The New Reality of Health Care

These days the ground under physicians’ feet is constantly shifting. The recent historic passage of Patient Protection and Affordable Care Act, or health care reform bill, has set the stage for some of the most significant changes to the U.S. health care system in a generation. What will these changes mean for physicians and your ability to run a profitable practice and provide the best patient care? At athenahealth, we’re prepared to help our clients manage the complexity and seize new opportunities. To read in more detail about our perspective on health care reform and our response to the challenges it presents, click here.

“Meaningful Use” and the HITECH Act

While many reform bill provisions won’t take hold for years, the HITECH Act is rapidly reshaping the funding and implementation for electronic health record adoption in the U.S.

According to the Act, physicians are eligible to receive up to $44,000 in total incentives per physician from Medicare for “meaningful use” of a certified Electronic Health Record (EHR) starting in 2011. (Note: Physicians reimbursed by Medicaid can receive up to approximately $63,750 starting in 2011 based on state-defined guidelines.) After releasing preliminary requirements at the end of 2009 and fielding more than 2,000 comments, the Center for Medicare and Medicaid Services (CMS) released their 864-page final rule on July 13, 2010. For an in-depth analysis of the final rule and the established measures physicians using an EHR will need to meet in order to receive their HITECH Act incentives, click here.

Guaranteed Incentives, Nimble Technology

In response to the release of meaningful use, and to affirm our steadfast confidence in our ability to meet the new requirements, athenahealth is extending the deadline for participation in our Federal Stimulus Bonus Payment Guarantee Program to June 30, 2011. This program guarantees that eligible physicians using our EHR, athenaClinicals, will receive their HITECH Act incentive payments for meaningful use.

How can we be so confident in our ability to meet meaningful use that we are willing to put our own money on the line?*

• CCHIT Certification – athenaClinicals has received the most current CCHIT certification, and, as of July 2010, the most recent version was certified by CCHIT as EHR technology, IFR Stage 1, preliminarily meeting 24 of 24 requirements for Eligible Providers published by the U.S. Department of Health and Human Services (HHS) in the Interim Final Rule (IFR).
• 100% Client Confidence – According to the KLAS report, Ambulatory EMR: On Track for Meaningful Use?, athenaClinicals achieved 100% client confidence in its ability to enable them to meet 2011 Meaningful Use standards.
• Nimble Technology – As a network-based service, we are able to quickly incorporate across our entire nationwide network current and future meaningful use requirements mandated by the government. Many have expressed concern that in its final rule CMS only addressed Stage One criteria, leaving two additional sets of criteria to be articulated and met in the future. Our web-based solution and real-time rules engine are uniquely positioned to respond in real-time to the uncertain changes to come, with constant updates made instantly available to all providers on our network.
• Service to Manage the Complexity – At 864 pages, the new meaningful use rule includes a dizzying array of options and combinations for physicians to meet quality measures. But this flexibility creates more confusion for doctors struggling to get paid in a highly complex reimbursement environment. athenahealth’s back-office services take this burden of complexity off the shoulders of physicians, taking on the work of collecting and reporting on required data for meaningful use.

Here is a more detailed breakdown of how athenahealth is addressing key meaningful use measures:

Improved outcomes

• Care Coordination (Electronically exchange information): Unlike most EHR offerings, athenaClinicals is network-based, meaning that it already exchanges clinical information with dozens of labs, hospitals, providers, and payers across the country (including Medicare and Medicaid). We are well-positioned to meet and manage other interoperability requirements.
• Patient and family engagement: athenahealth’s existing ReminderCall^SM service, which will be incorporated into the soon-to-be-released athenaCommunicator^® service, is integrated to help practices meet these HHS priorities.

Advanced clinical processes

• Use of e-Prescribing: athenaClinicals is Surescripts® certified for Prescription Benefit Eligibility, Formulary, and Reporting; Medication History (payer); Prescription Renewals (retail); and Prescription Routing for New Prescriptions (retail and mail-order).
• Closed Order Management: Because our EHR includes document management services, we make it easy for providers to create and send electronic orders from the encounter. Users can also track and close orders within the application for better follow-up and quality reporting.

Data capture and sharing

• Quality care and population management: athenaClinicals’ rules database provides a set of payer-specific quality measures–including existing Pay for Performance (P4P) measures such as Physician Quality Reporting Initiative (PQRI). The database also allows for comprehensive and automatic demographic reporting.

The HITECH Act is an important opportunity for physicians who can “meaningfully use” EHRs to improve care outcomes to be rewarded, and a significant driver of widespread EHR adoption. We at athenahealth are here to help you navigate through the complexities of meaningful use, help you get all the incentive dollars you deserve, and free you from administrative red tape so you can focus on quality patient care.