EMR Stimulus Information
American Recovery and Reinvestment Act 2009 - “Stimulus Package”
- HR 1 contains 4 sections relating to EMR user
- 4201 Incentives for healthcare professionals
- 4202 Incentives for hospitals
- 4205 Study on application of EHR payment incentive for providers not receiving other incentive payments
- 4206 Study on availability of ‘open source’ HIT systems
The main objective of Obama’s Stimulus Package:
- To lower health care costs
- To reduce medical errors
- To improve point care
- To improve access to data, such as healthcare IT, opportunities will arise to improve business intelligence programs in healthcare
- To improve Quality
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 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 EHR technology including electronic prescribing.
2) The 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 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
Medicare Incentive:
Those providers who are not adopting EMR by 2015 will see reductions in their Medicare reimbursements of 1 % in 2015, 2% in 2016 and 3 % in 2017. The possible incentive will be offered maximum of $44,000 per physician, depending on when providers implement EMR. In order to receive the full amount, physicians must be implementing EMR by 2012; therefore, no payment will be made available after 2015.
Year-EMR use is first demonstrate |
Provider will receive incentives each year |
2011 |
2012 |
2013 |
2014 |
2015 |
2016 |
Total |
2011 |
$18,000 |
$12,000 |
$8,000 |
$4,000 |
$2,000 |
$0 |
$44,000 |
2012 |
$0 |
$18,000 |
$12,000 |
$8,000 |
$4,000 |
$2,000 |
$44,000 |
2013 |
$0 |
$0 |
$15,000 |
$12,000 |
$8,000 |
$4,000 |
$39,000 |
2014 |
$0 |
$0 |
$0 |
$12,000 |
$8,000 |
$4,000 |
$24,000 |
Source: American Recovery and Reinvestment Act 2009 |
Not adopting EMR by the year |
Providers will see reductions in their Medicare reimbursements (%) |
2015 |
1 |
2016 |
2 |
2017 |
3 |
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
Under the ARRA, providers will earn from $ 21,250 to $25,000 for the first year of payments, which may be not after 2016.
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.
- 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.
Year - EMR use is first demonstrate |
Provider will receive incentives each year |
2011 |
2012 |
2013 |
2014 |
2015 |
2016 |
2017 |
2018 |
Total |
2011 |
$25,000 |
$10,000 |
$10,000 |
$10,000 |
$10,000 |
|
|
|
$65,000 |
2012 |
$0 |
$25,000 |
$10,000 |
$10,000 |
$10,000 |
$10,000 |
|
|
$65,000 |
2013 |
|
|
$25,000 |
$10,000 |
$10,000 |
$10,000 |
$10,000 |
|
$65,000 |
2014 |
|
|
|
$25,000 |
$10,000 |
$10,000 |
$10,000 |
$10,000 |
$65,000 |
2015 |
|
|
|
|
$25,000 |
$10,000 |
$10,000 |
$10,000 |
$55,000 |
2016 |
|
|
|
|
|
$25,000 |
$10,000 |
$10,000 |
$45,000 |
The Congressional Budget Office estimates that approximately 90 percent of doctors and 70 percent of hospitals will be using EMR 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 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 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 EHR users and receiving incentive payments.
PENALTY FOR NOT USING AN 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 EHR user. The amount of Medicare payments (with some exceptions) will be
a) 2015 – 99%
b) 2016 – 98%
c) 2017 and beyond – 97%
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