Why Some Providers Are Opting Out of Meaningful Use

Lea Chatham February 25th, 2015

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Kareo Meaningful Use Rescource CenterBy Zach Watson

Since its inception, the Centers for Medicare and Medicaid’s (CMS) EHR Incentive program has had detractors. In fact, many organizations have expressed concern about the timeline for the program’s Meaningful Use criteria each year. In response, CMS has made some changes to reporting periods and other aspects of the program.

However, these changes haven’t been enough for some providers. 2014 appears to be the year that many practices decided the program simply wasn’t worth their effort.

The numbers vary, but Medscape estimated that nearly 1 in 4 physicians would not attest to Meaningful Use in 2014. Future estimates show a further decline, with a survey from Medical Practice Insider and SERMO forecasting that over 50 percent of physicians do not plan to attest in 2015.

Attrition may be climbing, but this loss of participants isn’t new. “We saw a 17 percent drop off of Meaningful Use users that engaged in 2011 but didn’t in 2012,” said Jason Mitchell, director of the American Academy of Family Physicians’ Center for Health IT.

Despite investing tens of billions of dollars into incentivizing EHR adoption, CMS is faced with a major drop off of participants in only the second stage of a three phase plan. Tweet this Kareo story

What are the factors behind this trend?

Misaligned Incentives
From a business perspective, healthcare has always been an industry dictated by incentives and reimbursements. Proponents of change have long called for a realignment of incentives to better reflect the priorities of physicians, but Meaningful Use wasn’t quite what they imagined.

Meaningful Use implemented a number of new standards, but research has yet to validate that adhering to these standards engenders better care or reduced operating costs. “The following sentence is false 100 percent of the time: ‘We completed Meaningful Use stages 1 and 2 and as a consequence the care we provided for our patients has improved,” said a physician respondent to Medical Practice Insider’s survey.

In addition, many providers have worried that the ambitious timelines for Meaningful Use would result in providers rushing to implement EHR systems without adequately training the practice staff. In some instances that’s exactly what has happened, and it’s resulted in new types of errors that could adversely affect patients.

Unrealistic Expectations
In addition to the incentive changes, Meaningful Use makes a huge leap in terms of quality measures and attestation expectations in Stage 2. Naturally, it’s when the majority of providers hit this stage in 2014 that the program began to see a large number of drop-offs.

The patient portal requirements, for instance, pose a conundrum for physicians who serve mainly patients who may have limited access to a computer due to age, illness, socioeconimic factors.

Additionally, the objective requiring data exchange between heterogeneous systems often seems out of the provider’s control. One provider may deploy a system that meets the interoperability standards, but the EHRs of her local peers may not match that capability. Obviously data exchange is a two-way communication, but physicians have little control over the other party’s priorities or systems.

CMS’s refusal to provide partial reimbursement for getting close to objective goals also means that months of hard work could be for nothing.

For some physicians this proposition no longer makes financial sense, and taking the penalty to Medicare reimbursement looks like the smarter business proposition.

CMS has implemented a hardship exception that allows certain providers to opt out of Meaningful Use attestation and avoiding penalties. However, this exemption simply reinforces the flawed nature of their rigid pass or fail system.

What Does this Mean for EHRs?
Despite the grim outlook for Meaningful Use, physicians shouldn’t abandon the concept of the electronic health records. Sticking with paper records only signifies a dedication to an antiquated system. Paper records offer no feasible methods for patients to access their health histories, for providers to effectively coordinate care, or for recovery in case of natural disaster.

In short, paper records are an anachronism, and technology will march on.

EHRs in their present condition are imperfect, but the increasing prevalence of cloud-based products will continue to simplify data transfer. And due to physician feedback, usability is becoming a larger priority for EHR vendors.

Additionally, there have been notable recent findings that link EHR use to better patient safety and outcomes. Success often lies in how the organization uses the EHR, rather than the software alone.

Even if the Meaningful Use program ultimately fails to reach the finish line, it will still have accomplished its main goal: to drive physicians to adopt electronic medical records in significant numbers offer a relatively short time period.

