Free $500 Membership to First 1,000 Physicians
Practices need fear "meaningful use" no more. The federal government has endowed 60 extension programs throughout the country to aid smaller medical practices in finding and utilizing electronic health records (EHR).
In Alabama, the grant largesse of $7.5 million fell to the University of South Alabama. "The model is based on ag extensions," says the new director, Dan Roach III, MD, and assistant dean of the College of Medicine. "We will be the local resource for providers in the electronic health landscape." (See related story below.)
The funding depends on whether the new Alabama Regional Extension Center (ALREC) fulfills their responsibilities to physicians. "We have to work for that funding," Roach says.
ALREC gets the first third of a set funding amount per provider when a physician signs up as a member. The second third arrives when the provider goes live with their software, and the final third is released only after the physician achieves meaningful use.
By April, ALREC wants to have their maximum 1,304 members registered. By the end of 2010, they had only 274 signed up, but that was before any real outreach to providers. "This means we've got to get going. We've got some very aggressive timelines," says Roach, especially with "meaningful use" reports needing to reflect activity taken this year.
Primarily, ALREC exists to serve practices of 10 or fewer primary care physicians. The annual membership fee runs $500 per doctor. But ALREC will waive fees for the first 1,000 who sign up by this April. "There are higher fees based on cost for specialists and those falling outside those parameters," Roach says.
In return, ALREC plays big brother, smoothing the path for physicians to find and use the right EHR for their practice, including helping practices map out workflow. "The biggest service is getting big-group discounts from ten vendors," Roach says.
With an ALREC membership, whether a practice has one physician or ten, it gets a deep discount of up to 30 percent off, usually reserved only for the super-sized practices. "If a practice has a system already with one of these vendors, there's a good chance they'll get a discount when they renew their license, depending on the vendor," Roach says.
To become a member, physicians can call 251-414-8170 or sign up online at al-rec.org. Then the practice works with ALREC to determine their needs in an EHR. "We'll take members who are at any level of their EHR integration," Roach says.
Once the practice determines which software to buy, the vendor takes over the relationship. "We're the liaison between the vendor and the practice to make sure it happens on time and completely. We're not replacing the vendor, just enhancing them," Roach says.
With an ALREC membership, practices can use their pre-approved and vetted purchasing contracts, as well. "We're here to make it easier for the provider, because this, after all, is a painful process," Roach says.
Members also gain access to best practices about how to set up EHR tables along with other complex and often expensive aspects of getting an EHR working effectively. "You can buy those upwards of $20,000, but we can offer them for no additional fees," Roach says.
The same deal holds with interoperability connections to the forthcoming health information exchange being developed at the state level.
But not all interfaces come free, Roach warns, including with local hospitals and labs. "We're working through hospitals interested in connecting with local providers to exchange health information, but we're not getting into the middle of their funding discussions," he says.
The big brother approach comes in handy when practices run up against sluggish vendor response. "We can hold vendors accountable for reasonable expectations. We know if something should take 90 days, and if it's taking longer, we can step in and push them to complete it," he says.
Much of ALREC's future processes still need ironing out, says Roach, including how ALREC will guide physicians through proving meaningful use to the golden reimbursements at the end. But what members can count on, "is that now matter how we do it, we will be keeping them apprised of the ever-changing landscape of meaningful use."
Vendors Vie To Be Chosen by ALREC
"It was a very voluminous process to get our name in the hat," says Nancy Ellis, vice president of MediSYS, one of only ten vendors chosen by the new Alabama Regional Extension Center (ALREC).
The chosen ten represent months of vetting, says the new director, Dan Roach III, MD. "We sent out about 60 requests for information to vendors nationwide, even before being awarded the grant." Only half responded.
Those thirty were sent a request for proposal, but only 19 submitted one. "They asked for references of physicians using our apps now and also those using interoperability functions specific to Alabama," says Jennifer Woodward, director of operations at MediSYS. "That's one of our stronger points over the national vendors. We're very specific to the Alabama market."
Using an objective scoring system, 12 vendors met ALREC's minimum cutoff score and were invited for onsite demonstrations. Following those, ALREC chose 10 based on more scoring. "It wasn't about how well we liked the screens," Roach says. It was about price discounts, training, interfaces, and much more.
"This is an extensive process that ALREC took on for providers, and they've done all this legwork before people even join," Ellis says.
Besides the deep discount, vendors have to train ALREC staff, so they can be effective when working with practices on implementing meaningful use. Vendors also agree to hold two marketing events before April and to provide certain interfaces.
Interfaces allow EHRs at a practice to connect and interact with software at other places, such as pharmacies, labs, and hospitals. "Those interfaces can range from $50 a month to a $25,000 set-up fee, and if you don't know to ask about the extra fees, you're stuck," says Woodward. "ALREC did a good job of pinpointing who has interfaces in place and what they charge for that so providers do not get nickled and dimed with fees because they have to have something to prove meaningful use."
"Our mission is to be vendor neutral," Roach says. He says vendors knew access to ALREC meant access to high volume sales. But ALREC's serves only providers, not itself. "We even had vendors offer to give us $500 back for each physician signed. We absolutely declined any of that. All the perks and discounts we can negotiate for go back to the providers, but it wasn't for lack of trying on the vendors' part," he says with a laugh.
"ALREC will play a tremendous role in moving practices through those channels to get that incentive money," Ellis says. "With meaningful use being a moving target happening over years, ALREC's involvement for members is going to be long-term."
