In rolling out its plan to help healthcare providers go digital, the federal government wants to make sure everyone has skin in the game. That's why there are penalties for those who decline the incentives offered under the plan to adopt health IT.
It turns out the principle will also extend to the regional extension centers called for in the $20 billion-plus project, a network of education and training organizations designed to help providers through the growing pains of health IT adoption.
If the centers don't deliver on training goals they agree to meet for physicians and practices, the organization may not continue to receive funds, said Dr. Farzad Mostashari, senior advisor at the Office of the National Coordinator for Health IT (ONC) and its point man on the extension center project.
"We are going to be tracking the attainment of milestones by the extension programs with each provider, and we are going to tie their budgets and their payments from us to the extension program to those milestones," Mostashari said in a recent interview.
ONC has a goal for the regional extension centers to assist 100,000 physicians to meet "meaningful use" of their electronic health record systems, the Holy Grail of the plan.
"We want everyone's incentives aligned in that direction, and everyone to be very clear that that is the goal," Mostashari said.
The training resources will be focused especially on smaller practices and solo physicians, where a majority of Americans go for health visits. These practices have sometimes shown a reluctance to go through the workflow makeover that is part and parcel of health IT adoption.
"The extension center is a key tool for addressing that concern," said Mostashari, who led a project to encourage primary care providers to adopt EHRs when he was assistant commissioner of the New York City Health Department.
Under the ONC plan, the extension centers must get a signed commitment from providers to adopt EHRs. The providers must also be able to document their progress toward meaningful use, "to go live with documentation of active e-prescribing and quality reporting," he said.
The extension centers will have a broad portfolio, depending on the needs of individual practices. A center could assist a practice with vendor selection, for instance, help with project management, provide training on meaningful use or perform a security assessment.
The agreements between the centers and physicians should clarify their roles and obligations, Mostashari advised. They could be cooperative agreements or legal contracts, "depending on whether money is changing hands," he said.
"It would be wise to require that the physician practice commit to certain things," he added, such the time needed for adoption, workflow redesign and quality improvement, he added.
The extension centers will also be offered a Web-based customer relationship management tool to help them track communication with providers, handle program documents, assist project management and report milestones reached, Mostashari said.
Such measures will not only protect the public purse but will offer assurance "to healthcare providers to make sure that the services that they are under contract for are indeed being provided," said Don Fisher, chief executive officer of the American Medical Group Association (AMGA), which represents about 300 multi-specialty medical groups.
AMGA has joined with the Medical Group Management Association and Perot Systems Corp. to form an alliance to offer technical services to the centers.
