Home Forums Discussions Meaningful Use Version 7.1.1 and doing MU Stage 2

Anyone here upgraded to version 7.1.1 and attempting to do MU Stage 2?
I ran our MU reports for Stage 2 and we are failing on so many core measures! Some I expected since we haven't set up yet(patient portal, secure messaging, immunization registry).
But, some measures that we passed in MU1 (e-prescribing, clinical summaries), are now showing zero denominator in MU2 reports. Is this an AC issue? Or is there now another step we have to do to pass those measures?

Straight to the points to save time for everybody, no nonsense words.

Get 7.1.2

Erx problem is fixed on 7 1 2.

Yes MU2 is a very different beast. Needs total revamp of the office flow.

Eg.,
you need email addresses of maximum pts. Tell them that is the way you will be communicating with them in future. They have to provide you the email for you to get scores.

They need to view what you send by portal for you to get scores. So you have to tell them to view what was sent and call if any errors are found. I hear doctors are setting up a new workstation for patients in office to log in the doctors office after doctor visit is done, and somebody in office will show them, then get score up.

ERx score is very different, you have click on formulary and keep running reports and see if it is catching and you learn on the way why this is behaving this way. We are having trouble in this area as we just got 7 1 2.

Family history: needs to be 20% of your visits. Chart prep gal the previous day can do that.

Lab reconciling is must to get up lab scores.

I have problem with core 14, it is not catching - med reconciliation.

Your bandwidth for core 7a needs to be fast, it may drop packets when you send full chart and you may not get score. I have DSL and per AC it is disadvantage and I send full record for missed pts at the end of the day when things are quiet if my staff fails.

I am running report constantly to see where I am.

Definetely a different beast that needs to be tamed seriously. No non sense way, tell pts and staff to get scores up. Needs constant engagement with staff. I am spreading my headache to my staff about this issue till the attestation is done. No other way to stay in business.

Take class with Jessice F. She helped us spending almost 2 hrs on phone while a mistakes were found.

Good luck.

Discouraging. Seems like not a very efficient process. My staff have enough to do without "geek squading" technophobe patients to get the latest fed handout.

Sorry we are not talking efficiency. Not sure if efficiency and government are on the same page. We are doing it just to stay in business.

Yes one could just get out of Medicare and avoid all headaches and be eternally happy.

"Medicare eligible professionals who are not meaningful users will be subject to a payment adjustment beginning on January 1, 2015".

http://www.cms.gov/Regulations-and-...aymentAdj_HardshipExcepTipSheetforEP.pdf

To avoid reduced payments for the same work done in future, got to work hard now, like it or not.

Just do it.

My 2cts. To avoid cuts.

This is just horrifying.

This is not patient care; it is just madness.

So far as I know, nothing happens if we don't do MU-2 except the 1% penalty. And beefing up office staff and slowing down production to make it possible will cost far more than 1%, so it is a non-starter.

Our hospital is doing it with their clinics -- but they have endless sources of money, which small offices don't (because they scam big time). But worse than that, patient care has degraded drastically, and the notes from them when we get the patients in follow up are simply unreadable.

That is the consideration is the extra time effort of MU compliance worth the money let alone the important issue of quality.
The knowns: penalties will start the amount of penalty and how one adapts is some function such as [medicare payments/month X penalty) = Loss]
Can loss be overcome by additional patients seen/month?
For me medicare is about 50% so that a 1% penalty should be overcome by 2 additional patients/month my situation allows that as I turn people away currently.
Once the penalty ramps up (think current cap will be 7%) may be tougher to cover.
The wild cards will be what if all commercial payers adopt same rules, what if accreditation or even licensure (see Mass.) is tied in to MU compliance???
F'-me then!

Exactly.

Unfortunately it is not about patient care in this Meaningful Universe.

It is all about scores.

If one is mentally and financially ready to accept cuts, inaction is the best prescription. If not....

One could lament now and once cuts come, lament then too.

Or could avoid lamenting now, go to work and avoid lamenting later ......

Choices.

So coming to AudreyB question: It was not a 4000.00$ (sans 2% cut) question, it was a 1% to a whopping super 7% cut question and what steps to take.

