Interview with Dr.Terry Ketchersid, Fresenius VP Clinical Health Information Management

Dr.Terry Ketchersid, MD, MBA, VP Clinical Health Information Management Fresenius Medical Care North America Interview with:
Dr.Terry Ketchersid, MD, MBA, VP
Clinical Health Information Management
Fresenius Medical Care North America

In an interview during 2013 Kidney Week, Dr. Ketchersid discussed several topics important to nephrologists including:

  • Stage 2 Meaningful Use implications
  • Acumen EHR update
  • ICD-10 implementation

Regarding Stage 2 implementation of the CMS EHR Incentive Program, Dr. Ketchersid notes there is good news and bad news.

The good news is that 4900 providers, over half of those eligible, have enrolled and been paid for Stage 1 implementation.  This includes 2/3 of eligible nephrologists.

The bad news is that the hurdles are much higher for Stage 2 compliance.  In addition to more requirements, the “50% rule” requires more than half of face-to-face patients encounters occur in a venue equipped with a certified EHR. The only exceptions will be hospital encounters using place-of-service codes 21 or 23 (Inpatient Hospital and Emergency Room-Hospital). If more than 50% of a nephrologist’s encounters occur in a dialysis setting, either the dialysis EHR note has to duplicate or contain all of the Stage 2 objectives that an office EHR note contains, or the nephrologist is not in compliance with the Stage 2 mandates.

The silver lining for nephrologists is that if more than half of encounters occur in a dialysis facility unable to capture the Stage 2 requirements, the nephrologist may qualify for a hardship exception. The nephrologist will not receive a meaningful use incentive, but will also not be hit with the 1% penalty.  It is worth remembering that the incentives for compliance are much lower for Stage 2 than Stage 1 as the incentive program was essentially front-loaded.

Dr. Ketchersid also notes that some of the mandatory quality measures in Stage 2 may not be pertinent, and may even be contraindicated, in chronic kidney disease patients.  For example, weight loss counseling may be counterproductive in ESRD patients, as moderate obesity confers a survival advantage.  In effect, the nephrologist may be ‘dinged’ for doing the right thing for the patient.

Editor’s note: Dr. Ketchersid explains the potential options for nephrologists in greater detail in his blog, linked here.

Regarding Acumen and ICD-10 implementation.

Acumen EHR will be certified for Stage 2 compliance. While preserving historic data with ICD-9 codes, the search function will be improved in order to search by text or number for the ICD-10 code and to generate the correct SNOMED CT.

Other Acumen improvements included a Help Language embedded search tool and Review of Systems and Past Medical History wizards.

Dr. Ketchersid notes that the vast majority of ICD-10 codes used by nephrologists will be replicated from ICD-9.

However, Dr. Ketchersid predicts that non-Medicare providers, particularly state Medicaid agencies, will not be prepared for ICD-10 claims, resulting in potential payment delays and cash flow interruptions for nephrology providers.  His advice:  stock up on cash and pay attention to how and when claims are paid.

Dr. Ketchersid concluded by stating he hopes CMS will back away from a rigid interpretation of Meaningful Use mandates, allowing providers to devote more time to the real meaningful use objectives of providing improved patient care.


Contact:  Marie Benz, MD

cell/text  610-453-0354


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Not for specific medical advice. Please consult your physician for recommendations and questions. Editor: Marie Benz