Home Forums Discussions Meaningful Use How long does it take

Wanted to ask the question for all those who are actively doing MU, especially those who do all the entering of data themselves,
how many extra minutes per encounter or minutes/day do you think it takes to do all the required documentation for MU after a note is done, diagnosis listed and prescription sent?

Not much from my side.

My staff spends some time on structured family history the first time, once caught up- no problem. Staff sends to portal- that days note, full chart..etc..

The main issue is keeping track on scores and see where you need make up and interact with staff on a daily basis/needs workflow instructions reminder to staff.

We successfully attested for MU2, year 1 on 9/30/14.

a follow up question then is on a daily basis how much time is staff doing mu work

Koby,
I think the questions that you are asking here are important, but rarely asked. I say that as someone who participated for 3 years and has now stopped. When the MU incentive program was announced, the $44,000 incentive was hard to ignore. The questions to ask were "how will my practice benefit and what will it cost me to get the 44k?" Every practice should do a calculation to decide if MU is right for them, or not.
For most people, that calculation included the cost of getting an EMR, which might be substantial (the entire $44k, in fact) but for those of us already with AC, this was not a significant factor.

My hope was that the program would lead to benefits in patient care. Investment of time and money in MU might be worthwhile if it leads to a better practice. That is a topic for another day, but suffice it to say that I have not seen the government mandates driving better patient care.

So the equation comes down to financial cost on one side vs. financial benefit on the other. The financial costs are software, hardware, and time. As stated above, we already have AC so lets assume that MU participation does not require additional investment in hardware or software (this is not entirely true, but lets assume it for now).

The pure dollar side of MU going forward consists of the penalties you would avoid. These numbers are constantly shifting, but the latest numbers indicate they would go from a 1-2% cut in 2015 up to 5% in 2020. Let call that an average of 3% a year over the next 5 years (here is the chart). Of course you use your own practice numbers to calculate the impact. For example, if your practice gross is 350k (what some call an average gross) and 1/3 of that is from Medicare, your Medicare penalty will average about $3,500 per year. Not an insignificant amount of money; but it comes at a cost.

So what do you have to do to save the $3500, or $70 a week? You have to invest time; your own and your staff's. The amount of time is hard to quantify. One component is the time spent on each encounter (asking additional information and then entering it into AC). I would argue that our time investment to understand MU is most significant. The hours spent following the changing timelines, penalties, rules, and regulations are tremendous. To understand what we must do and by when, to train our staffs, then to attest and potentially sweat out an audit; these all "cost" something. Maybe if you are in a large group, the time investment can be spread by having one doc who learns all the MU stuff and the others share the benefit. In a 1-2 provider practice, we don't have that luxury, though some are kind enough to share their knowledge here.

The decision is a personal one, and might be made on grounds other than a true cost-benefit analysis. I do think the analysis is worthwhile though. To me, it was worthwhile to participate the first few years, but now, with the smaller financial delta for participation, combined with the increased complexity of understanding and implementing MU2... I have bowed out. I am happy that I do not need to learn about MU2 or understand the intricacies of how AC records (or does not record) the various CQM's, or worry that I must have the most up to date version that allows for MU participation. I will use that time to improve my practice in other ways, to see one extra patient every week (to cover the $70/week), and to do some CME.

Koby:

Time taken by staff: that is a bit hard to answer. It is just a workflow issue. In addition to above: they ask patients at check in for email address for example. Once it is there - nurse can configure portal, which may take 10 seconds / to push the records. So overall, once the staff gets used to new workflow they are fine.

Nobody ever complained. I guess in this day and age, where private practices are dwindling and big practices seem to be norm, it may be hard to find job to ones likes. They work as you tell them. They will still have time to talk about their husbands, children, birthday, life etc...

If I have to give you an anology : when we had paper records - they would enter the vitals on papers; the same work - now they enter into computer. I cannot ask how long does it take, it takes what it takes. No other option.

They save time on copying the xray result for eg., stuffing into envelope, putting a first class stamp and take it to the area for outgoing mail. Now they push the info into portal. So give or take few secs.

So, all in all, we had mind to do it. We did it. If you have mind to do it, you will do it. Give or take few mins lost there, few mins gained here. Hard to keep track of precise minutes. So is life.

