Análisis de la demanda

The community partner in each site served as the recruitment arm for the demonstration and represents diverse collaborations of organizations (such as the South Dakota ehealth Collaborative or the Louisiana Health Care Quality Forum) representing local stakeholders (such as medical societies or other physician professional organizations), large payers, public entities (such as the Maryland Health Care Commission and the South Dakota Department of Health), and other health care organizations interested in advancing health IT use. The community partners were valuable for (1) providing an overview of site-specific context (as was described in Chapter I), (2) commenting on potential roadblocks or difficulties for the demonstration, and (3) describing the recruiting experience, which helps us understand the applicability or limitations in generalizing the demonstration experience outside the demonstration practices.

1. Recruitment Experience

Details the community partners shared about their recruitment give us insight into how the demonstration practices may be similar to or different from other small practices nationally in ways that might be hard to quantify but might matter when interpreting demonstration findings.13

It appears that the demonstration may have been disproportionately successful in recruiting practices affiliated with hospitals and health systems. To recruit practices, community partners leveraged hospitals and health systems, and worked with other membership organizations, such as the medical society or the rural health association. The health systems and hospitals were very helpful, according to the community partner staff we interviewed, and were often very successful in bringing their affiliated practices onboard. It may be that health systems and hospitals regarded participation in the demonstration as potentially cost-effective, since they could leverage central health IT support staff and have a larger resource base to cover any up- front costs to make changes to better meet demonstration measures, and at the same time the potential total financial reward to the system is larger, across several participating practices. The independent practices were much less likely to be responsive to outreach and more difficult to convince to participate in the demonstration.

In addition, the demonstration may have been successful primarily in recruiting practices that were further along than many others in their knowledge about and acceptance of EHRs. The community partners reported that the practices that tended to apply were those that already had an EHR, had made the decision to adopt one, or were close to making that decision. One community partner representative commented she had believed practices were closer to embracing EHRs than they actually were: “A lot of practices weren’t even thinking about it, it wasn’t on their radar.”

2. Comments on Potential Difficulties or Roadblocks for the Demonstration

The comments from the community partners about the difficulties the demonstration may face are important because they are knowledgeable about the broad set of demonstration practices in their site, not just the narrower slice provided by our site visits. The main worries that the community partners expressed centered on four topics: the potential to lose some practices that do not have the interest or energy to implement EHRs, demonstration reporting requirements, transparency in terms of how adoption of certain EHR functions will affect the incentive, and fit with the other ongoing initiatives.14

Lack of interest or energy among some practices for EHR implementation. One community partner reported that when its staff made calls to remind practices about the OSS, a handful of treatment group practices said it is not “worth it” to implement an EHR at this time even with the Medicare and Medicaid EHR Incentive Program incentives as well as the demonstration incentives. In addition to cost and other barriers discussed elsewhere in this report, small practices have difficulty making time available so staff can train to implement an EHR, the community partners learned. One respondent commented that the recession may be accentuating this difficulty, as visits and procedures have dropped some, affecting practice revenues and causing the physicians to have to work harder to keep revenue stable. The Pittsburgh Regional Healthcare Initiative suspects this is a reason that the demand for available and free EHR assistance services has been slim to date. Another community partner reported difficulty gaining good attendance at educational webinars it has offered. On the other hand, there is hope that the coming months will increase attention and enthusiasm for implementation due to both the beginning of the second year of the demonstration, and the approach of the Medicare and Medicaid EHR Incentive Program incentives.

Reporting requirements and vendor role. Practices are reportedly concerned about how they will report the data for the demonstration. “There are lots of questions about how their reporting is going to be done, and that is detracting from the focus on outcomes,” one community partner representative reported. While practices are being told to work with their vendors, there is concern that vendors won’t have time enough to help them because so much of vendor activity is geared toward preparing for the Medicare and Medicaid EHR Incentive Program. Another community partner suggested that because clinics do not all use the same software, the level of help they receive may vary, depending on which vendor they have chosen. “There needs to be a group that knows how software works and can help all practices” to make sure that the

differences in how much help the vendors give do not result in differences in practices’ ability to report and get incentives.

Transparency of incentive and incentive design. One community partner wants to be able to write articles such as “what electronic prescribing can do for you” that include information about how much adoption of e-prescribing could be worth to practices participating in the demonstration. However, the respondent noted that it is not clear enough at present how the criteria for the demonstration incentive payment are applied to be able to estimate that. Another wondered if the lower amounts of incentives in the first two years of the demonstration will be enough to keep participating practices motivated.

Fit with ongoing initiatives. One respondent thought that if EHRD reporting requirements are not well-aligned with the Medicare and Medicaid EHR Incentive Programs, and both sets are burdensome, reporting to the demonstration may “go by the wayside” because of the all-or- nothing nature of the latter program’s requirements and incentives. Another respondent observes, “There is an awful lot going on, and trying to get the physician community aware of everything that is going on is large and hard to do.” The long list of initiatives described in Chapter I seems to confirm that point.