If you have made an appointment recently with a new Primary Care Physician or a Specialist for medical care, you probably have been contacted by mail, phone or e-mail before your visit and been asked to answer a lot of personal questions pertaining to your medical history. You may understand why this occurs and patiently suffer through the process or you may find it tiring, annoying or even insulting. Have Physician offices gotten especially nosy in recent years or is there something more to the story than you know?
Let me assure you, physician offices are staffed with people, just like you, who have to make their own medical appointments and go through the same process. They understand how frustrating filling out medical history forms or answering 10 minutes worth of personal questions can be. We get it – you have more important things to do with your time than try to remember if it was 1974 or ‘75 when you had your tonsils removed or if your great-Grandma had diabetes, high blood pressure or both.
Of course, there are many good reasons for sharing your health information with your healthcare providers. Your safety and well-being are a top priority and we want to ensure that we do nothing to harm you when we provide care and treatment. When you share your medical history, drug allergies, list of current medications and any other pertinent information, it helps the Physicians and other healthcare professionals at OSC keep you safe.
With that being said, let’s discuss the main reason why you are now asked so many more questions than a few years ago. It is due to The Affordable Care Act, aka Obamacare, enacted in March 2010, which according to Medicaid.gov, refers to “two separate pieces of legislation — the Patient Protection and Affordable Care Act (P.L. 111-148) and the Health Care and Education Reconciliation Act of 2010 (P.L. 111-152)”. In a nutshell, the Federal Government mandated that certain quality criteria had to be met by healthcare providers in order for them to be paid fully for providing services for patients on Medicare and Medicaid. Monetary incentives are offered to physicians to offset the costs of meeting government mandates. If providers choose not to participate, they may be fined, have reimbursement for services rendered reduced or be prohibited altogether from seeing Medicare and Medicaid patients.
You may ask, “How does that pertain to me? I don’t have Medicaid or Medicare…I have private insurance.” The reporting requirements of the law apply to ALL unique patients, even though reimbursement penalties apply only to those patients for whom care is rendered who are covered by Government-administered programs.
The first requirement is the purchase of an Electronic Medical Records and Patient Portal System for the healthcare practice. These systems are quite costly and transferring thousands of paper patient records to an electronic records system can be a huge, time-consuming challenge. Annual maintenance of these systems is expensive and may require that the practice hire an EMR specialist to deal with day-to-day operational issues. As such, small practices or solo practitioners might find it less expensive to pay fines or incur reimbursement losses than to comply with the mandate. OSC was one of the first practices in Hampton Roads to implement an EMR, way before Obamacare. Fortunately, we were more prepared than many of our medical colleagues for this monumental change. Still, OSC had to purchase a new government-certified EMR and migrate our existing patient records before meeting compliance guidelines.
To ensure these EMRs are being utilized to improve patient care, the government instituted a Meaningful Use Program comprised of 13 Core Measures for which ALL healthcare practices must collect information. They are as follows:
1. Use computerized order entry for prescription drugs being ordered by a licensed healthcare professional for at least 30% of patients (at least one Rx)
2. Implement drug to drug and drug/allergy interaction checks
3. Up-to-date problem list of current diagnoses (80% of patients must have at least one or notation of none)
4. Generate and transmit prescriptions electronically for 40% of patients
5. Note all active medications (80% of patients must have at least one or notation of none)
6. Medication allergy list (80% must have at least one or notation of none)
7. Preferred language, gender, race, ethnicity and date of birth (>50%)
8. Record and chart changes in weight, BMI, height, blood pressure
9. Smoking status for patients >13 years
10. Implement one clinical decision support rule with relevance to specialty (OSC chose Bone Density screening reminders for patients)
11. Provide patients with the ability to view, download patient records within four days of being updated by Provider
12. Provide clinical summaries for patients after each visit
13. Create, maintain and protect health information in the EHR
Additionally, there are Meaningful Use Menu Measures from which providers much choose. To read them for yourself, go to http://cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/EP_Attestation_Worksheet.PDF. Guess what? This is just the beginning – Stage One of the Meaningful Use implementation process. Full implementation will occur in various stages, to be ramped up over several years, which will require even more information to be collected.
Unfortunately, we do not foresee the Federal Government saying to us “I think we have all the information we need. You guys can take a break and quit asking so many questions of your patients”. So, the next time you are asked to fill out yet another form or answer a bunch of questions about your health when you visit your physician, say a silent “thank-you” to your elected officials who enacted this legislation for your benefit. At least, you now understand who is asking for all the information!
Written by Shannon Woods – Director of Community Outreach, Orthopaedic & Spine Center