Many of the doctors I know have done it: One Ob gyn and one FB has allscrpts and did it I believe in second quarter and already got paid.

My secondary speciality is hospice and palliative medicine (board certified). But I feel this is not certifiable, though many feel it is a DNR status for their practices and wasting resources fighting the implementation.

You can do it too. Don't give up.

Mind and application is how I would put it. It will all equalize at the end.

Thanks absolutely loads, Jon.

I completely agree with your analysis.
Meaningful use and excellent practice are largely at odds with each other.

I am getting to like the electronic medical record -- at least, AC
When I talk to people who use EPIC or Cerner products, and when I try to make sense of a hospital history and physical or discharge note, I am simply appalled. Their outpatient notes are even worse.

If that is the future of medical communication, I can only shake my head in disbelief.

Apparently Mr. Duncan from Liberia told the admitting clerk he was from Liberia, and that he had been exposed to Ebola. Apparently the doctor didn't have time to take his own history, and either didn't see, or didn't believe the "history" the clerk put in. At any rate, the EMR in this case (and many others) turns clerks into clinicians -- they are responsible for the patients' histories -- and clinicians into clerks-- physicians have to transcribe their own notes and fill out all the papers. What a mess.

I, too, have abandoned MU after 3 years, and will take the penalty -- my calculations are the same as yours. I just hope the Feds don't come after the money they have already paid me because I folded early.

I actually believe I am using AC "meaningfully" -- but without lying, I can't claim to meet the standard of MU2, let alone MU3.

Thanks Jon, Tom and Joseph, this post was started because I as a solo doc(Mom and Pop office just my wife up front and myself in back) who has been using AC for 10+ years looked at MU from the onset as a new time burden that didn't figure into my (already not enough time in my) day.
My Medicare/Medicaid population accounts for about 50% of my revenue so the penalty may have some impact; I was trying to see if I should rethink it and so far think not. I will try to get those 2 or 3 extra visits a week and hope the commercial insurances don't follow suit.

Great summary and fantastic point at the end! You will be doing more for healthcare in your community by seeing that extra patient. When will physicians quit bending over and just say, "Enough!"

Good point, Tom. This issue of delegation of patient histories to ancillary staff is important--Ebola important. I have not delegated the taking of patient histories in my practice--how else am I going to understand the patient and develop a viable doctor-patient relationship?

Getting back to the original theme of this thread, Koby, I have just been doing MU1 and find that it takes minimal time on my part. The cost in time/hassle with MU2 are what have kept me from going on to the next stage. I suspect that we would all do well to move slowly. CMS will probably continue to make adjustments as they did this year. Early adopters will have to pay the penalty in time/hassle.

Just as another way to view this, my MA does patient histories when she triages patients. That doesn't mean I can't add a history to hers. In many cases, there are things in her history that the patient would not have offered to me or I simply would have forgotten to ask.

I think the more information you can get from a patient the better. I do correct her history if the history I get is different. We also clearly make it known which history is which.

It also keeps my MA in the loop which is helpful for a lot of things. If the patient's chief complaint is fever or maybe only sore throat, the patient would be put in the room with nothing done. This way, she may get the history of headache, sore throat and abdominal pain with exposure to Strep, and the strep test is usually completed by the time I take my history. This in no way changes my relationship with the patient.

Bert --
Of course. Just to be clear, we, too, get a history by the receptionist, another one by the nurse, and I take the final history. Everyone gets a little different picture, and the result can be very illuminating.

What burns me is the "specialists" and the ER docs checking a box on their EMR that they "read and agree with the history" that was obtained by ancillary staff. I know they don't bother to ask much themselves -- their notes are proof of that.

The ER doc in Dallas most likely didn't really bother with a history AND didn't read what the ancillary staff wrote.

What is a Medicare-eligible provider?

Is that just a rhetorical question?
It seems to be anyone the administration can get the doctors to sign off on.

Definitely not rhetorical question. I want to know if this affects me. I only have Medicaid. We have three patients with Medicare but we do not participate with Medicare so we treat them at no charge.

It seems that a lot of these penalties are directed at Medicare. I don't know much about the business of medicine.

So my question is (as it talks about this a lot), what is a Medicare-eligible provider?

