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How We Met Difficult Meaningful Use Stage 2 Measures While Improving Care

by Peter E. Masucci, MD, P.C.

Heading into 2014, we knew we had our work cut out for us at our practice: We’d be attesting to Meaningful Use Stage 2 and transitioning to ICD-10 all within the same year. And since ICD-10 preparation was starting 10 months out from the transition date, as recommended, we knew we needed to tackle Stage 2 the first quarter of 2014, so we could really focus on ICD-10 needs closer to the October deadline (which has now been delayed of course, but that’s another blog post…)

Having successfully survived Stage 1, we were optimistic about meeting Stage 2 measures without too much excessive effort. However, we soon realized how much we had underestimated the requirements necessary to achieve Stage 2; more specifically, the ‘Preventative Care Reminders’ and ‘Secure Electronic Messaging’ measures.

As we began the process, we found these measures presented an overwhelming challenge for me and my staff. Realizing we are part of
only a small percentage of caregivers who has attested to Stage 2, I wanted to share our story of struggle (and triumph!) hoping others can learn from our experience.

Delivering Preventative Care Reminders
When Stage 2 attestation began, our patient follow-up workflow was both a curse and a blessing. We were essentially doing too good of a job.

As part of our existing workflow, when a patient checks in for their well visit we immediately schedule their next interim well visit — meaning the patient can bypass the check-out desk after their appointment. Very efficient for us and the patient, but also negates the opportunity to meet the Stage 2 reminder measure.

Additionally, we were creating reminder ticklers to contact our no-show patients (particularly on Saturdays, when we have a high success rate calling patients to schedule appointments). As a result of this workflow, we have more patients with already-scheduled appointments and far fewer needing outreach to schedule; again, this is efficient, but doesn’t satisfy the Preventative Care Reminders measure.

We had two options: a) Change our workflow to fit the requirements of Stage 2, or b) find a patient population that needs more proactive contact from us. Since our electronic health record (EHR) has the ability to augment our workflows to send clinically relevant population health campaigns to patients — and, like the saying goes, “If it ain’t broke, don’t fix it” — we went with option B.

By leveraging our EHR’s report capability, we identified patients who should receive a specific vaccine, plus any patients who needed or failed to keep follow-up appointments. We created and sent automated group call campaigns to these patients and reached out via phone, patient portal and text message.

Preventative Care Reminders measure: satisfied.

Using Secure Electronic Messaging
It is always worrisome when your success depends on others’ actions, and the Secure Electronic Messaging measure is the perfect example. As providers, we have no control over whether patients will exchange a message with us — but every challenge always comes with opportunity.

To kickstart this measure, here’s what we decided to do: Using the patient portal, reach out to patients after a visit to our office, asking if we satisfied their needs, and if they had additional questions. Not only did this tactic encourage patient engagement and portal adoption, helping satisfy the measure, but it also reduced the number of calls we were receiving (for prescription refills, in particular) and cases that needed to be created for the nursing team. To ensure the maximum level of engagement, we initiated an outreach campaign informing patients of the portal, and implemented a hands-on “training session,” in which our nursing team would coach patients on how to log on to the portal during the intake process.

I’d say that is a win-win for everyone. Patients and parents have a seamless experience, my staff is freed to focus on other goals and work at a higher level of service, and the Secure Electronic Messaging measure is met.

Despite the challenges that came with meeting Meaningful Use Stage 2 measures, I would never advocate for delaying progress, and I’m disappointed to see other providers haven’t had the necessary support from their EHR vendor to meet Stage 2. We’re now in a great place to continue educating our staff and patients, and to be prepared for a full year of Stage 2 in 2015 — and we know we’ll have the time and resources to devote to the ICD-10 transition, whenever that may be.

We have the comfort and satisfaction of knowing that we set the bar high in attesting to Stage 2 as early as possible, and achieved our goal.

There are only a handful of Stage 2 measures that providers are having difficulty with based on our transparency into performance.

Dr. Masucci is an athenahealth client and a pediatrician at Peter E Masucci, MD, PC, based in Everett, Massachusetts.

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