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Why do Medicaid providers struggle with meaningful use?

By Kyle Murphy, PhD

The challenge of meeting meaningful use varies according to whether a healthcare provider is an eligible hospital or professional or is participating in the EHR Incentive Program for Medicare or Medicaid (or in the case of some hospitals, both). That last bit may end up being a more significant factor in determining whether providers decide to participate in and have the motivation sufficient to continue with meaningful use.

HITEC-LA, the federally-designated regional extension center (REC) for the Los Angeles, has experienced firsthand the differences between Medicare and Medicaid providers in the context of meaningful use in metropolitan California.

Despite having helped more than 2,500 eligible providers achieve Stage 1 Meaningful Use, the REC has noticed that Medicaid solo practitioners have a particularly harder time dealing with meaningful use. “The Medicaid solo providers are the ones who struggle and they struggle on two fronts,” HITEC-LA Executive Director Mary Franz told EHRIntelligence.com.

“One is they know that the Medicaid programs in general are more tolerant because of the safety net that they care for and the fact that they have limited infrastructure of their own to be able to do things like this,” she continues. “And then many of them felt overwhelmed because they weren’t certain that they really needed to do something like this for the benefit of their patients and felt stretched because of the large panel sizes or populations that they take care of.”

These providers were not as familiar as Medicare physicians and Medicaid clinics with working with government agencies in a program such as meaningful use.

As a result of working their status as federally qualified health centers (FQHCs) many of which received funding from the Health Resources and Service Administration (HRSA), Franz says that Medicaid clinics were well suited to working within “grant kind of program pushed by the federal government” and equipped with the tools necessary to “typically support a program like this.”

A similar situation has held true for Medicare providers of all kinds. “Because of the fact that they are heavily reliant on the Medicare program for the incentives whose schedule was shorter and had potential penalties, Medicare providers — even the solo doctors — tended to move along fairly quickly,” adds Franz.

Familiarity with government-run healthcare programs, however, isn’t the only factor. There is also the matter of Medicare providers facing potential penalties for non-participation in the EHR Incentive Programs. The same isn’t true of Medicaid providers. What’s more, these providers can receive their first payment of $21,250 for satisfying the adopt, implement, or upgrade (AIU) provision of the EHR Incentive Program for Medicaid in their first year of participation. Only after this do “traditional” meaningful use objectives and measures then come into play.

In working with Medi-Cal physicians, HITEC-LA has had to adjust its estimations and adapt its resources appropriately.

“Our original market segmentation strategy and estimate suggested that we might have a ten- to 15-percent attrition rate and in the Medi-Cal side of it we’ve had significantly higher so we have had to over-enroll a lot,” Franz explains. “While we provided similar services to everybody, we ended up probably spending more time — although we didn’t measure it so much — with Medi-Cal providers who decided to engage than we did with others in terms of support.”

Fortunately for Medicaid physicians in LA County, HITEC-LA has managed its resources well and enabled the organization to apply for and receive approval of a scope of work change that will allow the REC to help these providers along as well as others working to achieve Stage 2 Meaningful Use and care coordination initiatives.




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