It's become clear that when I retire it will mainly be due to government regulations. Overall I like my patients and make a good living but the government is making things worse and worse for solo doctors. A large group or hospital-owned practice can hire people to figure all this out. There is no one on my staff that can manage this so it comes down to do I want to spend the time figuring out and implementing these programs or just call it quits. I work in a small town and concierge practice is not an option.

Joseph, thanks for the info. AC got back to me and said that they corrected the zero denominator issue in 7.1.2 like you said. We just installed version 7.1.1 last week! You would think they would've just given us 7.1.2 instead. geez.

Med reconc has to be under provider signin to count for mu2
Ma doing under her signon does not count for provider

I feel so sorry for you guys. I've only been open for 3 years and decided I wouldn't take any of the socialist plans when I opened. I grew much slower (took 3 years to fill while my friends who took them took 2 years) and had to do urgent care on weekends for longer than I'd like but now I don't have to worry about any of this stuff. I just hope private plans don't move this way. If so then I'll move to a retainer model and charge like $20 a year or something for each patient and that should make up the 1% difference. That's what all the other business do when their taxes get raised, they just pass it on down.

I just installed 7.1.2 from 6.6.7 but the Updox Account Interface Activation doesn't let me link our existing Updox account in the setup window. I'm entering the same login info that I use to login into the Updox Workspace application (outside of AC) but it doesn't work. Am I doing something wrong? Does this interface work yet?

As you can see our Practice Name was automatically entered but the other fields won't take our login credentials.

Josue:

If I remember correctly that one is the login and password for your login to Amazing charts website, the one you use to download updates or pay annual bill at below website:

https://www.amazingcharts.net/ac/

Hope this works.

Yep thank you Joseph. I don't know why I didn't try that.

If we stay on V6, can we do Stage 1 yr 3? Anyone know?

I thought they were going to let us choose to do stage 1 year 3 for 3 months as long as we use a 2014 certified version. I read that a final rule about this would appear at the end of July but cannot find any final rule info. There is no way that I could get 40% of my lab or radiology data granularity. My patients come from 71 different towns in 28 different state. Until the whole " healthcare system" has better connectivity, I won't be connected.

So...I think I've found the answer....took me most of the day....

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Stage_2.html

I hope the link works

It works...scroll down to 2014 only and I think that is the answer.
Nancy

"ERx score is very different, you have click on formulary"

My friend at AC Stephan, guided me to set formulary to automatically start after going under E prescibing from the Toolbar. There is a box to check to automatically start formulary checking without clicking it.

Nancy,

That is hugely helpful. Thank you so much. Bottom line as I read it is that we are welcome to attest to Stage 1 for any 3 month period this year. I may never get to stage 2 and just take what I can get this year and call it good.

The "NPRM" referred to under 2014 means "notice of proposed rule making". It doesn't mean that a Final Rule has been published in the Federal Register yet. Stay tuned...

It is the only information available for a rapidly approaching deadline and is what CMS.gov has posted on their own website.

As I read post I don't think it can be any 3 month period, I think it has to be a fixed quarter.

I'm amazed that we, the providers, are just bending over for this. Well, just like we've done for every other fool idea that has come down the pipe. If we do not participate, it's a non-starter. Our only hope is to abstain from this nonsense. In 20 years when our professional relationship with patients is completely altered or destroyed, when we have no way to be in solo private practice, and all the providers are just corporate drones, I will have to thank everyone that just cooperated with this.

You are right. I misread it.

Proposed Rule Pending

Published May 23, 2014 ? Expected to be Final Fall 2014

This is from a webinar held yesterday, so participants BEWARE

Sunil, you did not provide a link. What is it we should beware of?

I think it is okay to be working on MU now with the expectation that the "Stage 1 again for 3 months" NPRM will probably be finalized. But it hasn't been yet.

This was from a FL Medicaid Webinar

For those trying to attest: If not aware: here are the instructions for MU2 Core 15:

Start with updating the consultant or referring doctor in practice rolodex.

