EMR Stimulus Information

Many healthcare providers would have heard about the stimulus package by now, but many are unsure about how it might affect them. Most providers would like to know if they qualify for incentive payments, and if so, what they need to do in order to maximize payments they receive.

The American Recovery and Reinvestment Act of 2009, abbreviated ARRA and commonly referred to as the Stimulus or The Recovery Act, will revolutionize the provider’s usage of information technology. The Health Information Technology for Economic and Clinical Health (HITECH) Act, a component of ARRA, accommodates for incentive payments to encourage information technology across the healthcare community.  EMR/EHR systems are principal focus for physician practices and groups of all sizes. Medicare and Medicaid will administer the majority of the billions of dollars that will go to physicians, hospitals, and community health centers to help them compensate their costs.

An eligible healthcare professional who participates early in the program may receive more than $44,000 over five years from Medicare/Medicaid if they are utilizing an EMR/EHR in 2011 and beyond.

    * Late adopters will receive significantly less.
    * Providers may receive incentives under only one of the programs
    * 2015: penalty reductions in Medicare/Medicaid fees for non-EMR/EHR users

The main objectives of Obama’s Stimulus Package:

To lower health care costs.

To reduce medical errors.

To improve point of care.

To improve access to data, such as healthcare IT, opportunities will arise to improve business intelligence programs in healthcare.

To improve quality of service.

American Recovery and Reinvestment Act 2009 - “Stimulus Package”

HR 1 contains 4 sections relating to EMR/EHR user

4201 Incentives for healthcare professionals

4202 Incentives for hospitals

4205 Study on application of EMR/EHR payment incentive for providers not receiving other incentive     payments

4206 Study on availability of ‘open source’ HIT systems

This summary will discuss only section 4201 relating to healthcare professionals.

DETAIL INCLUDED IN THE BILL ITSELF

Much of the detail in this measure is undefined and left to the discretion of the Secretary of Health and Human Services. The implementation plans are required to be published in the Federal Register for public comment, thus be actual payment mechanisms and the exact requirements to qualify for payment are not fully defined.

ELIGIBILITY FOR PAYMENT

An eligible professional is defined as a physician as defined by section 1861 of the Social Security code. This includes medical doctors, dentists, podiatrists, optometrists and chiropractors.

Payments will be made to outpatient physicians who have demonstrated that they are a meaningful EMR/EHR user.

Hospital-based physicians such as pathologists, anesthesiologists, emergency physicians or hospitalists who furnish substantially all of their services in a hospital setting through the facilities and equipment of the hospital are not eligible. Note however hospitals are provided incentive payments in section 4202.

There are three requirements to be met:

1) Use of certified EMR/EHR technology including electronic prescribing.
2) The EMR/EHR technology is connected in a manner that provides electronic exchange of health information.
3) The eligible professional submits information for the period on the clinical quality measures and other measures selected by the Secretary.

The Secretary is also empowered to accept individual State determinations of meaningful EMR/EHR usage with Medicaid as meeting these requirements. This provision allows practices that see relatively little Medicare populations but large Medicaid populations such as pediatric offices to qualify.
 
AMOUNT OF PAYMENT

Incentive for Physicians:
In addition to grant programs, physician’s incentives are apportioned in two different payment forms of Medicare and Medicaid reimbursements. By demonstrating "meaningful use" of EMR/EHR, physicians can start earning incentives in 2011. Incentive earnings for physicians can be about $2,000 to $18,000 in a given year.

This "meaningful use" can be best described as using the advanced technology to exchange electronic health data to improve quality of care and submitting quality of care measures to the department of Health and Human Services (HHS). In addition within a specified time frame, hospitals and doctors will need to meet these requirements.

HIMSS has a few suggestions in order to provide information about receiving incentive payments, described below:

Rely on Certification Commission for Health Information Technology (CCHIT) as the certifying body for EMR/EHRs.

• Adopt metrics that can demonstrate meaningful use, and make them increasingly more stringent over two years or so.

Work with HITSP and IHE to make sure systems are interoperable.

Close the existing gap between "certified EMR/EHR technologies", "best of breed" and "open source" technologies.

As per the law defines, eligible providers will be treated as a meaningful user of EMR/EHR technology if they meet the following three criteria:

Uses a certified EMR/EHR in a meaningful manner, which includes the use of Electronic prescribing (e-prescribing).

Uses a certified EMR/EHR that can accommodate the electronic exchange of Health information to improve quality of health care.

Submit information on clinical quality measures, as chosen by the Health and Human Services (HHS) Secretary, for the reporting period.

Medicare Incentive:

Physicians will be eligible for up to $44,000 each in incentive payments who implement a certified solution and become meaningful users between 2010 and 2012. Physicians who hold back to become meaningful users between 2012 and 2014 will be eligible for lower payments. Physicians who do not become meaningful users before 2015 will not qualify for any payments and will be subject to increasing penalties. Incentives are based on the lesser of either 75% of the provider’s Medicare Part B billings or the maximum allowable incentive.

Providers will get incentive either from Medicare or from Medicaid under the stimulus package, because they can not get both as per the law notes.

Medicaid Incentive

Physicians are eligible for payments of up to $64,000 over six years who see more than 30% of patients paying with Medicaid (20% for pediatricians). The incentives will be calculated through a formula that multiplies 85% by amounts ranging from $25,000 in the first year to $10,000 in subsequent years. Additionally, those meeting the 30% threshold can begin earning the incentive payments even as they adopt, implement and upgrade their EMR/EHR software; they can begin proving Meaningful Use of the EMR/EHR in the second year of their program participation.

Eligibility of the provider

Physicians, nurses and midwife nurses who are not hospital based and whose patient volume is at least 30 percent attributable to Medicare, are eligible for up to maximum 85 percent of their net allowable technology costs, which is subject to specific annual limits.

Medicaid Incentives will be available only to non-hospital based clinicians, encompassing dentists, certified nurse midwives, and physician assistants practicing in rural health clinics.

Medicaid incentives range up to $65K over a five-year period.

Acute care hospitals with Medicaid patient volume of 10 percent or more and children’s hospitals with any Medicaid volumes are also eligible.

Medicaid has not mentioned any penalties for lack of adoption of EMR/EHR.

After obtaining startup funds, providers who will prove "meaningful use" can eligible to receive up to $10 K annually payments for an additional four years.

The Congressional Budget Office estimates that approximately 90 percent of doctors and 70 percent of hospitals will be using EMR/EHR within the next decade, as a result of the American Recovery and Reinvestment Act of 2009.

PROOF OF ELIGIBILITY
Professionals may satisfy the requirements proving use of the EMR/EHR and electronic health exchange by methods to be determined by the Secretary which could include:

a) An attestation
b) Submission of claims with a CPT code indicating the use of certified EMR/EHR technology
c) A survey response
d) Submission of quality measure data
e) Other methods determined by the Secretary

Satisfaction of the quality measures is to be determined by the Secretary these measures must be published in the Federal Register for a period of public comment. The Secretary is instructed to avoid redundant or duplicative reporting.
 
PUBLIC REPORTING
CMS will post on a public website, in an understandable format, the names, business addresses, and business phone numbers of eligible professionals and group practices who are meaningful EMR/EHR users and receiving incentive payments.
 
PENALTY FOR NOT USING AN EMR/EHR
Beginning in 2015 there will be a reduction in Medicare payments for professional services furnished by in an eligible professional if that professional is not a meaningful EMR/EHR user. The amount of Medicare payments (with some exceptions) will be

a) 2015 – 99%
b) 2016 – 98%
c) 2017 and beyond – 97%