Unless they want to see reduced Medicare payments, medical practices across Arkansas will be replacing their paper charts with health information technology, and they'll be working with the Arkansas Foundation for Medical Care (AFMC) to make it happen.

 

AFMC will serve as one of 60 regional extension centers across the country after being awarded a two-year, $7.4 million grant by the Centers for Medicare and Medicaid Services.

 

The regional extension centers serve both as consultants and authorities. First, they will help providers qualify to meet "meaningful use" requirements in their adoption of health information technology. They also have the authority of certifying which providers meet those requirements.

 

The term "meaningful use" had not been fully defined as of press time, but the foundation will be working with general practitioners and others who have prescriptive authority to help them choose a workable electronic medical records system that can receive and transmit data and can meet other clinical criteria.

 

According to AFMC Chief Operating Officer Jonathan Fuchs, AFMC staff members will begin working with doctors' offices in July. About 400 physicians from 120 unique sites have already submitted preliminary applications, which are available at the foundation's website, www.hitarkansas.com.

 

The goal is to move from paper charts to electronic records that instantly can be transmitted to other providers to save costs and improve care – a systemwide digital transition that already has been made by many other sectors of the economy. That means providers across Arkansas will need both appropriate onsite technology as well as broadband internet access capable of transmitting the data. AFMC is responsible for the onsite technology side of the equation.

 

The federal government is taking both a carrot and stick approach to encourage this transition. The carrot? Providers who achieve meaningful use by December 2011 are eligible for grants under the American Recovery and Reinvestment Act, otherwise known as the government's stimulus package. They can choose to take advantage of either Medicare or Medicaid funding depending on their patient load. Those who choose the Medicaid route are eligible for up to $63,000 for up to 10 practitioners, for a possible total of $630,000. Providers that choose the Medicare route are eligible for up to $44,000 per practitioner, for a total of $440,000. Providers that achieve meaningful use during the two-year period after December 2011 will be eligible for smaller grants.

 

The stick? Providers that have not achieved meaningful use within five years could see reductions in their Medicare reimbursements.

 

There's another carrot – or stick, depending on how you look at it. The foundation's $7.4 million grant covers about 90 percent of the cost of operating the program, which will serve a maximum of 1,280 practitioners during the first two-year period. The rest probably will come from fees charged to participating practices. During the following two-year period, which also will serve a maximum of 1,280 practitioners, AFMC expects only to receive $1 million from the federal government and will have to make up the difference with higher fees for participants. After that, AFMC must be completely self-sustaining.

 

"The key is, get in now, because if you're at the end of the line, I can't make any guarantees," Fuchs said.

 

According to Fuchs, the definition of "meaningful use" probably will change during outlying years, which will force providers to change with it to maintain their certification. Providers who achieve meaningful use during the first two years can continue to pay membership fees in order to take advantage of AFMC's consultative services.

 

Providers do not have to be members to be certified by AFMC as having achieved meaningful use. But Fuchs said the foundation will be providing services that won't be available elsewhere as cheaply, including consultation on safety, security and privacy issues. AFMC will have access to preferred vendors providing health information technology support and will be able to identify lenders that understand providers' financing needs.

 

Fuchs pointed out that, apart from the federal government's inducements, there will be other pressures on providers to go digital. Malpractice carriers will begin to charge higher rates to those providers still relying on paper systems. Patients also will demand providers use the technology and will take their business to providers that have it.

 

Debbi Karwoski, director of AFMC's HIT Arkansas, said the foundation is working on getting the word out about its mission. "One of our biggest goals right now is just to get out there and get some recognition and attention so that these providers can get enrolled early and we can reach them so they have the time to do that," she said. "So right now, we're all about getting noticed, so to speak."

 

According to Fuchs, the program ideally would serve rural and underserved providers that seemingly would be the last able to adopt this kind of technology. Unfortunately, through no fault of their own, many may not yet have the broadband access they will need to qualify as achieving meaningful use. The state of Arkansas has received a grant to expand health information exchanges, while the group Arkansas Connect is working to expand broadband access throughout the state.

 

AFMC previously has helped more than 200 physicians adopt electronic medical records technology. Fuchs said this transition from long-established office practices can be difficult. The workflow changes, and there are questions of job security for staff members. A few longtime physicians who always have used paper charts will choose to retire rather than change. "The major challenge is acceptance and commitment to doing it because it's too easy to walk away," he said.

 

But Fuchs said the benefits of moving to electronic technology are well worth the costs. "Once they do change and once they get into it, they find that it really improves their efficiencies," he said. "It eliminates a lot of error as it relates to medication errors. It gives prompts relative to wellness and health improvements. So there are a lot of positives to it. It just requires a great deal of effort and commitment, and our job has been always to make it as painless as possible."