Electronic Health Records
Flashback: IT Incentives for Doctors, Hospitals to Accelerate Adoption of Electronic Health Records Vary Under Federal Stimulus Package
March 24, 2009iHealthBeat - Health IT is expected to experience a huge boost with the new economic stimulus package. The health IT provisions of the stimulus bill aim to accelerate the adoption of electronic health record technologies and facilitate nationwide health information exchanges to improve the quality and coordination of care between health care providers, thereby reducing medical errors and duplicative care.
Most of the package's health IT funding -- approximately $17 billion over five years -- will be made available across the next 10 years as Medicare and Medicaid payment incentives to health care providers who adopt certified health IT systems. According to the Congressional Budget Office, the proposed incentive structure is expected to boost health IT adoption rates to about 70% for hospitals and to about 90% for physicians within the next decade -- a significant improvement over the projected adoption rates of 45% and 65% for hospitals and physicians, respectively, by 2019, in the absence of any incentives.
Another approximately $2 billion in funds will be available immediately through competitive grants and loans to support the development of health IT standards, build the infrastructure for health information exchanges, and enhance patient privacy and information security guidelines ...
"Will the Feds Really Buy Me an EHR?" and Other Commonly Asked Questions About the HITECH Act
Medicare and Medicaid Incentive Payments for Implementing Electronic Health Records
Abraxas Medical Solutions - With unprecedented incentives of up to $64,000 per Eligible Professional for implementing electronic health records (EHR), there is a lot of interest on behalf of medical providers to learn more about the Stimulus Plan and how they can benefit from it. Therefore, we have created this page as an information center covering some of the most commonly asked questions concerning the Stimulus Plan and how medical practices can benefit from it.
What is the 2009 Stimulus Plan?The American Recovery and Reinvestment Act of 2009 (ARRA), widely referred to as the Economic Stimulus Plan was signed into law in February 2009. The Act aims to stimulate the economy through investments in infrastructure, unemployment benefits, transportation, education, and healthcare.
What is in it for you?The part of the stimulus bill that pertains directly to medical providers is the Health Information Technology for Economic and Clinical Health Act, or HITECH Act. The HITECH Act contains multiple economic incentives to accelerate the adoption of Electronic Health Records by medical providers nationwide, including $20 billion via Medicare and Medicaid incentive payments to aid eligible medical providers in adopting electronic health records.
If you become a meaningful user of a qualified EHR by 2011, you can receive up to $44,000 from Medicare or up to $64,000 from Medicaid
Are you eligible to receive the incentives of up to $64,000?Eligible Professionals who qualify for the incentives are Medicare-participating physicians who adopt qualified EHRs and use them in a meaningful way or Eligible Professionals who have at least 30% Medicaid patients and who also meet the health IT adoption standards. Pediatricians can qualify under the Medicaid incentive if they have at least 20% Medicaid patients, but they would be eligible for only two-thirds of the incentive payments available to physicians meeting the 30% standard.
How can Abraxas help you?In order to qualify under the Medicare or Medicaid incentive plans, you need to demonstrate that you are a "meaningful user" of a "qualified EHR".
We can provide you with a "Qualified EHR":A Qualified EHR software is expected to include patient demographic and clinical health information, such as medical history and problem lists, and have the capacity to provide clinical decision support, to support physician order entry, to capture and query information relevant to healthcare quality, and to exchange electronic health information with, and integrate such information from other sources.
The upcoming CCHIT Stage 1 Certification program meets or exceeds these principals. CCHIT is currently the only recognized certification body for ambulatory EHR software. Industry leaders predict that CCHIT will serve as the framework for this new certification.
Abraxas EMR version 4.1 is a CCHIT Certified 08 Ambulatory EHR.
Abraxas is currenlty in process of obtaining CCHIT Stage 1 certification.
We can help you become a "Meaningful User":In order to demonstrate that you are a “meaningful user” of an approved EHR, you should prove that you:
- use your EMR actively at the point of care (experts predict for at least a year)
- use your EMR for e-prescribing
- use an EMR that allows interoperability
- use an EMR that is capable of clinical reporting
Abraxas EMR is already well positioned to help you maximize your incentive payments in year one, 2011.