I too decided not to pursue MU. While the incentives were tempting, I looked ahead (as best as I could a few years ago) and reckoned meeting MU part 2 would be extremely difficult, so pursuing the first incentive would not be honorable (I come from the military). I also wondered if there might be an additional penalty, or call for return of funds, if one failed to complete the full MU process. I estimate I will sacrifice at most $5000 a year. Not chump change, yet a decent trade off given the need for extra documentation and compliance monitoring (for MU) which doesn't seem to add a lot to the quality of the care provided.

ScottM -- I had no intention of dropping out of MU when I started this project. I thought it would be refined and made easier and more sensible (as most every other aspect of the IT revolution has become) as time went on. Instead, it has become a moronic madhouse that suckers doctors into an ever more time-consuming and expensive enterprise. Not for the benefit of themselves or their patients, but for the benefit of IT geeks, administrators, and government officials.

I have cried "uncle" -- and I don't feel like I have betrayed any trust by giving up in disgust.

I certainly hope there is no clawback -- I am still operating a meaningful electronic record. It just doesn't meet the standards of "meaningful use."

Bert -- anyone who has a Medicare provider number is a "Medicare eligible provider". I don't think you have to have any Medicare patients -- you just have to be willing to see them, and to accept money from Medicare.
How does it work for pediatricians? Do you apply under the Medicaid rules?

I do not do MU. I am not on the Medicare panel. So, my question is will I be penalized if not doing MU in the future as it stands now?

Don't you think that private insurers will sooner or later adopt some of the same "meaningful use" rules as Medicare? If only to separate sheep from goats, and provide another control point (and potential profit center).

There is an interesting post on another thread http://amazingcharts.com/ub/ubbthreads.php/topics/63234/Interoperabiltiy_-_Old_Stray_D#Post63234

The byword is "quality" -- which might at some level be true, because there isn't any way of determining "quality" unless we are all more or less on the same page.

But that begs the question of who determines "quality" -- and to whose benefit.
Ever read Zen and the Art of Motorcycle Maintenance?

Tom that is a concern of mine i.e. what will the 'private' insurers do.
Talk about another lifetime, it's been 40 yrs since I've read Zen, better see if I can find the old copy otherwise may be an Amazon trip, you've tweaked my interest.

I think that the private insurers will certainly look towards the use of quality metrics as a means to evaluate us and (more importantly) to control costs. I would be surprised and sorely disappointed if they used MU as their basis for this, though the basic idea of identifying measures and using an EMR to document them does make sense. Either way, does it make sense for us to spend years trying to wrap our minds around the ever-shifting, rather opaque MU rules because MAYBE some insurance company will try to copy them? My answer is no, but others may disagree.
I doubt that Aetna will pay us more to document the race and language preference of our patients.

When are doctors going to stand up for themselves? I know it won't happen, and it would probably hurt the office financially but imagine if 50% of the physicians dropped Aetna from their panel. Of course, that would likely be illegal if two or more practices discussed it.

I resent the fact that we are all paying for meaningful use, in unexpected ways. For instance, the problems with tech support, the slow development of our EMR because of this distraction, so many problems that need fixes being put on hold, and the difficulty getting help with other problems. Again, this is because of the MU distraction. It has not improved healthcare yet, and I suspect it never will.

Why is it that members of a giant corporate insurance company, that controls all the health payments for a whole city, can discuss how to corner the doctors and ratchet down their payments, but 3 doctors in a town cannot sit down and discuss dropping Aetna as a poor payer. How did we lose this legal battle, and is there any way back to sanity?

Short answer is the McCarran-Ferguson Act exempts them from federal anti-trust.

http://voices.washingtonpost.com/ezra-klein/2009/10/why_are_insurers_exempt_from_a.html

Greg

I agree. I think the problem is how they went about it. They could have got the same result by just fining doctors 2% or whatever if they didn't get an EMR by such and such a date. Since they paid them to get one, they felt they had to pay those who already had one. Crazy.

I have often wondered what would happen if the entire state of Maine stopped seeing Medicaid patients. They would all end up in the ER and there would be chaos. But, the state would simply revoke our licenses until we started seeing them.

Hey, Bert,
Revocation of our license to practice was my prediction many years ago. That is the only reason I agreed to participate in MU. In another time, they would have controlled the industry by tying concrete blocks around our necks and taking us out on a 7 hour cruise. Thought I saw Jimmy Hoffa at Cracker Barrel the other day