CMS Plans New EHR Demonstration Project

CMS is launching a demonstration project designed to encourage small- to medium-sized physician practices to adopt electronic health records, or EHRs, to help manage and deliver health care; however, the AAFP has raised some questions about the project.

In an Oct. 30 press release, HHS announced that CMS intends to launch a five-year Medicare demonstration project this spring that will pay small- to medium-sized physician practices a fee for using certified EHRs to meet clinical quality standards. CMS will base bonuses on a physician group's score on a standardized survey that assesses specific EHR functions used to support the delivery of care. The agency will pay an additional bonus for how well integrated the EHR system is in the management of patient care.

The project, which will include as many as 1,200 physician practices, should affect about 3.6 million Americans, said HHS Secretary Mike Leavitt in the release. "Broad adoption of electronic health records has the potential not only to improve the quality of care provided, but also to transform the way medicine is practiced and delivered," Leavitt noted.

In a Nov. 5 letter to Leavitt, AAFP EVP Douglas Henley, M.D., said the AAFP applauds the "establishment of a project focused on small physician practices and family physicians."

"EHR costs and malalignment of payment structures are large barriers that our members face regarding EHR adoption," Henley said in the letter. "It appears this project will begin to address those issues for a meaningful number of practices."

However, he added, the Academy has several questions about the project. In particular, Henley asked about the resources that practices must provide to participate in the project and about "up-front monies to assist in the purchase and implementation of an EHR (system)."

"Specifically, how must data be structured and transmitted for quality reporting?" Henley asked.

He also inquired about the amount of money to be paid to physicians for participating in the new demonstration project.

In late 2006, CMS launched the Physician Quality Reporting Initiative, or PQRI, which pays physicians a 1.5 percent bonus for reporting on a designated set of quality measures for their Medicare patients. The 1.5 percent payment has not proven a sufficient incentive to drive the adoption of PQRI in most practices, however, and there is a possibility the new project could suffer a similar fate if CMS does not pay physicians adequately, said Steven Waldren, M.D., M.S., director of the AAFP's Center for Health Information Technology.

According to Waldren, CMS has not consulted or even contacted the AAFP about the new demonstration project thus far, even though the project is so specifically aimed at small- and medium-sized physician practices -- essentially family physicians.

"The majority of our members fit within the demographic CMS is trying to assist," said Waldren. "The Academy has been a very strong proponent of electronic health records and quality performance metrics, so it is a little concerning that CMS has not reached out to us. We have a lot of expertise we can really bring to bear to make this a very successful project."