Precocious 2-Year-Olds

Texas RECs Did a Lot in Past Two Years 

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Practice Management Feature – June 2012 

Tex Med. 2012;108(6):31-35. 

By Crystal Conde
Associate Editor 

Texas' four regional extension centers (RECs) turned two this year, and they have a great deal to celebrate. The centers have enrolled more than 5,900 Texas physicians and helped them select, install, and implement electronic health records (EHR) and train their staff members to use them. They also helped many physicians achieve meaningful use of an EHR to earn Medicare or Medicaid bonus payments. 

In fact, an analysis of Centers for Medicare & Medicaid Services (CMS) data by the Institute for Health Technology Transformation ranks Texas No. 1 in the number of physicians meeting the federal meaningful use criteria in adopting EHRs. The institute said 1,761 Texas physicians attested to meeting meaningful use criteria in 2011. Ohio was second with 1,653, Illinois third at 1,533, Pennsylvania fourth at 1,450, and Florida fifth at 1,387.  

The full report is available by calling (720) 539-1285 or emailing

The meaningful use criteria make up 25 government-mandated measures. Physicians must meet 20 of them to be eligible for EHR incentives paid by either Medicare or Medicaid. The criteria set various goals to improve the quality, safety, and efficiency of health care delivery. 

James Sawyer, MD, a Diagnostic Clinic of Longview internist, is one of many Texas doctors to achieve meaningful use. He describes the consulting services he received through his membership in the North Texas REC as "superb." 

The group practice, which has more than 100 physicians and 20 midlevel practitioners in 18 locations, implemented an EHR system in 2007. 

"Since that time, the clinic has grown, and we wanted to ensure we didn't lose out on the meaningful use incentives. The North Texas REC filled in the blanks and helped 28 of our physicians and two nurse practitioners achieve meaningful use," Dr. Sawyer said. 

That earned the clinic $432,000 in Medicare incentive payments and $129,000 in Medicaid incentives. Dr. Sawyer says the clinic anticipates receiving an additional $180,000 in Medicare incentive payments and $43,000 from Medicaid later this year. 

Dr. Sawyer, who helped drive meaningful use efforts within the clinic, says 81 physicians in 44 offices use the EHR system. 

"When we have one patient who sees multiple physicians, the EHR allows us all to look at the same record and medication and problem lists. We don't have to guess. That's one of the many benefits of achieving meaningful use and leveraging the EHR more fully. We couldn't have gotten to this point and earned the incentives we did without the help of the REC," Dr. Sawyer said.  

The Office of the National Coordinator for Health Information Technology (ONC) funds the national REC program with a $721 million allocation. Texas' RECs have received $38.2 million from ONC, allocated as follows: 

  • North Texas REC, anchored by the Dallas-Fort Worth Hospital Council Foundation, $8.8 million;  
  • Gulf Coast REC, led by The University of Texas Health Science Center at Houston, $15.7 million;  
  • CentrEast REC, directed by the Texas A&M Health Science Center-Rural and Community Health Institute, $6.4 million; and  
  • West Texas REC, headed by Texas Tech University Health Sciences Center, $7.1 million.  

To find out which REC serves your region and to access contact information for each center, visit the TMA website. On the website you can also view an informative video on how RECs help physicians adopt EHRs and earn federal incentive payments for meeting meaningful use criteria. (See "TMA Meets Your HIT Needs.") 

The Texas Medical Association has ensured physician involvement in governing each Texas REC. At least half of the members of each REC board are physicians nominated by TMA and the county medical societies.  

Under the federal program, the RECs receive government funding for four years. After 2014, they'll have to fend for themselves financially. All four centers are developing sustainability models to help ensure their economic survival and to continue helping physicians meaningfully use their EHRs.

Achieving Meaningful Use 

Physicians in the Medicare incentive program can earn up to $44,000 over five years for meeting meaningful use criteria from 2011 to 2016. Eligible Medicare physicians in a health professional shortage area receive a 10-percent increase in incentives. Attestation forms for the Medicare EHR incentive program are available on the TMA website.  

Gonzales solo family physician Garth Vaz, MD, says the CentrEast REC was invaluable in helping him meet the Medicare meaningful use criteria. His practice implemented an EHR system in 2009. 

"Last August I started looking into the Medicare incentive program and the meaningful use criteria. I realized I couldn't do this myself; it was more complicated than I imagined," he said. "A representative from the REC came to my office and guided me and my five staff members in using the EHR to achieve meaningful use." 

Dr. Vaz received his $18,000 Medicare incentive payment earlier this year. 

