Sunday, July 25, 2010

The Role Incentives Can Play

Eugene Heslin, M.D., Lead Physician for the Bridge Street Medical Group in Saugerties, New York, appeared before the House Ways and Means Subcommittee on Health on July 20th to support health IT and the meaningful use regulations related to the incentive payments.

He said, “Primary care physicians see Medicare age patients two to three times more often than younger patients and the number of older complex patients is going to double. Because of this, we will have to develop efficient systems and use more intelligent tools.

He described his practice as a typical primary care practice serving a community of about 18,000 in a suburban-to-rural small town. He told the Committee how 6 months ago he was called at 3 a.m. because an 89 year old patient of his was at the emergency room experiencing shortness of breath plus the patient was disoriented.

The patient had given the paramedics a list of his medications and Dr. Heslin was able to access his medical record from his home computer to look up his medications. He realized right away that the medications being read to him over the phone didn’t match his patient’s medical record. On a hunch, he pulled up the patient’s wife’s record and discovered the patient had given them his wife’s medication list by mistake.

He explained how with grant funding and technical support from MedAllies, his office went live with EMRs in 2006, and installed the second system in 2008. The system provides electronic registries and has the capability to use e-prescribing for about 90 percent of the prescriptions.

According to the doctor, the hardest part of the transition from paper to electronic record was redesigning the workflow and this is still an ongoing process. Two of the nurses in the office are now enrolled in a training course and in addition, more structured care management is being used in the office.

In 2009, his practice adopted the medical home model along with ten other Hudson Valley physician practices and three community health centers. The practices worked with Taconic IPA to help the practices achieve NCQA medical home recognition.

Over the course of one year, all 11 practices including 237 primary care physicians working at 51 practices sites, all transformed to the patient-centered medical home model and now these practices provide care to nearly half a million residents in the Hudson Valley.

Dr. Heslin emphasized that there was an incentive attached to that medical home project, and this speaks directly to the value of the Medicare meaningful use incentive payments. The Pay for Performance part of the project paid bonuses to the practices and incentives were paid by six local health plans and a large employer IBM. He told the committee that the incentives were useful and engaged physician interest and offset some but not all the costs of health IT adoption and meaningful use.

He added that ultimately my patients are why meaningful use of health IT is important. Although financing and practice workflow redesign are challenges for small practices, he said, “The federal incentives can help me persuade my colleagues that there is critical mass and that it is doable at the community level.”