Healthcare has already moved forward. Debating the merits of using EHRs has lost its value. The conversation should now be focused on which products are working for physicians and how these successes can become the standard.

About the Author
Zac WatsonZach Watson is a content writer at TechnologyAdvice. He covers healthcare IT news, business intelligence, and more. Connect with him on Google+.

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Preparing for Value-Based Payment

Lea Chatham February 24th, 2015

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Tweet this Kareo StoryBy Lisa A. Eramo

Healthcare is a dynamic industry, and physician practices must be able to adapt constantly by revising processes, enhancing documentation, implementing technology, and more. One of the most significant changes on the horizon is the transition from a traditional fee-for-service model of care that emphasizes volume of services provided to a model in which the quality of care as well as patient outcomes dictate payment. In a value-based payment model, physicians are paid for all of the care they deliver to patients, including face-to-face services as well as coordination that takes place outside of the office visit encounter.

The move to a value-based model is already underway, and CMS continues to advance these efforts. On January 26, the agency announced a goal of tying 30% of traditional (fee-for-service) Medicare payments to quality or value through alternative payment models, such as Accountable Care Organizations or bundled payment arrangements by the end of 2016. Fifty percent of payments will be tied to quality initiatives by the end of 2018. These goals are included in its campaign titled, Better Care, Smarter Spending, Healthier People: Improving Our Healthcare Delivery System. As stated in a CMS press release about the campaign, “this is the first time in the history of the Medicare program that HHS has set explicit goals for alternative payment models and value-based payments.”

“Whether you are a patient, a provider, a business, a health plan, or a taxpayer, it is in our common interest to build a healthcare system that delivers better care, spends healthcare dollars more wisely, and results in healthier people,” said HHS Secretary Sylvia M. Burwell in the CMS press release. “We believe these goals can drive transformative change, help us manage and track progress, and create accountability for measurable improvement.”

The value-based payment model will only continue to expand as commercial payers jump on the bandwagon as well. For example, Anthem Blue Cross announced in January that it will ramp up value-based payments, according to an article published in Forbes.

“We’re changing the way providers and insurers interact with one another to lower medical costs,” Anthem chief executive officer Joe Swedish said during a call with Wall Street analysis, the article noted. “Currently, we have more than $38 billion in spending tied to value-based contracts, representing 30 percent of our commercial claims and approximately 40,000 providers.”

In December 2014, United Healthcare announced that it would initiate a new bundled payment program to pay MD Anderson Cancer Center a flat fee to provide care for head and neck cancers. This pre-priced payment provides an incentive to focus on the essential elements of care and avoid unnecessary steps in care.

Many organizations, including the American Academy of Family Physicians (AAFP), support the transition to a value-based model of payment. “Since 2004, the AAFP has had a policy that recognizes the importance of replacing the fee-for-service payment model,” says Amy Mullins, MD, CPE, FAAFP, medical director for quality improvement at the AAFP. “The current focus on fee-for-service payment must end and be replaced with better alternatives, such as blended or prospective global payment models that promote value over volume.”

Embracing the patient-centered medical home (PCMH) that promotes continuous quality improvement processes, team-based care, and population health management is one path to a successful value-based environment says Mullins. ACOs—a group of doctors, hospitals, and healthcare providers that work together to provide higher-quality coordinated care to patients—will also become more prevalent.

Participation in the Physician Quality Reporting System (PQRS) is also important. PQRS previously provided incentive payments to eligible professionals (EPs) who reported quality information via one of five methods, depending on whether the provider is an individual or part of a group practice. However, those incentives are no longer available, and EPs are currently penalized for non-participation. For example, EPs who did not submit quality measure data in 2014 will receive a 2% payment adjustment to their Medicare physician fee schedule amount for services provided in 2016. These payment adjustments will continue to increase over time.

Unfortunately, although physician participation in PQRS continues to increase, overall participation is still relatively low. According to an April 2014 CMS report, the overall PQRS participation rate is 36%.