"I would recommend physicians enroll in their area REC. It's a small investment that pays off," he said.  

On the Medicaid side, non-hospital-based eligible physicians with at least 30-percent Medicaid patient volume can receive up to $63,750 over six years in incentive payments from 2011 to 2021. Non-hospital-based eligible pediatricians with at least 20-percent Medicaid patient volume could get up to $42,500 during the same period.  

Medicaid doesn't require program participants to achieve meaningful use until the second year. In year one of participation with the Medicaid program, a physician can earn an incentive payment of up to $21,500 for certifying that he or she has adopted, implemented, or upgraded to a certified EHR system. For year two, the physician must meet 90 days of meaningful use. Once the physician has fulfilled meaningful use for 90 days, he or she can then attest to receive the year-two payment of $8,500.  

Physicians in the Medicaid incentive program who successfully attested to first-year requirements in 2011 may now certify meeting Stage 1 meaningful use requirements and receive a payment for program year two.

Susan McBride, RN, PhD, senior advisor for the West Texas REC, says more than 500 physician participants there are well on their way to meeting Stage 1 Medicaid and Medicare meaningful use criteria. 

Because the payer mix in West Texas is Medicaid- and Medicare-heavy, Dr. McBride explains, many of the region's physicians stand to benefit from achieving meaningful use. 

One such physician is Beverly Nixon-Lewis, DO, regional chief medical information officer for Texas Tech University Health Sciences Center (TTUHSC) School of Medicine and a West Texas REC participant.  

She said the medical school is part of the REC "because of the wealth of information it has garnered and because the university knew the REC would be able to get our EHR fully functional in a meaningful way."  

Dr. Nixon-Lewis adds the REC helped the school enroll eligible practitioners in Medicaid and analyze risks to its computer system.  

"The REC has been a valuable information resource for our campus on interpretation of meaningful use objective measures and sorting out our complicated workflows. Most importantly, the REC is simply a call or email away," she said. 

Fifty-seven TTUHSC eligible practitioners adopted, implemented, or upgraded to an EHR and earned $1.2 million under the Medicaid incentive program. Dr. Nixon-Lewis says those practitioners are now achieving 90 days of meaningful use in the Medicaid incentive program. The institution also plans to register 10 more physicians in the program this year.  

"We are looking at another $500,000 in incentive payments this year," Dr. Nixon-Lewis said. 

As the school moves forward with meeting Stage 2 and, eventually, Stage 3 meaningful use measures, Dr. Nixon-Lewis envisions the West Texas REC continuing to be a valuable resource.  

It's not too late for physicians to register for one of the incentive programs. The last year physicians may begin using an EHR to qualify for the incentive payments is 2014 for the Medicare program and 2016 for Medicaid. Payments will continue until 2016 for Medicare and 2021 for Medicaid. (See "Meaningful Dollars," August 2011 Texas Medicine, pages 65-69.) 

REC Pricing 

Thanks to federal funding, the RECs have been able to offer $5,000 in consulting services for $300 to primary care physicians and to other specialists who attest to providing primary care services. REC services include: 

  • EHR implementation and project management;  
  • Health information technology education and training;  
  • Guidance with electronic prescribing;  
  • Vendor selection and financial consultation;  
  • Practice and workflow redesign;  
  • Privacy and security compliance education;  
  • Meaningful use analysis, tracking, and monitoring;  
  • Assistance in meeting meaningful use requirements for CMS incentives;  
  • Collaboration with state and national health information exchanges; and  
  • Ongoing technical assistance.  

Once the RECs meet their enrollment goals, however, they're no longer able to offer the $300 subsidized rate. The North Texas and Gulf Coast RECs had instituted new, increased pricing structures for services at press time. 

Joseph Schneider, MD, MBA, chair of TMA's Ad Hoc Committee on Health Information Technology, says even though the federal subsidies for the RECs will not be available, physicians who enroll will receive "tremendous value" for their money. 

"The RECs are very knowledgeable about the EHR incentive programs and what physicians need to do to qualify. As meaningful use becomes more complex in stages 2 and 3, the value provided by the RECs will only increase," Dr. Schneider said. 

Among its achievements, the Gulf Coast REC surpassed its enrollment goal of 2,200 members and boasts more than 2,500 enrolled physicians. It now charges primary care physicians and other specialists $500 to enroll and access training. In addition, they pay $125 per hour for consulting services.  

North Texas REC Executive Director Mike Alverson says in the past two years, the North Texas REC enrolled nearly 1,500 physicians and helped more than 200 physicians achieve meaningful use of their EHRs.  

