Accessing Stimulus Money for EHRs
When President Obama signed the American Recovery & Reinvestment Act (ARRA) in mid-February, the new law contained provisions to propel the use of electronic health records (EHRs) forward at a much more robust pace than the industry has seen in the past.
Who Is Eligible for Incentives
Medicare Incentives for Physicians:
•Eligible physicians are defined as medical doctors, dentists, podiatrists, optometrists and chiropractors
•Hospital-based physicians such as pathologists, anesthesiologists, emergency physicians or hospitalists are not eligible
•Physical therapists are not eligible for EHR incentives and not subject to penalties
•If physicians are using a qualified EHR in 2011 or 2012, they can receive up to 75 percent of allowable charges (maximum $44,000 over 5 years)
•Physicians practicing in "health professional shortage areas" can receive a 10 percent additional payment
•HHS secretary may consider additional providers for incentives
Medicare Incentives for Hospitals:
•Incentives start in 2011; reduced incentives after 2013
•$2 million base amount with additional funding based on a complex formula
•Certain acute-care and children's hospitals are eligible for Medicaid incentives
•Incentives vary by hospital based on total discharges, Medicare population (Parts A and C) and level of charity care
•Payments made over four years
•No incentive payments for hospitals first adopting after 2015
•Practice/hospital relationship one of the more difficult areas of law –specifics on if and how hospitals can assist practices is still to be determined
Medicaid Incentives for Physicians and Hospitals:
•Non-hospital based professionals who have at least 30 percent patient volume attributable to Medicaid patients
•Categories include physicians, dentists, certified nurse mid-wives, nurse practitioners and physician assistants (leading applicable clinics)
•Non-hospital based pediatricians who have at least 20 percent of their patient volume attributable to Medicaid patients
•Federally Qualified Health Center or Rural Health Clinic that has at least 30 percent of patient volume attributable to individuals who are receiving Medicaid assistance, receiving SCHIP assistance, furnished uncompensated care by the provider or for whom charges are reduced by the provider on a sliding scale basis based on an individual's ability to pay.
•For hospitals eligible for Medicaid incentive payments, payments will be determined by the same calculation as the Medicare payment algorithm
•The first four payment years will be weighted for, rather than follow the descending weights in use for Medicare incentive payments, and will use Medicaid patient load instead of Medicare patient load.
Source: Medical Group Management Association, Understanding the 2009 Economic Stimulus and Other Challenges and Opportunities for Medical Group Practice Webinar
The dangling carrot is nearly $19 billion in funding through the Health Information Technology for Economic and Clinical Health portion of ARRA to launch the national effort, assist providers with the purchase of qualified systems and reward the meaningful use of EHRs. Taking full advantage of the money offered by HITECH, however, requires fast action by physicians.
Despite the time pressures and details that are still being finalized through the federal regulatory process, healthcare information technology companies and associations see this as a major plus for physicians, patients and the industry at large.
"It gives doctors the opportunity – for those who don't currently have an EHR system – to acquire one with reduced risk, have technical support, and for them to interact with a system that can provide clinical decision support and other features to improve care for their patients," said Donald T. Mon, PhD, vice president of practice leadership for the American Health Information Management Association (AHIMA).
In a Webinar hosted in late March by the Medical Group Management Association and led by the organization's president and CEO, William F. Jessee, MD, FACMPE, it was pointed out that the current slow economy is expected to translate into lower patient volumes and revenues. Not only does the adoption of EHRs have the potential to improve efficiencies and provide access to pay for performance monies, MGMA also pointed out that not implementing such systems would ultimately cost practices and hospitals federal revenue. Those who do not adopt EHR technology by the year 2015 will see a significant reduction in Medicare payments (although Medicaid payments won't be affected).
While early adopters and information technology professionals have long touted both the administrative and clinical benefits of EHRs, providers in the United States have been slow to act for a variety of reasons ranging from confusion over what system to purchase to cost barriers to the manpower needed to complete a switch-over.
"Only about 17 percent of doctor's offices and 8-10 percent of hospitals have an EHR, depending on how you define an EHR," said Mon.
He added that of the small percentage of practices currently using EHRs, the majority of those early adopters are from large practice groups. Mon said the government is relying on HITECH to reach other core audiences.
"They have an initial target for those providers who serve the underserved, those who work in critical access settings, as well as smaller physician practices because they are the ones who need it the most," Mon said.
