Gastroenterology: Advice for Climbing the MU Mountain

Ask Joy: This Week – Gastroenterology:  Advice for Climbing the MU Mountain

Meaningful Use Stage 1

This week’s question comes from in from a Practice Manager of a Gastroenterology group that has already implemented an EHR, but is struggling to get the providers to work toward certain objectives for Meaningful Use Stage 1 because they feel like they are geared more toward Internal Medicine or Family Practice. She mentioned to me that the doctors can be very cooperative when they have a good understanding of what needs to be done and so I advise her to arm them with information.

I’m trying to guide our doctors through the Stage 1 Meaningful Use requirements. We use a certified EHR, but I’m struggling to get the doctors to work on some of the MU objectives that they think are geared to Internal Medicine and not relevant to their specialty. How do I get these doctors on board? 

First of all, good job. It sounds like you’ve already started down the MU path, so congratulations on this achievement. Gastroenterologists have a notoriously low participation rate in incentive programs. To some extent, it’s understandable — many specialists have pointed out that there are few specialty-relevant measures in both the PQRS and EHR Incentive Programs. However, the penalties for abstaining will catch up with them very soon and will certainly add up.

By 2015, Medicare reimbursements will be reduced by 1.5% for providers not participating in PQRS. After that, a 2% cut looms in 2016 and 2017. Together, with penalties for not attesting to Meaningful Use, reimbursements to practices could fall by 10%. Kudos to you for trying to avoid this scenario.

While Family Medicine and Internal Medicine are among the top providers receiving EHR bonuses, you may be surprised to know that gastroenterologists are not too far behind. As of July 2013, nearly 9,000 gastroenterology EPs have received more than $147 million in EHR incentive money. That means these providers have successfully demonstrated Meaningful Use, so it’s safe to let your docs know that it’s possible and it’s happening.

For stage 1, you’ll have a 90 day reporting period, so if you plan on attesting for 2013, the last day to start the reporting period is October 3. However, demonstrating Meaningful Use will not be as easy as filling in a blank or simply checking a box. The best way to get a handle on where your providers need improvement is to arm them with information. Start by going to your EHR’s reporting area, select a 90-day reporting period, and print out a copy of each providers Meaningful Use results. When they see exactly where their numbers are lacking, it gives them an idea of what areas to concentrate on.

If you want to go the extra mile to help them, along with each EP’s report, provide them with education materials on each of the objectives that need improvement. Consider including directions from the EHR vendor on how to meet the criteria within the system, as it may just be that the measure takes place in unchartered software territory. gGastro by gMed is a popular EHR for Gastroenterology practices and certified for Meaningful Use. If you use this EHR, their support team should be able to guide you through how to hit some of the targets your providers are currently missing. Don’t be afraid to lean on them for guidance.

As for reporting Clinical Quality Measures, you’re limited to choosing six measures from this list for 2013, but can choose from a wider range of measures in 2014. Unfortunately, the only GI-specific clinical quality measure is NQF #0034 Preventive Care and Screening: Colorectal Cancer Screening. However, since there is no threshold for CQMs, reporting zero on some of the measures is acceptable. Just make sure that all providers in the specialty agree to report on the same quality measures. This will make the information gathering and reporting processes go much smoother.

On a brighter note, this set of GI-related quality measures qualify for PQRS:

  • PQRI #86 / NQF #0397 Hepatitis C: Antiviral Treatment Prescribed
  • PQRI #89 / NQF #0401 Hepatitis C: Counseling Regarding Risk of Alcohol Consumption
  • PQRI #113 / NQF #0034 Preventive Care and Screening: Colorectal Cancer Screening
  • PQRI #183 / NQF #0399 Hepatitis C: Hepatitis A Vaccination in Patients with HCV
  • PQRI #184 / NQF #0400 Hepatitis C: Hepatitis B Vaccination in Patients with HCV
  • PQRI #185 / AQA adopted Endoscopy & Polyp Surveillance: Colonoscopy Interval for Patients with a History of Adenomatous Polyps – Avoidance of Inappropriate Use

This set could be a good starting point for your providers. And to make it easier for you as a practice manager, it may be worth getting in touch with one of these two gastroenterology registries available for measuring quality:

  1. The American Gastroenterological Association’s (AGA) Digestive Health Outcomes Registry
  2. The GI Quality Improvement Consortium (GIQuIC), available through a partnership of the American College of Gastroenterology and the American Society for Gastrointestinal Endoscopy.

Hopefully, this is enough to get your group farther up the Meaningful Use mountain.

About the Author: Joy Rios has worked directly with multiple EHRs to develop training programs for both trainers and practice staff. She has successfully attested to Meaningful Use for multiple ambulatory practices in both Medicare and Medicaid. She also authored the Certified Professional Meaningful Use course for Joy holds an MBA with a focus in sustainability. She is Health IT certified with a specialty in Workflow Redesign, holds HIPAA security certification, and is a great resource for information regarding government incentive programs.Ask Joy is a regular column on 4Medapproved HIT Answers.