In 2012 the United States Department of Health and Human Services released final rules related to Electronic Health Records (EHR) and Health Information Technology (HIT). The rules require health care practitioners falling under the title of a physician to comply with federal laws, under the title Health Information Technology Act from Congress. The act made it so that pretty much all health care providers except PTs will have to upgrade EHRs to remain compliant through what is termed “Meaningful Use.”1 This list includes medical doctors, osteopathic doctors, podiatrists, optometrists, oral surgeons, dentists, and chiropractors.
The act also specifies payment adjustments for entities and providers that do not meet meaningful use requirements and other program requirements. Physical therapists are not yet defined as eligible professionals for demonstrating meaningful use and, therefore, are not subject to these payment adjustments for failing to demonstrate meaningful use. The American Physical Therapy Association reports that once a while at this time physical therapists are not directly affected by the rules related to meaningful use under Medicare and Medicaid, they should remain aware of issues relating to HIT technology, particularly in this dynamic health care delivery environment.
Thus, outrageously this new act allots credit to these aforementioned eligible health care providers to receive incentive payments (financial reimbursement) for achieving Stage 2 meaningful use requirements of the act with their certified EHR systems. Physical Therapists were not included, yet Chiropractors were. This is interesting, considering that physical therapists coordinate care and provide services by way of direct referral from hospitalists, specialists, and family care physicians at a much more frequent rate than chiropractors do.
As a pelvic practitioner, I exchange images, documents, and prescriptions on a daily basis with primary care physicians, oncologists, gynecologists, obstetricians, general surgeons, gastroenterologists, nurse practitioners, physician assistants, osteopaths, midwives, orthopedists, and naturopath physicians. I am not unique, all outpatient PTs see patients from a wide variety of practices, and all of these folks have been mandated to comply with the Health Information Technology Act. In a few years it is speculated that the various electronic health record systems will communicate with each other, thus physicians from various hospital and clinical settings will be able to access charts and images for any given patient. There are Electronic Health Records that are certified through the Office of the National Coordinator for Health Information Technology (ONC) Health IT Certification Program. This program helps to ensure that health IT conforms to the standards and certification criteria adopted by the Secretary of Health and Human Services.
We as PTs are faced with an interesting financial paradigm. We are not mandated to participate in the use of Electronic Health Records, nor do we receive financial reimbursement for its use. Yet, all of our colleagues and referral sources will be participating in this program and accessing patient information seemingly seamlessly, without faxing a pile of documents back and forth with each other.
The question becomes, how do we as PTs respond? The PTs who do switch over to an approved electronic health record system may face the realization that referring physicians do not want to fax piles of documents back and forth with non-participating PTs when they can easily and seamlessly communicate information and prescriptive paperwork with PTs who do have and ONC approved EHR system. Hospital based PT systems are by and large participating and compliant in electronic health records and PQRS reporting and may benefit from increasing referrals by other participating practitioners.
On a professional level, the PQRS reporting by PTs demonstrates our value to our patients, third party reimbursement, and referring physicians. Because the reported values are based on functional outcomes measures we are able to objectively quantify the good that we do for our patients. It is a given that for certain oncological, cardiopulmonary, and geriatric diagnosis the goal may be to preserve current function instead of to progress, we may look to patient quality of life (QOL) outcomes measures as well to demonstrate that we have effectively done our job.
The pain points of all of this are that PTs in the private practice sector may face decreased referrals from physicians for choosing not to participate in EHR and PQRS reporting. Meanwhile, at this time we do not receive medicare credit or immediate financial repercussion from ONC approved use of EHR from our compliance with this act either. The APTA spells it out for us: once in a while physicians and hospitals are the beneficiaries of many of the federal government’s initial efforts to encourage EHR system adoption, they will expect the other providers they work with, including physical therapists, to implement it as well. Patients also may begin to expect their providers to use EHRs to manage their care. It appears that the writing is on the wall, and that it would benefit outpatient physical therapists greatly to comply, lest we be swept out to sea without the support of our referral sources.
BestPT is an ONC certified Electronic Health Record software and a sustainable solution to this paradigm. Visit APTA’s HIT webpage for resources and updates on HIT program development and legislation, as well as APTA’s related advocacy efforts.
1. Final Rules on EHR Meaningful Use Incentive Program and HIT Standards Released. PT in Motion News. Available at: http://www.apta.org/PTinMotion/NewsNow/2012/8/24/EHRHITRUles/ Accessed on April 1, 2015.
2. Physician Quality Reporting System List of Eligible Professionals (PQRS). Center for Medicare and Medicaid Services. Available at: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/PQRS_List-of-EligibleProfessionals_022813.pdf. Accessed on April 1, 2015.
3. Health Information Technology. APTA. Available at: http://www.apta.org/FederalIssues/HIT/. Accessed on April 1, 2015.
About the ONC Health IT Certification Program. ONC Health Certifcation Program. Available at: http://www.healthit.gov/policy-researchers-implementers/about-onc-health-it-certification-program. Accessed on April 1, 2015.
4. About the ONC Health IT Certification Program. ONC Health Certification Program. Available at: http://www.healthit.gov/policy-researchers-implementers/about-onc-health-it-certification-program
-Amanda Olson, DPT