“Some [physicians] have been trying to meet  PQRS requirements through various means of reporting. Others have decided that neither the incentives nor the penalties are worth the trouble of reporting,” she says, adding that extracting information for EHR and registry reporting is often difficult. Some practices forget to submit appropriate codes for selected measures when using the claims-based submission method.

Mullins says physician practices need to understand and embrace value-based payment models because they  are not going away anytime soon. Tweet this Kareo story
“We anticipate these programs will continue to expand as commercial payers increase their use of this payment model,” she says.

However, physician anticipation of these changes remains unclear. Nearly 49% of the 1,613 respondents who participated in the 2014 Fee Schedule Survey, published by Physicians Practice, said that they expected fewer than 10% of 2015 revenue to come through non-fee-for-service contracts. Only 11% said more than half of their 2015 revenue would come from such contracts.

When asked whether the shift in payment methodology would be good for their practice, nearly 20% said yes. Approximately 23% said the shift would be bad for the practice. Nearly 13% said neither, and approximately 44% said they weren’t sure yet.

Mullins says it’s only a matter of time until  most payers shift to a value-based model of payment. Although this shift may require practices to  transform certain processes to effectively take advantage of the new model, making the necessary changes will surely pay off—especially for smaller practices. For example, the incentives offered through value-based payment oftentimes provide care management fees that can be used support extra office staff—a much-needed commodity in a small practice.

“The new payment models also offer incentives to deliver care outside the office visit, paying physicians for services that they have been delivering for free for years. The focus becomes less on how you deliver the care, and more on how well the care is delivered,” says Mullins.

About the Author

LisaEramofreelanceLisa A. Eramo is a freelance writer/editor specializing in health information management, medical coding, and healthcare regulatory topics. She began her healthcare career as a referral specialist for a well-known cancer center. Lisa went on to work for several years at a healthcare publishing company. She regularly contributes to healthcare publications, websites, and blogs, including the AHIMA Journal and AHIMA Advantage. Her focus areas are medical coding, and ICD-10 in particular, clinical documentation improvement, and healthcare quality/efficiency.

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6 Steps to Building a Great Medical Practice Work Culture

Lea Chatham February 18th, 2015

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Tweet this Kareo StoryWe’ve all seen how a great office work culture can make a company not only fun to work for but draw more business too. Zappos did it. Google did it. But, they are huge, right.

Companies like that may have the advantage of a large budget, but even a small medical practice can create an office culture to rival the big boys, one where employees love to come to work and that enjoyment reflects in all of their patient interactions.

Just follow these 6 steps to build a great medical practice work culture. Tweet this Kareo story

  1.  Define your practice: First, decide what type of practice and work culture you want. Envision desired interactions between your staff and patients. How do you want your staff to view your practice and their jobs. Once you know what you want for your practice, have a group meeting. Explain your goals so that everyone can work toward the same objective.
  2. Hire people who complement the work culture you want to build: Yes, skills are important, but when hiring new staff members, you also have to look at how the person will fit into the overall culture you are trying to build. Will their attitude and personality bring other staff members together or create a division in your practice.
  3. Communicate: Always encourage open lines of communication with your staff. Take time to ask them what they do and don’t like about their jobs, and be responsive. Improve where you can, and if there is a problem area that can’t be changed, be open and clear about why. When there are things your staff likes, focus even more effort there to build on your success.
  4. Celebrate: To bring your staff closer together, celebrate! Birthdays, holidays, and goal achievements are all opportunities to make things fun and memorable. Don’t just do the same old cake and song routine. For a birthday, order balloons to be delivered with a singing telegram. Have a pumpkin carving contest for your Halloween party. Hide Easter eggs around the office with rewards like a massage or an extra day off for your staff to find. For Christmas, what about an ugly holiday sweater contest?
  5. Reward success but learn from failure: Praise successes, and say thank you as often as possible to your staff for keeping your practice running smoothly. And, just as important, treat any failures or bumps in the road as a learning experience. By accepting failure as part of the learning curve, you signal to your staff that you are open to new ideas, making them more likely to try new things to help improve your practice.
  6. Take it out of the office: Finally, remember that a great office work culture doesn’t end at work. Making time for your staff to get together outside of the office for things like a picnic, a Christmas party, or even a quick lunch promotes bonding and increases their ability to work through problems as a team.

