The Neurologist's April

As we move into April 2011, several dates are likely foremost in the minds of all neurologists:

· April 9-16: The American Academy of Neurology annual meeting in the conveniently and centrally located state of Hawaii

· April 15: Usually the deadline for filing federal income taxes that is postponed this year because of Emancipation Day until April 18 giving us seventy two whole hours to further procrastinate

· April 18^: The Attestation System for the Medicare EHR incentive program opens

For some, this third event does not carry the significance of the others. However, this red-letter day represents the first opportunity eligible professionals have to report on the meaningful use of their certified EHR. I know what most of you are thinking: the 18th couldn’t come soon enough. For the vast minority of you who are thinking, “Huh?”, the date marks when those clinicians who have implemented an EHR in their office can report on which of the 20 meaningful use measures they have successfully completed to qualify for incentive monies.

According to the Office of the National Coordinator and CMS, one of these measures is the capability of your EHR to report on clinical quality measures. Three “core” measures must be reported by all eligible professionals. In addition, three out of 38 potential quality measures must be selected and reported upon. For each of the total six measures, the number of patients who you successfully fulfilled that quality measure (numerator) divided by the total number of patients who qualified for that measure (denominator) must be able to be reported by your EHR. This almost seems reasonable, until you look at the actual measures that are being requested.

The three “core measures” are:

1. Blood pressure measurement

2. Tobacco use assessment and tobacco cessation intervention

3. Adult weight screening and follow-up

You might think that these measures do not really reflect the scope of your practice and so would not really be relevant. Have no fear; our government, in its infinite wisdom, has anticipated this and allows for the selection of “alternative core measures” instead:

1. Weight assessment and counseling for children and adolescents

2. Influenza immunization for patients >50 years old

3. Childhood immunization status

That should certainly cover all the bases. The other quality measures are no more relevant to neurology. They mostly apply to primary care physicians for the care of diabetes, congestive heart failure, cancer screening, etc. Probably most relevant to patients cared for by neurologists would be the ischemic vascular disease quality indicators, which call for the successful control of BP and LDL cholesterol—usually not the purview of the treating neurologist.

In order to qualify for the EMR incentive money, neurologists will need to report on quality measures that are mostly irrelevant to the scope of our practice. Fortunately, there is no requirement to satisfy a minimum value for the numerator or denominator for any of these measures, either the core or additional. As long as you have a certified EHR that can calculate these values, you will not be penalized in Stage I reporting years (2011-2012) for not accomplishing the goal of the specified measure.

However, it is anticipated that future stages of meaningful use will require that you demonstrate not only the capability of your EHR to calculate the frequency of quality compliance, but that you have successfully accomplished the measure in question. Therefore, it becomes more important that the AAN adopt quality measures that reflect important and practical indicators of best neurology practices. Quality indicators no longer represent an academic exercise in evaluating existing literature. Adherence to suggested quality measures may actually determine our rates of reimbursement.

As I head off into the sunset in Hawaii, I am looking forward to learning more about the latest hot topic: accountable care organizations and how neurologists fit into the scheme of this new reimbursement model. More to come.