CMS unveils electronic records project for smaller practices.

Primary care doctors welcomed news of a federal project aimed at extending the use of electronic health records in small- to medium-sized practices, but noted that its success rests on how it is implemented. "The devil is in the details," Dr. Steven E. Waldren, director of the Center for Health Information Technology at the American Academy of Family Physicians, said in an interview. "What are going to be the real requirements for physician practices to participate and submit data?"

The demonstration project, sponsored by the Centers for Medicare and Medicaid Services, would be open to participation by up to 1,200 physician practices beginning next spring. Over a 5-year period, the project will provide financial incentives to physician groups using certified electronic health records (EHRs) to meet certain clinical quality measures.

Bonuses will be provided each year, based on a physician group's score on a standardized survey that assesses the specific EHR functions a group employs to support the delivery of care.

All participating practices would be required to use a certified EHR system to perform specific functions that can positively affect patient care processes, such as clinical documentation and writing prescriptions. The system, which must be in place by the end of the second year of the 5-year demonstration, must also be approved by a certification body officially recognized by the Department of Health and Human Services, according to CMS.

The core incentive payment to practices will be based on performance on the quality measures, with an enhanced bonus based on how well integrated the EHR is in helping manage patient care.

"This project will appropriately align incentives to reward doctors in small physician practices who use certified EHRs as tools to deliver higher-quality care," CMS's acting administrator Kerry Weems said in a statement.

Over the course of the demonstration project, CMS estimated that 3.6 million consumers will be affected directly as their primary care physicians adopt certified EHRs. In order to amplify the effect of the project, CMS also is encouraging private insurers to offer similar incentives for adopting EHRs.

Dr. David C. Dale, president of the American College of Physicians, praised the demonstration project as "an encouraging step in the right direction," and said it was acknowledging that market forces alone will not be enough for physicians to afford new market systems.

"For physicians in small and medium-sized practices, the cost of an EHR system--not just the dollars spent on the hardware and software, but the time lost on training and conversion to a new system--makes implementing these systems a financial impossibility," Dr. Dale said in a statement.

AAFP's Dr. Waldren agreed that the biggest barriers to implementation of EHRs in physicians' offices are the cost and the design of the physician payment system. "They're trying to overcome both barriers for up to 1,200 practices," he said. "In that regard, we're pretty supportive. Those who have the most difficulty are those in the smallest practices."

But he added that CMS has not yet divulged the details, including which EHR systems will be certified and whether physician practices must provide up-front funding for the EHR systems in order to join the demonstration.

BY JANE ANDERSON

Contributing Writer