A Conversation with Brian Foster, Director of Client Solutions at CareCloud
The availability of incentive payments to providers from the Centers for Medicare and Medicaid Services (CMS) to implement electronic medical records (EMR) systems is a hot topic these days among healthcare providers.Marshall Burack, a partner in Akerman's Healthcare Practice Group sat down with Brian Foster, director of client solutions at CareCloud, a leading provider of healthcare IT solutions, to discuss various EMR-related issues and answer some frequently asked questions from Akerman's physician clients.
Meaningful Use and Medicare Payment Adjustments
Akerman: The government has been making incentive payments to healthcare providers who install interoperable electronic medical records systems and make meaningful use of such systems. Can providers still receive the incentive money?
CareCloud: Incentive money is still available, but the clock is ticking. There are three stages to the incentive program. Stage 1 focuses on data capturing and sharing. Stage 2 focuses on advanced clinical processes, and Stage 3 will focus on improved outcomes. Stage 2 starts this year (2014). Here are some key guidelines:
- Make sure any EMR you purchase is labeled as "2014 Certified."
- If you are a Medicare-eligible professional, you need to start this year with Stage 1, and you must use the EMR for a 90-day period beginning no later than July 1, 2014.
- If you've already completed Stage 1, then you simply need to report for one 3-month period fixed to any calendar quarter in 2014. If you are a Medicaid-eligible professional, you can choose any 90-day period this year.
- Also beginning this year, you will be required to report on 9 out of 64 Clinical Quality Measures (CQMs) in order to demonstrate Meaningful Use, regardless of whether you are participating in Stage 1 or Stage 2 of the Incentive Program. CQMs for adults include measures such as "controlling high blood pressure" and "use of imaging studies for low back pain."
The much talked about payment adjustments (Medicare's euphemism for "penalties") will begin in 2015 for providers who do not demonstrate meaningful use by October of this year.
Cloud-Based Software vs. Server-Based
Akerman: Some of our physician clients who are looking to purchase new practice management and EMR software are confused by the term "cloud-based." What does this mean and what are the advantages?
CareCloud: With a cloud-based system, you should not have to purchase, install or manage any software. A system that is truly "cloud-based" allows you to access it from any hardware (Mac or PC), using any Internet browser (e.g., Microsoft's Internet Explorer, Google Chrome, Safari, or Firefox), and from any geographic location (e.g., office, home, or mobile hot spot) – all with complete security and reliability. Think of the way you access Gmail, for example – you do not download software or require special hardware, once you login, you access the Gmail service from any device, using any browser, from any location with an Internet connection.
Security breaches also are rare in cloud-based Practice Management (PM) software systems since there is no patient data in your office or on a laptop that could be stolen. As always, be sure you have a current and robust data security compliance plan for your medical office.
When purchasing a cloud-based service, since you are not responsible for software maintenance, upgrades, or fees for adding new users, costs can also be significantly lower if you engage in a "software as a service (SaaS)" agreement, depending on the vendor. A SaaS agreement differs from a standard software license in that the SaaS customer does not receive a physical or installed copy of the software, no ownership in the SaaS software will be transferred to the SaaS customer, and the customer's right to use SaaS software will end upon termination of the SaaS agreement.
Interoperability: Will Software from Different Vendors Work Together?
Akerman: Should physicians purchase a combined EMR/Practice Management system, or is it preferable to purchase a dedicated EMR system and a separate practice management system?
CareCloud: The ideal solution is to have one vendor and a single product with PM, EMR, and billing tools for your practice. Some practices go the route of purchasing a specialty-specific EMR. However, these products often fall short when it comes to practice management and billing functionality.
You can purchase PM software and, in most cases, these systems can be integrated with your existing EMR (the vendors might charge for this). That means your staff would schedule appointments and collect patient demographics on the PM system, you would document patient encounters on the EMR, and then staff would manage the claims submission and collections back on the PM software. The two systems will push the necessary information back and forth to create a seamless workflow. This type of integration is pretty common today but not every vendor will participate, so make sure you ask about integration before you sign the contracts and not after.