4 Reasons You’ll Need an EMR for Pay-for-Performance

There’s no stopping payment reform, and no matter how tightly you cling to the fee-for-service structures you know—and, um, love?—you can’t slow the nationwide transition to a pay-for-performance environment. And it should come as no surprise that the move toward innovative payment structures goes hand-in-hand with the push for widespread adoption of innovative healthcare technologies, including electronic medical records (EMRs). But while federal initiatives—like the meaningful use program—have ushered medical professionals in other specialties into the technological age, physical therapists have, by and large, been left to fend for themselves on the EMR front. And if you’re a PT who hasn’t yet jumped on the EMR bandwagon, the pay-for-performance movement might be exactly the nudge you need to take the leap. Here’s why:

1. Outcomes tracking is crucial to proving your value as a healthcare provider.

In a pay-for-performance world, getting paid for your services hinges on your ability to objectively prove the effectiveness of those services. And that means introducing—or ramping up—outcomes data-collection efforts within your practice. The easiest way to do that? Implement an EMR with built-in outcomes tracking functionality. That way, you can easily complete outcome measurement tools directly within the patient record. If your EMR system is really on top of its game, it also will offer functionality that allows you to analyze your data in a way that produces real, meaningful insight—the kind that will go a long way toward ensuring you get the payments you deserve.

2. The more data PTs can collectively amass, the more powerful that information becomes.

For the PT industry to assert the value of physical therapy services on a grander scale—thus ensuring consistently high payment rates across the board—individual providers must coordinate their data-collection efforts. That means:

  1. using a standardized set of tools that the entire medical community—regardless of specialty—can recognize and understand, and
  2. entering data into a national—or even international—registry or repository.

After all, the larger—and more geographically diverse—the data is, the more authoritative it appears to payers and policymakers.

3. The dream of creating a national PT data registry probably won’t come to fruition without EMR integration.

The APTA has been working on creating a national data registry for a while now, and although the association’s head is definitely in the right place, the question remains: “How will the data get from individual providers to the registry?” As it stands, the answer to that question is that providers will have to manually enter their data into the registry—and as we all know, data-entry takes time. Many PTs are already so bogged down by administrative burdens that the mere thought of having to add one more item to the list is enough to outweigh the perceived benefit of having access to such a powerful data set. That’s why it’ll probably take an integrated solution—one in which patient outcomes data flows seamlessly from the EMR to the larger repository—to make the industry’s vision for a national registry actually happen.

4. Interoperability is crucial to care coordination, and web-based EMRs are crucial to interoperability.

For PTs to thrive in the coming era of pay-for-performance, they’ll need to step up and own their roles as care coordinators. But when you take on the responsibility of serving as a patient’s first point of medical contact, you also become responsible for guiding that patient’s journey through the care continuum. That means collaborating with your peers in other specialties to ensure the patient receives the best—and most appropriate—care possible, thus ensuring the best possible treatment outcome. But that kind of collaboration can’t happen—at least not in an organized, efficient manner—without patient records systems that talk to each other. Because for teams of providers to truly function as teams, each “player” must be able to access the most updated version of a patient’s medical record in real time. So, as you explore your web-based EMR options, make sure you look for a system that has interoperability on its roadmap.

There’s no way to sugar-coat it: pay-for-performance is going to have a massive impact on how—and how much—physical therapists get paid for their services. But with the right EMR by your side, the transition to value-based payment could actually benefit your practice.

The EMR Mandate

Per the American Recovery and Reinvestment Act (ARRA) of 2009, all eligible public and private healthcare providers across the US must have adopted an electronic medical record (EMR) and demonstrated meaningful use by January 1, 2014, to continue receiving Medicare and Medicaid reimbursements.

Incentives and Penalties

To facilitate this transition—which meets the United States’ goals of improving quality, safety, and efficiency; reducing medical disparities; engaging patients and family members; improving care coordination; and maintaining privacy and security—the government is offering financial incentives for compliance and assessing penalties for non-compliance. Specifically, according to this CMS webpage, eligible providers can receive up to $44,000 and/or up to $63,750 through the incentive programs for Medicare and Medicaid, respectively. On the other hand, eligible professionals who don’t implement an EMR and/or fail to demonstrate meaningful use by 2015 will face a 1% reduction in reimbursements—and experts speculate that this “rate of reduction will likely rise annually thereafter.” Some say penalties will reach 5% in coming years.

Meaningful Use

So what does meaningful use actually mean? Well, it means that providers must use an EMR that meets specific Centers for Medicare and Medicaid Services (CMS) requirements. These requirements are organized in stages: stage 1 requirements must be met for at least nine months in the first year and 12 months in the second; stage 2 requirements must be met for 12 months in both the third and fourth years. However, according to CMS’s website: “For 2014 only, all providers—regardless of their stage of meaningful use—are only required to demonstrate meaningful use for a three-month reporting period. For Medicare providers, this three-month reporting period is fixed to the quarter of either the fiscal (for eligible hospitals and CAHs) or calendar (for eligible professionals) year in order to align with existing CMS quality measurement programs, such as the Physician Quality Reporting System (PQRS) and Hospital Inpatient Quality Reporting (IQR).” To complete stage 1 requirements, eligible professionals must meet 19 (out of a possible 24) meaningful use objectives:

  • Fourteen required core objectives (e.g., maintain active medication list, implement drug-drug and drug-allergy interaction checks, or record smoking status for patients aged 13 years or older.)
  • Five objectives from ten menu set objectives (e.g., implement drug formulary checks, incorporate clinical lab-test results into record system as structured data, or send patient reminders per patient preference for preventive/follow-up care.)

Specification Sheets

Looking for more specifics? CMS provides downloadable specification sheets that include definitions, clarifications, and information about:

  • Meeting the measure for each objective
  • Calculating the numerator and denominator for each objective
  • Qualifying for an exclusion to an objective
  • Attesting to each measure

For Therapists

Although EMR adoption improves the nature of health care for patients and practitioners in every facet of the industry, not every medical professional is considered eligible. Thus, not every medical professional is mandated to make the switch or eligible to earn the incentive for doing so. For example, the Act does not consider physical therapists, occupational therapists, or speech-language pathologists eligible professionals. That’s why PTs, OTs, and SLPs should look for a rehab-therapy specific EMR and disregard the requirements for meaningful use. After all, there are all sorts of benefits associated with switching to an EMR, even without the promise of an incentive. And as the APTA points out: “While physicians and hospitals are the beneficiaries of many of the federal government’s initial efforts to encourage [EMR] system adoption, they will expect the other providers they work with, including physical therapists, to implement it as well. Patients also may begin to expect their providers to use [EMR]s to manage their care.”

What do you think about the EMR Mandate? Tell us your thoughts in the comments below.