Building a great medical practice work culture takes time, but it can be a fun experience and a way to increase employee satisfaction and retention, ultimately improving patient interactions and your bottom line. For other strategies to improve the patient experience, download 10 Powerful Ways to Engage Patients.

About the Author

Adria Schmedthorst is a writer focusing on the medical device, technology, software, and healthcare industries. Adria is the founder of AMS Copy and a healthcare professional herself with more than 10 years in practice. She now uses her knowledge of the industry to help companies achieve their goals of writing content that speaks to the hearts and minds of medical professionals. She has been featured in blogs, written articles, and other publications for the industry, and ghostwritten books for doctors in both the United States and Australia.


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Use Your EHR to Increase Patient Visits

Lea Chatham February 16th, 2015

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Register Now to Learn How to Get ROI from Your EHRby Joe Capko, Senior Consultant and Partner, Capko & Morgan

No matter if your practice implemented an EHR years ago or if you are a relative EHR newbie, you can benefit from periodically stepping back and evaluating how to get more still from your EHR. Tweet this Kareo story
In our consulting work with practices, we’re almost always able to spot easy ways to improve practice efficiency and profitability by tapping underutilized EHR functionality. Considering that practices need to continue to serve patients as these systems are adopted, it’s not surprising that every bell and whistle isn’t thoroughly explored from day one. There are many ways to boost profitability by making better use of less commonly tapped features in your existing technology.

If you’re a primary care practice (including OB/GYN and pediatrics), one great way to improve profitability and patient care while also smoothing out your practice’s seasonal patient volume is to get your patients in on time for their annual wellness visit. Patients love that there is no out-of-pocket cost, your practice enjoys relatively generous reimbursement, and you can schedule these appointments to help smooth your patient volume.

Your EHR’s reporting capabilities can help you understand the size of the opportunity as well as define the patient population that needs to be scheduled. If you haven’t been disciplined about recalling patients for preventive visits, you can start by generating a report of active patients who haven’t had a wellness visit in the last eleven months. Your providers should be consulted to see if there are particular patient populations that should take priority (e.g., diabetic patients). With cost being a factor in many patients’ behavior, make sure that patients know that the visit is almost always paid in whole by their insurance as a result of the Affordable Care Act (ACA).

If you have a well-adopted patient portal in place, reaching out to these populations in their preferred method can be reasonably straightforward, but if not, you’ll want to be careful that you don’t generate more inbound phone calls than your office can manage—send out alerts in manageable batches over a period of weeks if you have a sizable backlog. If your portal is new or isn’t yet widely used by your patients, take the opportunity to tout its benefits in whatever outreach you choose. Increasing adoption of your patient portal will make future recall programs that much simpler.

My partner Laurie Morgan and I will be exploring this idea and other ways to get more out of your EHR in our upcoming free webinar, Finding the ROI in Your EHR. Please join us on February 19. Register Now.

About the Author
Capko & MorganJoe Capko is partner and senior marketing & market research consultant with Capko & Morgan. He specializes in strategic planning, business development, qualitative/quantitative studies and statistical analysis for healthcare and high technology sectors. He has conducted numerous research projects, patient satisfaction surveys and community needs assessments for the healthcare industry including such impressive clients as Lovelace Health System and The Sage Group, Inc.


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Free Webinar: Finding ROI in Your EHR

Lea Chatham February 12th, 2015

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Register NowFinding the ROI in Your EHR
Thursday, February 19. 2015
10:00 AM PT, 1:00 PM ET

Learn how you can maximize and track the ROI from your EHR in this free webinar. Tweet this Kareo story

Are you worried that a new EHR will just cost more time and money? If you have been putting off switching or signing up for your first EHR, there is good news. You can find a return on investment (ROI) in your EHR. It just may not be what you expected. 

