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Selling doctors on digital records Cash-for-charts checks coming in, convincing holdouts in N.J.

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Dr. Ronald G. Nahass, president of the ID medical staff, says digital records enable doctors to more easily access patient data.
Dr. Ronald G. Nahass, president of the ID medical staff, says digital records enable doctors to more easily access patient data.

Federal grants to help doctors buy the technology needed to adopt electronic medical records have started flowing into New Jersey, as more doctors make the leap from paper chart to digital database in an effort to improve the quality and lower the cost of medical care. And the loosening of the government's purse strings is generating interest from doctors who aren't yet plugged in.

Nine physicians with the infectious disease practice ID Care received their initial $18,000 incentive payments from the federal Centers for Medicare and Medicaid Services in August, a total of $162,000, according to Bruce Topolosky, executive director of the practice. ID qualified under Medicare, and over several years, 16 of its doctors will receive $44,000 each from CMS.

The incentive payments only cover about 60 percent of the cost of going digital, but the value of the technology far outweighs the cost, Topolosky said. Most significantly, he said, "you can properly document the contents of the patient medical record in a very systematic way."

Dr. Ronald G. Nahass, president of the ID medical staff, said digital records present an advantage to doctors because they're available at any time, anywhere. If a patient is in a hospital emergency room, "I log on to a computer in the hospital, and log on to the office (database) and look up the patient's records, with all their issues and medications. I can quickly get up to speed and make the evaluation more thoroughly."

The accuracy of the medications "is far better than a handwritten" prescription, and when lab data come in electronically, "it is easily reviewed … so you don't have transcription errors."

The practice began adopting digital records five years ago, and now, "we can't live without them," Nahass said. ID's 33 physicians and four nurse practitioners had about 100,000 patient contacts last year, he said.

Another early adopter is Warren pediatrician Dr. Rao Vinnakota, who began moving into digital medicine about six years ago, and said it took about a year to integrate the technology: "You have to be personally involved to make it work, and you have to do it with a passion."

Vinnakota has 2,000 patients, and the technology helps him treat them. If a patient is allergic to penicillin, "the computer will not allow you to prescribe penicillin," and a patient who is overdue for a vaccination is easily flagged by the system. If a 13-year-old discloses that he or she is a smoker, the condition is electronically noted, "and we can start addressing it, slowly but steadily. We can't afford to miss it, like we did in the past."

Federal incentives depend in part on the patients doctors treat. For instance, doctors who treat Medicaid patients get better rewards for going digital than those who treat Medicare patients. If 30 percent of the doctor's services are to Medicaid patients — 20 percent for pediatricians — the total incentive over six years is $63,750. Early next year, CMS will hand out first-year payments of $21,750, according to William J. O'Byrne, executive director of the New Jersey Health Information Technology Extension Center, or NJ-HITEC, at the New Jersey Institute of Technology, in Newark.

NJ-HITEC received a federal grant to get New Jersey doctors on the digital path; it is working with 3,529 doctors and will eventually enroll at least 5,000. Hundreds of doctors made an early switch to digital before the federal push began a couple of years ago, so at this point, New Jersey probably has at least 4,000 doctors who qualify for the incentive payments via Medicaid, O'Byrne said. At $21,750 per doctor, that's more than $80 million heading into the state in 2012.

CMS has said it eventually will penalize doctors who don't go digital by withholding a portion of their reimbursement.

The Medicaid doctors "will start filing their paperwork in early November, and then the number of doctors receiving incentive payments will jump exponentially" as the money is paid out, O'Byrne said. Under NJIT's federal mandate, "we have given priority to the Medicaid doctors that work in the poorer communities in the state — most of them are primary-care doctors, and we know there will be thousands" who qualify for incentives.

And doctors who have resisted the switch to digital are taking more interest, now that checks are in the mail, O'Byrne said. "The skepticism ended when doctors started actually getting checks," he said.

E-mail to: bfitzgerald@njbiz.com

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