By Rose Hoban
As North Carolina quickly moves toward transforming Medicaid from a state-paid system to one run by managed care companies, lawmakers have been pushing providers to get their health records into electronic form.
Now, as deadlines loom, some of those providers are pushing back.
While most hospital systems and large clinics and physician practices have been online for several years, many smaller providers, in particular behavioral health providers, have not yet gotten their health records into bits and bytes.
“There are not many electronic health records just for behavioral health,” said Kay Castillo, the lobbyist for the National Association of Social Workers. ”Most of them are physical health, you know what shots did you give, what medication did you prescribe.”
Castillo is among the providers who are urging lawmakers to pass a bill delaying the deadlines for behavioral health providers to have EHRs until as late as 2021.
A little more latitude
“There are many reasons for requiring to connect sooner rather than later,” bill sponsor Josh Dobson (R-Nebo) told Tuesday’s meeting of the House Health committee. “It breaks down information silos between providers and achieves better outcomes for patients and creates efficiencies in state-funded programs such as Medicaid.”
But Dobson said many providers were having trouble connecting because of the cost and other issues.
“So the purpose of the bill was to give them a little more time before they had to connect,” he said.
Some of the types of providers who would be granted more time include licensed clinical social workers who do counseling, hospice agencies, speech and language therapists, respiratory therapists, drug treatment programs and a half dozen other types of small provider types.
Included in that group are state-run facilities such as psychiatric hospitals and small behavioral health agencies such as the Wright School.
“You’re talking about literally hundreds of millions of dollars, so that’s the reason for this to grant them some latitude,” Dobson said.
According to a position paper prepared by Castillo’s organization and others, the systems can cost around $50,000, a lot of money for a small practice that perhaps has only a few shingles outside the door.
“I get inundated [with calls] from other physicians and providers across the state about this,” said Rep. Greg Murphy (R-Greenville), who is a physician. “It is an undue burden in my opinion for so many providers who cannot pay the bills to connect with this.”
The bill passed easily through the house committee on Tuesday and seems to have an easy passage through that side of the legislative building.
Push to integrate
But the bill could run into more trouble in the Senate, where Ralph Hise (R-Spruce Pine) is a powerful voice and has been a strong proponent of getting the state hooked up to electronic medical records.
Hise said he hasn’t seen the bill yet, nor has he spoken to anyone in the House about it, but he’s leery of more delay.
“If you’re going to integrate mental and physical health into a single system that’s coming forward, you’re going to have to have IT systems that communicate with each other,” he said. “My concern [is]…are we delaying being able to provide whole-person care?”
For Medicaid, the 800-pound gorilla of state-run programs, that day of integration is still several years off, but Hise said people should have been moving since the legislature passed the original connection mandate in 2015 and an initial delay enacted in 2017.
A feasibility study performed by the Department of Health and Human Services and released in July 2018, after lawmakers had already concluded their work in the last session, concluded that behavioral health providers should get a delay until at least 2021. The study found that 35 percent of providers do not have the technology in place as yet to meet the mandate.[sponsor]
But Hise said providers have had time to get ready.
“We have 150 vendors already that are doing electronic health records and submitting to the [health information exchange], so there’s a lot that needs to be done with shopping for vendors, and which fits best with smaller offices,” he said.
And Hise pointed out that it’s important, in particular, for mental health patients who might be in extremis to have their treatment plans and prescriptions available for a provider, say, in an emergency room.
“We’ve had this [health information exchange] that’s been going for several years now and … you come near the end and everybody needs an extension,” he said. “I think there may be some things that we can do to help small providers to get on … but I think it’s important to lay out that we need to be on a system where your health records will follow you through any providers within the system and within the state.”
Time for these small providers is running short, Castillo noted. On the same day the bill was heard in committee, Blue Cross and Blue Shield of North Carolina sent notice to providers that if they were not connected by the legislative deadline of June 1, the insurer would not reimburse for services to members of the state employees’ health plan.
“Which means you’re not going to get paid,” Castillo said. “That’s a big deal. It’s a huge issue about access to care.”
I, personally, am horrified at the systemic loss of privacy and confidentiality of an individual’s medical and behavioral health records in this kind of insecure system. And with major insurance companies, government agencies, and hospitals whose electronic record systems are breached on a regular basis, this system shows, once again, that the government cares more about the money than the people.
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