In this free webinar, you’ll learn how you can:

  1. Cut costs for supplies, transcription services, and records management
  2. Eliminate onsite storage and covert it to revenue generating space
  3. Reduce time-consuming phone calls from pharmacies, labs, and patients
  4. Use analytics to spot bottlenecks and improve workflow
  5. Generate more patient visits for preventive care and follow up appointments

Register now to learn new ways to become a new best practice.

Register Now

About the Speakers

Laurie MorganLaurie Morgan is a senior consultant and partner at Capko & Morgan. She managed both start-ups and large-scale operations in the media industry before turning her focus to medical practice management. Her consulting focus is on driving and capturing revenue and operating more efficiently. Laurie has an MBA from Stanford University. 


Capko & MorganJoe Capko is partner and senior consultant with Capko & Morgan. He specializes in strategic planning, business development, qualitative/quantitative studies and statistical analysis for medical practices. He has conducted numerous research projects, patient satisfaction surveys and community needs assessments for the healthcare industry including such impressive clients as Lovelace Health System and The Sage Group, Inc.


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Get the Latest on EHR, MU, and Social Media in February Newsletter

Lea Chatham February 10th, 2015

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The February edition of the Kareo Getting Paid Newsletter has great tips on getting ROI out of your EHR, what you need to know about Meaningful Use, and the best thought leaders to follow in Twitter. The newsletter also provides a chance to discover upcoming events, news, and resources from Kareo. Plus, you’ll learn about how to register for our upcoming free educational webinar, Finding the ROI in Your EHR, presented by Laurie Morgan and Joe Capko or Capko & Morgan. Read all this and more now! Tweet this Kareo story

Read Now

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5 Things to Know about Meaningful Use in 2015 Before You Go too Far

Lea Chatham February 9th, 2015

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Kareo Meaningful Use ResourcesAre you attesting for meaningful use in 2015 for any year or stage beyond Stage 1, Year 1? Are you sure you are doing it right? Tweet this Kareo story

Before you go much further, here are five things to know to be sure you do it right.

  1. The reporting period for 2015 (except for Year 1, Stage 1) is January 1, 2015 to December 31, 2015, a full 365 days’ worth of MU data.
  2. For Stage 2 if providers order labs they need to have elabs integrated into their certified EHR. For Stage 2 the incorporation of lab test results is now Core Measure 10, in Stage 1 it was Menu Measure 2.
  3. Engage your patients in utilizing the Patient Portal because in Stage 2 of MU patient interaction starts to play a bigger role. Core Measures 7b and 17 require that 5% of patients seen by the provider during the reporting period interact with the provider by: A. viewing, downloading, or transmitting their complete health records, and B. by sending a secure message to their provider. These measures are all completed from within the Patient Portal.
  4. In moving forward with MU, Stage 2 has initiated the sending of secure messages of a patients Summary of Care record when the patient is being transferred to another setting of care or provider. In order to send secure Summary of Care records, providers will need to setup Updox.
  5. If providers give immunizations, another item that providers will need to get setup for Stage 2 of MU is connecting to their state’s immunization registries to achieve on-going submission of immunizations.

Also, be aware that there is a possible change pending for the reporting period. CMS recently said that it may change the reporting period back to 90 days in this announcement.

For more of the latest news on meaningful use, visit the Kareo Meaningful Use Resource Center.

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Free Assessment: How Well Are You Managing Your Online Reputation?

Lea Chatham February 9th, 2015

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When was the last time you Googled your practice name or providers’ names? You’d be surprised by how many results there are, especially for physicians. Sites like Healthgrades and Vitals get physician data and populate their systems whether you agree or not. Patients post reviews on Yelp or other rating sites whether you are paying attention or not. Your practice and providers have online reputations whether you track and manage them or not. And, your patients are looking for providers, services, and engagement online. You simply can’t wait any longer to start managing your online presence and reputation.