HITECH includes up to $44,000 in Medicare incentives over a five-year period per physician for "meaningful use" of EHRs starting in 2011 with additional state incentives for those that accept Medicaid. It should be noted that some confusion remains as to whether providers who qualify for Medicare incentives also qualify for Medicaid incentives. What is perfectly clear is that to qualify for funds, physicians must demonstrate they are a "meaningful" EHR user, which includes implementing the technology to e-prescribe, collect and report quality data and to exchange health information.
The incentives apply to physicians who can attest to the use of a "qualified" and "certified" system (including those who have already purchased an EHR system). Mon said the Certification Commission for Healthcare Information Technology (CCHIT), a recognized certification body approved by the federal government, has certified health information technology for the last three years. The assumption going forward is that "certified" systems from CCHIT is what will be required to access HITECH incentives.
To help physicians harness an EHR system's full capabilities, Mon said Regional Extension Centers are being established. In addition to training and tech support to get a system up and running, physicians should ask staff at the centers to help them understand privacy and security issues – including a number of new rules and penalties attached to HITECH – and establish effective record management practices. Physicians might also get such assistance from their respective medical specialty associations, or organizations that deal with these issues, such as AHIMA and MGMA.
Why HITECH Belongs in the Stimulus PackageDonald T. Mon, PhD, vice president of practice leadership for the American Health Information Management Association, said the money set aside for broader implementation of electronic health records makes sense on multiple levels.
"At a high level, healthcare represents the highest percentage of expenditures of the Gross Domestic Product. Right now, it's between 16-17 percent. If the growth is left unchecked, then it could be 21 percent of the GDP around 2014," he said. "It would be difficult to improve the economy without improving healthcare."
At a more detailed level, Mon continued, there is economic stimulation within the healthcare industry in terms of the savings providers could receive by adopting EHRs. Research has indicated savings … in the billions … could be recovered from reducing duplicate tests and services, operational efficiencies, computer physician order entry, health information exchange, and minimizing fraudulent activity. "Recovering all that money from the healthcare system allows us to save taxpayer dollars and/or reinvest in the healthcare system," he said.
Finally, Mon pointed out, there is an additional boost to the economy in the near term as practices purchase EHRs at a greater rate thereby stimulating technology sales and support.
"When there is this much federal money on the line, there is both the urgency to get the program out, but also the need to do it right," Mon said of balancing the tight timeframe with finalizing HITECH's parameters. "Keep a watchful eye on the Federal Register or announcements from the Department of Health and Human Services as details of the program are released," he continued, adding that professional associations are also monitoring the progress on behalf of their memberships.
Mon said there are important preliminary steps physicians and administrators could take to jumpstart the process. First, hold internal meetings to decide what EHR functionality is important to your practice. Many common questions related to healthcare information technology are asked and answered at ehrdecisions.com
. Second, familiarize yourself with HITECH and other funding made available to healthcare providers and entities through ARRA by going online to the United States Department of Health and Human Services Web site (www.hhs.gov/recovery
). The complete text of the law as passed is also available through the Government Printing Office at www.access.gpo.gov
. Finally, begin the research process to determine which system is best for your practice. Go online to www.cchit.org
to look at the list of products that have already been certified. In addition to CCHIT certification, the Health Level Seven (HL7) EHR System Functional Model and derivative profiles in long term care, behavioral health, child health, and emergency services, describe general EHR functionality, as well as in those specific care settings, and may be useful in selecting EHR systems (www.hl7.org
Former President Bush stated in 2004 that every resident should have an electronic health record by 2014, which President Obama reinforced in ARRA. Despite the tight timing, Mon said he believes it is possible to achieve significant movement in the adoption of healthcare information technology systems by next year.
"The target doesn't say everybody must be up and running by the end of the year," he pointed out. "What we're looking for is accelerated growth now and in the next few years."
AMA Unveils One-stop Shop for ePrescribing Information and Resources
The American Medical Association (AMA) launched a new online learning center to provide physicians with the information and tools needed to make informed decisions about electronic prescribing (ePrescribing). The learning center can be found at www.ama-assn.org/go/eprescribing
The new online learning center includes:
•Complete and unbiased information on ePrescribing vendor prices and features
•Calculators to estimate time savings and determine Medicare ePrescribing incentive payments
•The latest information on federal and state programs offering ePrescribing incentives
•Readiness and planning tools to map out an implementation plan
Additional resources like "A Clinician's Guide to Electronic Prescribing," frequently asked questions about Medicare's new ePrescribing incentive program and an ePrescribing practice readiness survey can be downloaded from the learning center.