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Break barriers to incentives: Ask providers what they need
Medicaid providers may be eagerly awaiting incentives to purchase electronic health records (EHRs) for their practice, as a result of funding from the HITECH Act. However, at this juncture, some troubling questions remain.
"Let's say I'm a doctor, and I have all these vendors knocking at my door wanting to sell me this product. How do I know which one is best?" asks Chris Collins, deputy director of North Carolina's Office of Rural Health and Community Care and assistant director of the Division of Medical AssistanceManaged Care. "Also, who's going to install it? Who's going to teach me to use it? And where is the work force, in very rural communities, to support the upgrades?"
Medicaid directors are grappling with the best way to help their providers qualify for incentives. "This is one of the things that Georgia Medicaid is currently looking at. We want to get [those] providers who don't have a system currently, everything they need in order to get on board," says Rhonda M. Medows, MD, FAAFP, commissioner of the Georgia Department of Community Health (DCH).
As part of North Carolina's electronic prescribing initiative, providers aren't left high and dry when it comes to ensuring the participation of local pharmacists. They are given a great deal of assistance when the system goes live as well.
"You've got to tie the provider to the pharmacy down the street. Otherwise, there is no point in putting you on the system," says Ms. Collins. "We also stay on site with them for four days when they flip the switch. So, there is a lot of hand holding, even with something as simple as e-prescribing. If you have a provider at ground zero with HIT, you can't ask them to climb Mt. Kilimanjaro to demonstrate meaningful use!"
A related concern is that the bar will be set too high for primary care doctors, whose pay is generally substantially lower than other providers. "Primary care providers are not wealthy, and often they are the communities' safety-net providers," says Ms. Collins. "So, if they are going to make a bigger investment than others, that is going to be a real challenge for them. On the positive side, resources are going to be dedicated for this. It's not necessarily an unfunded mandate."
While some areas of the state have good primary care access, in some rural areas, there are no primary care doctors to link patients to. The same is likely to be true for HIT. "There are work force issues around primary care and qualified mental health providers. And I think you will find work force issues around HIT, not in terms of the vendors, but the person who will help you out if your system is down," says Ms. Collins.
ID needs, ASAP
Georgia Medicaid has received funding for a Regional Extension Center to help with provider adoption outreach and training. This is particularly aimed at small provider groups and those that care for underserved populations. The National Center for Primary Care at Morehouse School of Medicine in Atlanta is the primary applicant, as a nonprofit entity. "But the state is also a partner, because a lot of small group practices who care for the underserved are Medicaid providers," says Dr. Medows. "We have a common goal: to make sure they have all the tools they need to get on board."
Well before the grants became available, the largest medical associations in the state were asked the question, "What would it take for you to implement HIT?" They came up with 12 items that did not involve a direct payment.
Help with workflow assessments and technical support were two requests. "When you put EHR into somebody's office, you have to know how to use it and make it work in their practice," says Dr. Medows. "It would be great if states would ask providers in their community that question: What do they need other than cash? Then listen to them."
Providers also asked whether a group purchase could be made in order to get a discount, and whether the state would work with them on using Software as a Service web-based EHRs, which lease space, so it's not necessary to buy a separate server. "They didn't want to own their own servers. They don't want to worry about upgrading them or complying with the latest federal regulations, because the technology is changing every day," says Dr. Medows.
Contact Ms. Collins at (919) 855-4780 or firstname.lastname@example.org.