Now that the REC has met its enrollment goal, it increased the annual enrollment fee for eligible primary care physicians from $300 to $600. Similarly, the fee for specialists increased from $500 to $1,000. All physicians who join the REC have access to consulting services at $125 per hour. 

The West Texas REC gained serious ground in increasing enrollment, with 978 enrollees at press time. In fact, the REC exceeded its target of 933 members. Dr. McBride says the REC is solidifying its pricing structure. Contact the West Texas REC for pricing information at (806) 743-7960.  

At press time, the CentrEast REC had nearly met its goal of 1,000 enrollees, with 970 members, and had a limited number of openings available to primary care physicians for the $300 subsidized rate. Call the REC at (979) 436-0390 for pricing information.

RECs Plan for the Future 

Kim Dunn, MD, Gulf Coast REC principle investigator, says collaboration was the key to success for the Gulf Coast REC. She explains all four Texas RECs worked together to create a vendor-neutral best practices program for member physicians. The program provides a complimentary one-stop online source for certified EHR selection. Dr. Dunn calls the program " for doctors." Physician members can log on to to access EHR demonstrations, reviews, informative videos, tools, and other resources to help in the selection of an ONC-Authorized Testing and Certification Body certified EHR that best matches their practice. 

"The best practices program gives physicians the opportunity to have a level playing field with the various EHR vendors. The RECs have vetted the vendors and are able to outline what they have to offer," Dr. Dunn said. 

Seventy Gulf Coast REC member physicians have achieved Stage 1 meaningful use criteria, says Dr. Dunn. 

"At first we focused on getting doctors enrolled, and now we're focusing on getting as many doctors to meaningful use as possible," she said. 

Internist Robert D. Dewitt, MD, owner of The Dewitt Clinic in Alvin, says the Gulf Coast REC helped him prepare to attest to meaningful use in the coming months under the Medicare incentive program. 

"The consultant the REC assigned my office is extremely knowledgeable and has helped guide us through meaningful use. I hope to continue my relationship with the REC, because I think the center could be helpful with transitioning to ICD-10 and with adjusting to any other changes," he said. 

On top of its current services, Dr. Dunn says the Gulf Coast REC will offer a work study program as part of its sustainability model.  

"The work study program allows the REC to work with vendors to establish outsourced technical support to doctors. We've found one of the greatest needs among physicians is technical support, and we think we can collaborate with EHR vendors and provide a valuable service," Dr. Dunn said. 

Mehdi Rais, MD, West Texas REC director of clinical informatics, says the center is educating members on Stage 2 meaningful use proposed rules and plans to help them achieve the criteria once finalized.

"We're hoping to survey the REC landscape and develop best practices for physicians. We also plan to provide education on getting the most out of EHRs and connecting to health information exchanges and other entities," he said.  

CentrEast REC Codirector and Chief Operating Officer Kathy Mechler says it is still working on a sustainability model but plans to "continue to help physicians achieve meaningful use and move from Stage 1 to Stage 2 and beyond." 

Looking to the future, Mr. Alverson says the North Texas REC anticipates continuing a close relationship with ONC and CMS, actively promoting EHR adoption among medical practices, and assisting in the effective integration of those EHRs with clinician workflows.  

"The overall trend is clear: Get EHRs in place at physician practices and hospitals, share EHR data through health information exchange, and adopt improved practices based upon research and analyses. North Texas REC will be there at each stage to advise physicians," he said.  

In the long run, the North Texas REC and its parent organization, the Dallas-Fort Worth Hospital Council Foundation, anticipate building a physician data analytics program, according to Mr. Alverson. The program would help physicians understand and meet meaningful use and clinical quality reporting measures by giving them a sort of dashboard that identifies areas of improvement as well as emerging best practices.  

Crystal Conde can be reached by telephone at (800) 880-1300, ext. 1385, or (512) 370-1385; by fax at (512) 370-1629; or by email. 


TMA Advantage 
TMA Meets Your HIT Needs 


TMA has numerous health information technology (HIT) resources to help you successfully navigate the Medicare and Medicaid electronic health record (EHR) incentive programs.  

TMA's EHR Implementation Guide, EHR Product Comparison Tool (TMA member login required), Medicare and Medicaid EHR Incentive Comparison, EHR incentive eligibility tool, and Medicare and Medicaid incentive program instructions are available on the HIT site.  

If you have questions about the EHR incentive programs, contact the TMA HIT helpline at (800) 880-5720 or email HIT.  

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