protects providers from being fined for non-compliance, we think that a lack of payment in 2012 would be an even more distressing financial penalty.  Many payers (Medicare included) will not accept 4010 claims after December 31, 2011, so timely conversion is critical.

There it is. We are ready. Our clients are ready. And if you’re a physician who lives in a state of denial about ANSI 5010, maybe it’s time you talk to someone instead. In the meantime, check out this on-demand webinar about ANSI 5010 and this recent ICD-10 webinar. Just know you are not alone and it doesn’t have to be so bad.

Thanks for reading the blog Dr. Dudley, and thank you for sending in your comment.

For anyone who missed it, Tim Dudley—former user of a pained, old school EMR and once nervous athenahealth prospect—pointed out the usual downside scenario of any results-based marketplace; it’s hard to account for wind in your face. As you suspected, Tim, it’s true that major drivers of “open loop” orders in our network are actually related to patients who bug out. They don’t want to pay or co-pay or (like me) they don’t want to be handled by a urologist but don’t want to admit it to their female MD! This is the same story line that caused resistance to capitation back in the day…or episodic rates, etc.

It’s all true!

But, where athenahealth’s revenue is concerned, I’m ready to take that in stride. So, in the case of athenaClinicals, I’m okay with the fact that the open loop order will cost athenahealth revenue even if we do everything right! We expect that to happen, and we will adjust our pricing so that we are more or less made whole, but, mostly, I believe that we will GET BETTER at closing those open loops if there is money at risk for us than we will if there is only “good will” at risk.

I had the exact same experience eight years ago when I told my employees that their bonuses would be driven by the DAR and bad debt of our clients.

• “But what if they suck?” was one anonymous question read at a company meeting back then.
• “What if the sales team ends up with more inner city clinics that are dependent on Medicaid?” read another.

To these questions, I used that age-old, enlightened management technique: insert thumbs in ears. Nevertheless, as the bonuses started to roll, teams started slicing and dicing our DAR across clients, specialties, markets and the supply chain. The relentless, unfeeling pressure of our tiny little marketplace actually caused our employee base to understand these numbers and their drivers WAY better than they would have without the pressure. Earlier in the history of the company, our clients’ DAR was much higher than the most recent 39.7 average.

By the way, I’m not saying that athenahealth is going to put CLIENT revenue at risk. I’m only talking about OUR revenue…and perhaps some bonus money for clients that they aren’t getting today.

Don Berwick recently stepped down from the helm of Medicare and Medicaid. While I hate to quote him, since he would never meet with me (I’m still free Don!), among his parting shots as to why health care is so expensive were, according to the article:  the failure to coordinate care, administrative complexity of the health care system and burdensome rules and fraud. The only way everyone is going to keep at the constant revisions and tweaks needed to separate the false positives and false negatives that Dr. Dudley points out will be a constant and reliable marketplace with an easily imaginable upside for figuring it out.

Net net, you are right about the false positives and the slag in the system today. The thing is, I truly believe the only way to bust through that stuff and bring it under control…is to be at financial risk for it!

 Hope that helps.

As the holidays draw near, I look forward to traditions shared with family and friends. Who doesn’t? There’s watching movie classics like Rudolph, eating all of the chocolates in my Advent calendar in one sitting and we can’t leave out all the family theatrics around the holiday table…

So it is quite fitting that DC seems to be honoring its own time-honored traditions: 

• In the wake of the Super Committee failure, we once again look to Congress to address the 27.5% physician reimbursement Medicare cuts —currently effective January 1, 2012—as defined by the Sustainable Growth Rate (SGR)… we need a ‘doc fix.’ I’ll catch you up on that particular topic in a future post.
• The Department of Health and Human Services (HHS) has started its annual end-of-year final rules and announcements blitz, including the We Can’t Wait campaign, the Meaningful Use (MU) Stage 2 delay announcement and new CMS Meaningful Use performance stats, all of which  I describe below. We also look forward to an announcement about the ACO Pioneer Program participants.

Along with the announcement of the We Can’t Wait campaign to encourage adoption and use of health information technology (HIT), HHS Secretary Kathleen Sebelius released a report from the Centers for Disease Control and Prevention (CDC) showing that adoption rates of HIT have doubled in two years. 

