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Stimulus Dollars

What does the American Recovery and Reinvestment Act (ARRA) mean to my practice?
This is a great opportunity to automate your practice with an electronic health record (EHR system) and receive financial incentives for its use under the Health Information Technology for Economic and Clinical Health (HITECH) provisions of the ARRA legislation.

What is a “certified EHR”?
Per wording within the HITECH-provision of the ARRA, a “certified EHR” is technology that meets specific standards outlined in the bill. We anticipate that the Certification Commission on Health Information Technology (CCHIT) standards will be the starting point.

What does “meaningful use” mean?
The ARRA sets out four criteria for a product to comply with standards of “meaningful EHR Use”: (a) the EHR technology used must be: (i) certified; and (ii) include electronic prescribing; (b) “connected in a matter that provides … for the exchange of electronic health information,” in accordance with applicable law and standards, “to improve the quality of health care, such as promotion health coordination.”; and (c) capable of use to “submit information … on clinical quality [and other] measures.

What does it mean to be a “meaningful user?”
A user can establish that they are a “meaningful user” by demonstrating the use of the functionality for electronic prescribing, data sharing, and clinical quality reporting.

What is the extent of funding available through the HITECH provisions?
There is currently $50B in funding available for the building of HIT infrastructure. This breaks down into approximately $37B in Medicare and Medicaid incentives (pay-for-reporting/performance) and $13B in a variety of grant opportunities available through federal and state agencies.

When will the definition of a “certified EHR” be finalized?
The most recent information available from the Office of the National Coordinator (ONC) is that a certification plan should be proposed by September 1 with final validation of this plan by the end of the year. Furthermore the HIT Policy Committee – chaired by the ONC Director has recommended a set of meaningful use requirements to Health and Human Services (HHS). This plan will be reviewed under federal rule making and put out for comment by January 1. Enactment of final regulations will most likely not be until April 1 but we have been advised that this set of criteria should be considered close to the final product.

Please clarify the start date for the Medicare and Medicaid incentives.
Hospitals could begin earning Medicare incentives late in 2010 and physicians could begin earning these incentives as of January 2011. Medicaid incentives could be earned sometime in 2010. Federal and state grants for medical providers have begun to be awarded and will continue to become available over the next several months.

What is the difference in incentive payments from Medicare and from Medicaid?

Medicaid:

  • Available only to non-hospital based clinicians, including dentists, certified nurse midwives, and physician assistants practicing in rural health clinics or FQHCs
  • Medicaid incentives range up to $63.5K over a five-year period
  • Minimum for Medicaid participation: 30% of a clinician's patients must use Medicaid, with the exception of pediatricians, who only need to have 20% of their patients using Medicaid
  • Startup incentive up to $21,000 in state loan funds will be available in year one toward the purchase a certified EHR
  • After receiving startup funds, providers who can prove "meaningful use" can receive up to $8,500 annually for an additional five years
  • No penalties have been defined by Medicaid for lack of adoption

Medicare:

  • Incentives will start in 2011
  • Available to all non-hospital physicians who see Medicare patients
  • Eligible physicians can receive up to $44K over a five-year period
  • Minimum for Medicare participation: Providers must bill 125% of the total incentive received over the five-year period of incentive distribution
  • Must prove "meaningful use" of an EHR
  • Physicians who have not adopted an EHR by January 1, 2015 will be penalized by reduced Medicare payments
  • CMS has extended full Medicare ePrescribing one full year until the end of 2011

May I apply for incentive funding from both Medicare and Medicaid if I meet the criteria?
No. You can only apply for funding from either Medicare or Medicaid, but not both. You will need to determine which is right for your practice.

Should I wait before I start looking for a certified EHR?
No. You should begin immediately to search for and implement a certified EHR, or fine-tune your existing implementation. A delay in beginning the process may increase the risk that your practice will not be able to demonstrate effective “meaningful use” of your EHR system, and as a result, you will not be ready when the incentive period starts in 2011. There is enough information available today to help you narrow your focus to quality IT solutions.

As a way to help you in your research, stay informed about the stimulus bill, sign up for updates and attend webinars. You should also inquire as to what your hospital or local community and state are providing by way of education and guidance.

If I have already implemented an EHR system, can I apply for incentives?
The HITECH provisions do not appear to distinguish between EHR systems installed before, or after, the February 19, 2009 enactment of the ARRA legislation. If you have implemented an EHR system that meets the definition of “meaningful use,” and can become a meaningful user with this system, you should be eligible for the incentives.

Do I have to collect data for a period of time before being eligible to apply for incentives?
This hasn’t been determined yet, but we recommend collecting data for six to nine months before applying for incentives, and you will need to continue to collect data.

I am affiliated with a health enterprise, but work for a small practice. Will I receive incentives through both the health enterprise and the practice?
While details are not fully defined, it seems unlikely that smaller provider practices with a larger affiliate partner will be able to “double dip” and receive monies from both incentives.

What will happen to a practice or hospital not using a certified EHR and reporting data?
Practices that are not actively using and reporting with a certified EHR will have their Medicare fee schedule reduced by 1% in 2015, 2% in 2016 and 3% in 2017. No Medicaid penalties are anticipated. Penalties will apply to hospitals that are not using and reporting by October 2014.