“Many of the staff were just uncomfortable asking that question of patients at registration,” Fortini says. “So we made them mandatory fields in the registration; you couldn’t go to the next page without answering that question. And rather than the staff having to ask, we handed each patient an explanation of why the question was being asked and had them fill in the answer themselves. Then the staff only had to use that information to populate the field in the practice management system.”
Within 30 days, almost all of the practices in the red on that metric turned to green, Fortini says. Another hurdle for Bon Secours involved the high proportion of its patients in some practices that were covered by Tricare, the insurer for military personnel. Tricare requires a written prescription, and complying with that meant that some practices were not meeting the minimum 40% threshold for electronic prescribing.
“We had to get with CMS and find a workaround for that, and there actually is an allowable exclusion clause,” Fortini says. “But digging down into the regs to find that exclusion clause was quite time consuming. And then changing the report so that it identified Tricare patients and excluded them from the count was time-consuming also.”
Bon Secours also found that it was including too many meaningful use metrics in the weekly reports to practices. Fortini recommends focusing on a select number of the metrics to keep the report lean and useful.
Another hurdle involved defining the metrics. It seemed not everyone had the same idea of what certain words meant.
“We’re a large organization, and we have lots of levels that all had a finger in the pot when determining what the metrics mean. I had an idea what I thought the metric meant, but someone in another department had a different interpretation,” Fortini says. “We went the first 90 days of 2011 without reporting capability because we couldn’t agree, and I was really getting worried about our ability to identify our problem areas and intervene with appropriate training and support staff.”
The final issue that prevented some Bon Secours physicians from being deemed meaningful users was the minimum $24,000 in Medicare services that must be billed before attesting. Medicare is only 10% of the payer mix for Bon Secours in some communities, so there were 35 physicians who had not billed that amount by August 31 when the health system attested at the close of its fiscal year. The remaining 35 physicians should be able to qualify for meaningful use by the end of 2011, Fortini says.