To get started, find out where you stand with this free online assessment.

Take Assessment Now

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Top 25 Healthcare Thought Leaders You Should Follow on Twitter

Lea Chatham February 9th, 2015

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@GoKareoIt’s hard to know exactly who to follow on Twitter. So, we’ve done the hard work for you.

This is a list of the top 25 healthcare thought leaders on Twitter who are saying things meaningful to the independent practice. Tweet this Kareo story

We identified them by looking at other lists of top influencers on Twitter, their Klout scores, their influence in top healthcare tweet chats, their number of followers, and finally by looking at what they had to say and share on their Twitter feeds. Follow them now for great perspectives on healthcare that are relevant to you.


  1. Kevin Pho, MD
  2. C. Michael Gibson MD
  3. Eric Topol
  4. George Huba
  5. Liz Szabo
  6. Berci Mesko
  7. Brian Ahier
  8. Dave deBronkart
  9. Farzad Mostashari
  10. Wen Dombrowski MD
  11. Susannah Fox
  12. Jane Sarasohn-Kahn
  13. Mike Sevilla, MD
  14. David Harlow
  15. Pia Christensen
  16. Daniel Kraft, MD
  17. Fred Pennic
  18. Joseph Kvedar
  19. Jeff Benabio, MD
  20. Shawn Riley
  21. Drval
  22. Brad Justus
  23. John Lynn
  24. Sherry Reynolds
  25. Andrew Spong

If you are looking for other great ways to get started on social media, download 26 Social Media Tips for Your Medical Practice.


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Revenue Drivers at Your Practice: Could Your EHR Become One of Them?

Lea Chatham February 9th, 2015

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Register Now to Learn How to Get ROI from Your EHRby Laurie Morgan, MBA, Capko & Morgan

Ask managers or physicians about what drives revenue at their practices, and I doubt you’ll find one whose first response is, “our EHR!”  In fact, I’m so sure of this, I might be willing to lay a wager. In most cases, EHR choices and the investment in getting EHRs up and running were driven by Meaningful Use requirements – not by a desire to use the technology to improve our practice business. It’s just not a natural reaction to think of EHR technology that way.

But now that most practices are several years into their grand EHR adventures, it’s time to start thinking about the technology differently. Even if you never considered the potential of the EHR to make your practice more profitable (besides earning Meaningful Use incentives), the technology has had the potential to do so all along.  And, as the market consolidates down to a more select group of EHR players, the increasingly competitive environment has helped drive more innovation – meaning that your EHR is continuing to improve and add features that can help your practice.

Your EHR can contribute significantly to practice profitability on both the revenue and expense side. Tweet this Kareo story
Yes, you heard me right: it’s not just an efficiency tool. Your EHR can be a terrific marketing tool to help drive revenue, too.

Take, for example, the ability to create patient lists. This is a Stage 1 requirement, so most practices have tried this at least once – but perhaps never again. That’s unfortunate, because patient lists aren’t just useful for clinicians to track their activities, they’re also very helpful for marketing.

Let’s say, for example, you are contemplating a group visit program. Do you have enough patients with your target condition (say, for example, type 2 diabetes)? Can you further segment the list by age, sex, or address – to offer patients the option to join a group that is most convenient or comfortable for them?

Using lists to set up a new program like group visits is just a starting point. There are many ways your EHR can improve your practice’s revenue and overall ROI. My partner, Joe Capko, and I will present many ideas on the subject in our upcoming free webinar, Finding the ROI in Your EHR, on Thursday, February 19 at 10 AM PT. Register Now.

About the Speaker

Laurie MorganLaurie Morgan is a senior consultant and partner at Capko & Morgan. She managed both start-ups and large-scale operations in the media industry before turning her focus to medical practice management. Her consulting focus is on driving and capturing revenue and operating more efficiently. Laurie has an MBA from Stanford University. 



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