She also announced the decision to officially delay Stage 2 MU requirements, which the HIT Policy Committee recommended to the Office of the National Coordinator (ONC) this summer. This gives vendors and providers more time to develop and implement Stage 2-certified technology. I understand that timelines became very tight for Stage 2, but I can’t help wondering what a delay does to the EMR market and health care industry. With more than 780 certified solutions in the ambulatory space alone, it seems there is more motivation to create a market in which the most innovative, adaptive solutions survive. I agree with the HHS campaign: We can’t wait. I just wish it didn’t feel like that’s what we’re doing.

Editorializing aside, the delay means that:

• Providers who began MU in 2011 will demonstrate Stage 1 requirements for an extra year—2011-2013 (Years 1-3)—and perform Stage 2 requirements beginning in 2014 (Year 4). 
• Providers who begin the program in 2012 must demonstrate Stage 1 requirements in 2012-2013 (Years 1-2), with Stage 2 requirements beginning in 2014 (Year 3).
• All eligible providers must perform Stage 3 requirements starting in 2015 or incur a fee schedule adjustment of 1% in 2015, followed by a 2% adjustment in 2016, and so on.

The Notice of Proposed Rulemaking (NPRM) for the Stage 2 requirements will be released in early 2012 and we expect the Final Rule to be issued in June.

Aaaaand finally, CMS released new Meaningful Use performance statistics during the HIT Policy Committee meeting on December 7, including the following highlights:

• Total # of Medicare-eligible professionals (EPs): 382,000
• Total # of Medicare EPs registered for the MU program YTD: 114,925
• Total # of Medicare EPs to receive their first MU incentive YTD: 10,155

Meaning?

Approximately 30% of eligible providers in the nation have registered for the program and only about 2.5% have gotten paid.

It is worth noting that 4,255 EPs were paid in November. This accounts for almost half the total payments in 2011, and CMS expects the rate to spike through February. CMS also recognized during the HIT Policy Committee meeting that the number of Medicare EPs is lower than desired. As a result, CMS plans to launch an exploration of barriers to program participation. 

I’ll be in DC this week so stay tuned… and as always, you can follow me on Twitter for constant updates.

If you talk to the pizza shop owner down on the corner—the successful one, that is —he won’t be standing there dusted in flour like he might have been years ago. No, he’s run the place well enough that it sorta hums along. He stops by every now and then when he’s not polishing his boat. And if he still makes pies, it’s because he wants to.

The athenahealth experience with Meaningful Use has not been totally dissimilar. We just heard from a client the other day who successfully attested to the measures in October. During a recent conference call, one of his colleagues who’d bought another EMR groaned into the phone about Meaningful Use. Our client’s response: “Really? It was easy.”  

In addition to keeping flour off our doctors in every way we can, we’ve been pumping out our performance tallies for all to see since September. There will be only one more installment before 2012 and we’ll save any conclusions for that last dashboard update.

In the meantime, the needle keeps moving and our clients keep improving. You may remember Dr. Reavis T. Eubanks of Asheville, N.C. He emailed a while back to say he’d received his Meaningful Use incentive check for $18,000. Along the way he made the most of our MU client support program, did his part and got paid. We couldn’t be happier for him.

Here’s how the rest of the athenahealth field has fared on the Meaningful Use Dashboard as of Dec. 3, 2011:

• 66.2% of Medicare MU providers have attested, a 4 point increase in two weeks
• 25% of Medicare MU providers have satisfied all but 2 core measures, a 3 point decrease in two weeks (which is a good thing)
• 92.2% of Medicare MU providers have satisfied the Clinical Summary measure, a 1.7 point increase in two weeks
• 96.6% of Medicare MU providers have satisfied 5 of 10 menu measures, an 8.7 point increase in two weeks that’s notable because menu measure performance has been pretty flat

This does not just happen. We have a pending whitepaper and a webinar scheduled for early 2012 that will explain and explore the benefits of cloud-based services for medical groups and how there’s no way we could see any of this if we just sold software. We provide a service and that’s the difference between Dr. Eubanks and the pizza shop owner who still has to strap on an apron.  

Here are some fun and helpful videos featuring Paul Hochman, technology editor of NBC’s Today Show, that explain just how our cloud-based service model works:

Stay tuned two weeks from now when we wrap up the dashboard for 2011!