How a Solo Physician Aced Stage 1 Meaningful Use

Mention "Stage 1" and most physicians will think you're talking about the initial phases of a disease or a medical condition such as cancer.  A few might think of a rocket launching into space.

But Stage 1 also refers to a portion of the so-called meaningful use requirements for electronic medical records, which providers must meet in order to qualify for financial incentives from the federal government.

That type of Stage 1 may be just as daunting as cancer or space flight to some older physicians who are tentative about the switch from paper files.

Patrick Golden, MD, a primary care physician and small practice owner in Fresno, CA, isn't one of them. He's unfazed when it comes to meaningful use. He has already steered his solo practice through Stage 1 approval, a journey he says has been occasionally frustrating, and sometimes funny, but ultimately worthwhile, with an EMR and a payday at the end.

"From the very beginning when I heard of the program, I knew we were going to do this. Absolutely there was no doubt," said Golden, 55. "We sought the electronic health records for a variety of reasons, even before the stimulus money was available. I thought it would be neat to upgrade our billing software. We had an old DOS (computer) system."

As of July 31, more than $397 million in Medicare and Medicaid incentive payments have been made to healthcare professionals who have demonstrated that they are making "meaningful use" of new technology.

The criteria are set over the course of the next five years. Stage 1 runs through 2011 and 2012, with financial incentives for records and data improvements such as e-prescribing.

Golden admits that when he began the meaningful use program in January 2010 it was a struggle. One nurse quit, probably over the program, and Golden and his wife spent months scanning documents, weekends, too. At the same time, he faced a Medicare audit, which he says was complicated by the switch from paper to EMR.

More than one year later, Golden has gotten some money back, and he says he runs a more efficient medical office without paper records and with an EMR portal that allows instant access to patient records, labs, and most tests. His patients are more engaged in their care, he says, and "and that's what healthcare reform is supposed to be about."

Golden says he's attracting younger patients, which he attributes to EMRs.  "I have beautiful records," he says, laughing.

Golden, has been in practice 24 years as an internist, specializing in cardiology and bariatrics. An electronic dashboard system that measures his  practice's meaningful use progress by collating and tracking data, has made the work much more efficient, he says. Patients are enjoying the "instant interaction and the connection they now have with us," he says. "With instant access to their records, they are taking greater ownership of their care."

"I realize this kind of stuff is going to allows healthcare to function at a lower cost in the future with respect to patient management issues," Golden says.

When Golden switched to EMR, he stopped paying the monthly rate for a storage facility for the paper records. Still, the process took months. "Most of our staff didn't help us out when it came to the scanning of the documents," Golden says. "That was mostly done with family members, and a couple of college students that we hired. It was labor-intensive for nine months. My wife and I were in the office scanning shots on Sunday."

In the meantime, CMS surprised him with an audit of Medicare patient visit codes. The paper and the electronic medical record transition appeared to confuse a CMS review, in Golden's view, leading to what he called a "funny" interaction with the agency. Still, Golden believes the electronic recordkeeping enabled him to "survive the audit."

"It was really interesting. We were audited right after we started with our electronic (records) and they requested 24 charts from one day's (work) at our office," Golden says. "Out of the 24 charts, three were paper charts. They automatically approved (the paper charts), and they automatically rejected the electronic charts, it was really funny."

"A reviewer at CMS didn't recognize the electronic signature was valid," Golden says. "Once a supervisor overruled her, they accepted everything. It was kind of comical. Eventually, we passed (the audit) with flying colors after they recognized an electronic signature made sure it was a valid one,"

"I think one of the reasons why we survived the audit without a glitch was because I had legible records."

That transition to EMR has increased payments from CMS, Golden says. "We've been getting the e-prescribing checks. Of course, I expect to get paid the $18,000 for the stimulus money, so a lot of these dollars that came back to us we would never have received had we not gone with the electronic system," Golden says.

While he is enthusiastic about EMR, Golden says there is one drawback.
"I will admit, near the end of the day, I become weary, in a different way before I had electronic records. You know, you just get tired of clicking and looking at the computer," Golden says. "I am older."
Golden's three tips for implementing EMR for any medical practice:

1. Get Physicians Involved. "Your doctors must be involved in the process from day one," he says. "They must be engaged and involved in learning the system and using it to be successful. They have to have a vested interest in learning the system."
    
2. Create an "In-House" EMR Expert. "If possible, try to create an in-house expert who will manage the technological aspect of the system from implementation to day-to-day operation of it. It's a long-term investment and if conducted properly from the beginning can significantly improve the health and viability of your practice, clinically and financially."
    
3. Be Patient and Flexible. "You have to be willing to change and see the positive in meaningful use. The data we're now able to track through the system – because of meaningful use – is incredible. That alone has been worth the change."

See Also:
Meaningful Use Means Engaging Patients in EHR, Too
In Meaningful Use Reports, Quality Matters
CHIME to Feds: Delay Meaningful Use Stage 2