"Meaningful Use" Question

[tripodbetsy]

Hi all,

I'm a PA practicing at a Federally Qualified Health Center. Over the past 12 months or so our corporation has been pushing us to meet the criteria for Meaningful Use. Our clinic has a separate area for acute care visits so those of us midlevels working on the "chronic care" side see a large number (up to 20 or more) complex patients daily (= busy practice, lots of uncompensated overtime). In addition to upgrading the EHR, we are now documenting completion of medication reconciliation at each visit, and are also completing an After Visit Summary which includes the patient's updated medication list as well as a summary of what we did at that visit, instructions to the patient, etc. Completion of the AVS has significantly increased my workload, which translates to more time after clinic hours trying to complete my office visits. We are not allotted administrative time at our clinic.

Recently we received an email from our administrators informing us that within the next week we are to amend our contracts to allot our Meaningful Use funds from the government be given to the clinic. We are not receiving any portion of these funds. Clinicians are upset. Meeting these criteria has significantly increased our workload, yet we are not being compensated in any way. In addition, no formal meeting was set up to address the specifics (how much is allotted, is it really meant for the clinic and not the individual clinicians, etc.), rather, it feels like a "just sign here and ask no questions" sort of situation. Since then we've been doing our own research. From what I gather, those funds (over 60k over 6 years) are meant for individual clinicians. Now, I'm no stingy grinch. I understand our clinic has put up a lot of energy and resources to implement our EHR. However, I'm not exactly happy about my current work situation and workload, and all those extra hours I've spent meeting these criteria.

Has anyone else run into this situation? What's your opinion? Just who is meant to get this money? Is it meant for those who implemented and purchased the​ EHR, or is it an incentive for clinicians to use that EHR in a meaningful way?

Thanks so much!

[jmj11]

I am sorry to tell you, that the intentions of the bill writers was to pay physicians (not "providers") for their cost of buying EHR systems. It was not to pay for the labor involved in the process and certainly not for the labor of PAs.. Also, we PAs were screwed in the bill because, while our work is required to meet the quota, the payments are only paid to the physician and based only what the physician bills medicare.

 

It is very true that this money is a financial reward, clean and clear cash, for many physicians and institutions because they already own an EHR or their true cost is no where near what they got from the Gov. so they buy a Porsche. Is it fair? Absolutely not. We got screwed because I, a PA, saw 99% of the patients but because I'm a PA, those don't count towards the payements. So I had to do a huge amount of work as did my office manager to meet meaningful use. So we got $1,800 rather than 44K because I'm a PA and even that check was made out to the physician (and I'm the one who bought the EHR systems). However, I had read the bill and saw this coming so it was in my SP's contract that he would pay that money to me.

 

Now, beyond fairness, I did turn around and give my office manger 10% (only $180) for her extra work for the process. So, a really thoughtful institution could share the money, but they are not obligated to.

 

There is a bill in congress that would partially correct for this, adding PA-led practices who are RHCs or underserved areas (HR 2729 ). Please write or call your congressman to support this. We are not invisible!

[tripodbetsy]

Thanks for your response, JMJ. I should be more specific. You're right, PAs do not qualify for the Medicare reimbursement.

In specific circumstances, however, we may qualify for the Medicaid reimbursement, and it is of this reimbursement to which I am referring.

This is from the official Incentive System website (cms.gov):

 

Eligible professionals under the Medicaid EHR Incentive Program include:

• Physicians (primarily doctors of medicine and doctors of osteopathy)
  
• Nurse practitioner
  
• Certified nurse-midwife
  
• Dentist
  
• Physician assistant who furnishes services in a Federally Qualified Health Center or Rural Health Clinic that is led by a physician assistant.
  

Most of the clinics in my FQHC are PA-led as most of our physicians are in each site on a part-time basis, dividing their time between the hospital as well as other sites. From my understanding, as individuals we do qualify, and the checks would be made out to each of us, which is why they are wanting to amend our contracts and take that money.

 

As to the question of what the money is meant for, this is also from the official site:

"The Medicare and Medicaid EHR Incentive Programs will provide incentive payments to eligible professionals, eligible hospitals and critical access hospitals (CAHs) as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology."

 

Again, from my understanding the midlevels at our FQHC are considered "eligible professionals" and we're being asked to amend our contracts to give that money back to our clinic. In a private practice setting, the eligible professionals and the owners of the clinic may be the same person. But that's not the case at my clinic. I'd love some more feedback. Thanks!

[jmj11]

You're right. As soon as I posted that it dawned on me that you were talking about the medicaid part rather than medicare.