Practicing Excellence: A small-town, rural doctor embraces technology

Here is one small rural doctor's experience with Electronic Health Records!

Practicing medicine takes on a different feel when you're the only doctor in town. But Jim Selenke, MD, the lone physician in Hudson, Iowa, wouldn't have it any other way.

"The rural practitioner has to be incredibly confident in his skills and able to address the unpredictable," says Selenke, a family physician. "You have a lot less control over your schedule. Patients often walk in unannounced with a wide variety of ailments."

One man hurt himself while securing a load to his truck and showed up at Selenke's door with the metal hook of a bungee cord still stuck in his eyelid. There was the elderly woman whose car veered off the road near Selenke's practice before a passerby brought her—unresponsive and without a pulse—to his office. In the midst of performing a well-baby exam, Selenke dashed outside, intubated the woman, and performed CPR before an ambulance arrived to stabilize her.

But patient care is only part of Selenke's job. He handles the landscaping outside his practice, fixes its plumbing, maintains his office computer systems—he even changed the tire on a patient's car recently, a deed that was rewarded with a batch of what he calls the best cookies around.

"In primary care and in a small town, if you want to survive, you put on multiple hats," says Selenke, who is known to everyone in town as "Dr. Jim."

Rural patients tend to be older, poorer, less likely to have private insurance, and more likely to suffer serious injury from accidents compared to their urban counterparts, according to the National Rural Health Association. Plus, Medicare reimbursement tends to be lower, and providers are harder to come by, ratcheting up the pressure on those who serve such areas.

For the most part, Selenke's patient population mirrors the trends typical of rural America: About 40 percent of his 4,000 patients are on Medicare. He practices five days a week and manages to see about 35 patients per day.

He keeps up that prodigious pace with help from his electronic health record system, an investment he made five years ago when he first opened his own practice. He also decided then to maximize his efficiency and lower his overhead by teaching himself what he needed to know to maintain his IT systems. Though going high-tech—and mostly going it alone—was a choice few others in his shoes would likely make, it has made all the difference for Selenke.

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Do You Qualify for a $63,750 Medicaid EHR Bonus?

Funding Comes Courtesy of Federal Stimulus Package

By Sheri Porter

A new report estimates that as many as 45,000 office-based physicians who participate in Medicaid and use electronic health records, or EHRs, could collect as much as $63,750 paid out over a six-year period as part of the American Recovery and Reinvestment Act of 2009.

Notably, about 9,800 primary care physicians — defined by report authors as family physicians, internists and general practitioners — could qualify for the bonuses.

Boosting Health Information Technology in Medicaid: The Potential Effect of the American Recovery and Reinvestment was issued by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative, an arm of George Washington University’s School of Public Health and Health Services in Washington.

The report provides insight into federal EHR funding efforts, according to Leighton Ku, Ph.D., M.P.H., professor of health policy at George Washington University and one of four report authors. He said the team wanted to research the little-explored Medicaid payout because it pays significantly more money than the $44,000 maximum provided by a similar Medicare program.

Ku noted that HHS’ bonus payment rules prevent “double dipping” from the Medicare and Medicaid programs. But “If you’re eligible for both (programs),” said Ku, “you’re probably better off taking the Medicaid money.”

HHS is anxious to expedite EHR implementation and is investing $49 billion in the two programs to help ensure that 40 percent of America’s physicians are up to speed with health information technology by 2012.

That goal may be difficult to attain. According to 2006 data from the National Ambulatory Medical Care Survey, only 15 percent of U.S. physicians have fully implemented EHRs; another 16 percent have begun the implementation process, and 69 percent do not use an EHR system.

Medicaid Bonus Criteria

To receive the Medicaid bonus, physicians must meet criteria beyond using a certified EHR. For example, to qualify for the full bonus, at least 30 percent of a physician’s patient panel must be enrolled in Medicaid.

Physicians who practice in federally qualified health centers or rural health clinics have less stringent criteria — they need only claim that 30 percent of their patients are “needy individuals.” As such, the patients must be covered by Medicaid, provided with free care or billed on a sliding-fee scale.

The authors point out that “after-the-fact debt forgiveness is not sufficient to classify a provider as one who serves ‘needy’ patient who are uncovered by Medicaid.”

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