How EHR Incentive Payments affect Dentists not seeing Medicaid/Medicare Patients

If you think that all of the uproar over meaningful use and EHR Incentive Payment deadlines does not apply to you because you don’t see Medicare and Medicaid patients, think again!

While the acronyms surrounding health information technology can be overwhelming, the distinction between electronic dental records (EDR) and electronic health records (EHR) is crucial. While many dentists have adopted electronic versions of patient records in the form of EDRs, these don’t integrate with systems and data outside of the individual practice. On the other hand, EHRs carry patient data across facilities and health care providers. EHRs contain patient demographics, medical history, and problem lists, combined with clinical decision support, quality measures, and the capability for health information exchange across providers and patient access through personal health records (PHRs). Providers with a percentage of patients (generally at least 30% of the practice) qualifying for Medicaid or Medicare respectively can receive incentive payments for meaningful use of certified EHR software.  This emphasis on Medicare and Medicaid to encourage EHR adoption may lead some private practitioners to erroneously believe that they are not affected.

Dentist Kirt Simmons points out that:

“Unfortunately, although you may not ‘mess’ with the public payer programs the legislation IS going to ‘mess’ with you!  Specifically, new privacy and security provisions (on top of current HIPPA requirements) and accessibility requirements are among the ARRA / HITECH legislation provisions.  These include privacy and security provisions extended to ‘business associates’ (for instance laboratories, etc.), breach notification requirements, health information privacy education requirements for your staff, a requirement to honor withholding of protected health information from a health plan when a patient pays for treatment ‘out of pocket’, a prohibition of the sale of protected health information, a requirement for patient authorization for marketing and fundraising-related activities, new accessibility requirements (to patient information- i.e. patients may request an electronic copy of their record and it must be provided and in a timely fashion), and finally it authorizes patients the right to request an ‘audit trail’ of all access to their record (i.e. who, when, why anyone accessed their record for any reason!).”

While final rules have not yet been released, by being aware of changes in the greater medical community dentists can prepare ahead.

Certified EHRs will meet these requirements, so it is worthwhile considering them for your practice even if you don’t qualify for Medicaid Incentive payments.  Other related features include ePrescribing, incorporation of standardized SNODENT vocabulary, and the addition of diagnostic codes to insurance claim forms.

As more dentists adopt cone beam computed tomography, they should closely follow the FDA “Initiative to Reduce Unnecessary Radiation Exposure from Medical Imaging.” Computed tomography has been shown to account for 89% of US radiation exposure, while accounting for only 26% of imaging. Certified EHR quality measures include the ability to track lifetime radiation exposure. Insurance, malpractice, federally mandated security protocols, pharmacy communication, updates to imaging software that require DICOM standards, and patient demands will all drive EHR best practices.

Lessons Learned:

  • Know the difference between EDRs and EHRs.
  • Even if you do not see Medicare and Medicaid patients, EHR incentive payments have a major impact on the future of your practice.
  • Lifetime radiation exposure, particularly from new cone beam computed tomography systems, can be tracked through certified EHRs.
  • Insurance, malpractice, federal security mandates, pharmacy connections, imaging software, and patient demands will all drive EHR adoption.

Simmons, Kirt E. (2012, July 9). The Electronic Patient Record: How it Affects the Private Practitioner. American Association of Orthodontists Committee on Information Technology Tech Talk.