In the General Info Demographics field for the patient under referrals and consultants you will have to select the add button; a little screen will appear; make sure the refer to is selected and either select from the drop down or add new the provider you are referring to, press save.

That name will appear in the referrals and consultants, above that there will be a drop down; select the record to link the referral to and select link and press ok.

Now you will be able to go into the Summary sheet for the patient select transfer care, fill out the HIPPA, on the bottom left where it says select referral ? select the providers name and then continue with either send direct or print or export.

You will need your colleagues/referral -direct-- email address from their EMR portals to test or send records directly.

This worked for me this am to get some numerators and denominators in core 15 MU2

Amen, brother!

After doing two years of meaningful use stage 1, my partner and I have decided to call it quits and forget about stage 2. I wish you all of the best that are still trying to go with the program but challenge you all to take a stand and stop this nonsense.

I really just wonder, is there anyone out there, anyone, that truly believes that meaningful use is the way to provide better care? I would love to hear from anyone that does.

I still love what I do but at only 45 years of age I have already seen how the value of our profession is being eroded by allowing others to take control of health care. I especially cannot wait to see how the quality of care in psychiatry is codified. They can codify my A--! I can guarantee that nearly every person who sees a PCP in the next few years will be given an Rx for an antidepressant based on a 5 question survey given by a PA. We all have to remember now, the future of "quality" care is population based health care not individual.

By the way, besides the pay cuts, CMS is trying to make those of us not participating look like bad docs who don't care about quality care. Check out Medicare.gov physician compare, type in your name and the site will list if you participate in "quality programs" such as e-prescribing and EHR's. So eventually be prepared for the patient who says, "but doctor, why don't you participate in these quality care programs".

Boy oh Boy:

Sure, there are a lot of doctors who feel board exams are useless and have called for boycott. So one could feel free to join those.

Many say the CME programs and state licensures are onerous, individual state licenses are restrictive interfering with easy relocation of doctors and you can call for boycott that also.

There a doc here on board recently who boycotted all insurances and set up an concierge practice.

There was a professional body recently, was it ACP? they said boycott concierge practice as it is considered creaming the cream and not taking care of all.

Boycott all pharmaceutical companies, they are too greedy, do not write brand name meds, they are too expensive to system.

Those are at professional level.

Now at personal level:

It would be funny to say that I am invited to nudist colonies. You see, those people have boycotted clothes. But to function in society, I could not join those. Thank you.

No end to the list.

One could become a master of all boycotts easily.

You see where this world is going.

Unfortunately this is seen as quality of care by the originator of this program. After a while everybody has high scores and these measures are grandfathered (that is when the Pompous Newspapers say the providers are gaming the system- getting high scores!)

or

the originator thinks this is not quality, so they change the rules again to start a Brand New grand experiment again.

Also the rules will be changed first and then the software developers will start scambling and scurrying again followed by doctors to meet those measures

the cycles start over again.

But I also have heard that Mr. Hippocrates -- remember that original guy, was the only one who meant to provide quality of care. All others who came after him had different agenda.

So, boy oh boy!!!

Joseph,

I could not agree with you more. I am now employed in a large entity that is fast-moving to population based health care and, in all honesty, it is not quality of care for which they are striving but rather a piece of the federal pay out. These "quality seekers" IMO are simply those that are prostituting themselves and are interested primarily in "following the money". And I work for a "non-profit" health care system. But, having now said that, I guess I myself have become a lady of the night because here I am...certainly not happy about what I am doing but at least able to put food on my table and have the money to buy new high heels and a tube top.

Leslie,

Can you post a picture with your new attire?

I was going to ask to see pictures, but I thought I would be accused of sexism. Thank you, Donna.

Have not seen you for awhile, Leslie. You look so.... uhhh .... young... in that picture.

Oh, Jon, you always were the flirt!

Leslie is clearly a fan of the "People of Walmart" emails that make the rounds.

Good on Boondoc

We are fools if we put up with this.
I'm hoping to survive 3-5 more years (I'm 71 now).
I don't think any of this is sustainable, so on a 20-year time frame everything will be totally different. But I won't be here then.