We are closely monitoring emerging requirements. Abraxas is commitment to help you achieve and maintain the status of a "Meaningful User."
All non-hospital physicians who see Medicare patients and are meaningful users of an approved EHR by year 2011 are eligible to receive a stimulus payment of up to $44,000 per physician over five years according to the following schedule.
- Medicare incentives are reduced over time and will be phased out after 2014.
- Rural health physicians are eligible for a 25% increase over and above the base incentive (up to $55,000).
- Incentives are based on the lesser of either 75% of the provider’s Medicare Part B billings or the maximum allowable incentive.
All non-hospital based physicians whose practice is greater than 30% Medicaid (or 20% for pediatricians), as well as their Certified Nurse Midwives & Nurse Practitioners, and Physician Assistants who are practicing in federally qualified health centers (FQHCs) or rural health clinic (RHCs) led by a physician assistant are qualified to receive up to $63,750 EACH, once they become meaningful users of a Certified EHR:
The exact incentive is calculated at 85% of the Net Average Allowable Cost of the HER system, including cost of software, hardware, implementation, training, maintenance, etc.; and it is capped at a maximum per year according to the following schedule:
- Year 1: $21,250 or 85% of your Net Average Allowable Cost, whichever is less
- Year 2 through 6: $8,500 or 85% of your Net Average Allowable Cost, whichever is less
- Total incentive not to exceed $63,750
Qualified providers can apply for either Medicare incentives or Medicaid incentives, but not both.When will incentives be available?
Incentives will be available beginning in 2011 for implementations completed and meaningful use established during 2010.
Are there penalties for not using an EMR?Starting January 1, 2015, eligible providers who are not meaningful users of an approved EMR will begin to have their Medicare reimbursements drop 1% per year until it reaches 5% in 2020.
Why should you act NOW?Target a purchase date of early 2010 — This is the best way to ensure you reach eligibility in time for the 2011 Medicare and Medicaid Incentives.
Once you select an EHR software, additional time is required for implementation, training and then allowing your staff to become proficient and for your use to be considered meaningful. Most experts predict meaningful use means having at least one year of active EMR use at the point-of-care.
Waiting could delay and/or reduce what you may receive in stimulus payments.
Industry experts are predicting an unprecedented surge in number of physicians purchasing EMR and rushing to learn it to be considered a “meaningful user” in 2010. Providers who choose to wait can expect the following:
- Pay more for both EMR software and training:
As EMR vendors get busy with the rush of buyers, they’ll be less willing to negotiate over the price.
- Wait longer for implementation and training:
Due to limited resources of professionals in this field, a rush of buyers will make the queue of implementation much longer than usual.
- Meaningful Use can be achieved an average of one year after go-live date.
- Rushing the implementation will sacrifice the quality: To make a physician a meaningful user of an EMR in a rush could reduce the quality of the implementation leading to frustration for the physician and the staff. The same project done in a timely manner will yield maximum benefits from using an EMR.
- Delaying the purchase means delaying the stimulus payments or losing them altogether.
Electronic Prescription Incentives: Bonus payment of 2% on allowable Medicare Part B charges provided the eligible professional reports one e-prescribing measure in at least 50% of the cases in which the measure is reportable by the eligible professional.
Tax Deduction Benefits for EMR: Medical offices are allowed to write-off up to $135,000 of EMR software and computer equipment costs purchased and placed in service during 2010, even when purchased under a lease or financing agreement. This Section 179 tax deduction limit will decrease to $25,000 in 2011.
The Stimulus Bill, the EHR, and the Physician
GroupOne HealthSource1. In a nutshell, what does the bill mean to the typical physician?
The opportunity provided to qualifying physicians is significant. Basically, the Bill provides that qualified physicians who utilize a certified electronic health record in a “meaningful” way will receive incentive payments through additional reimbursements via either Medicare or Medicaid, depending upon the individual physician’s payor mix. Incentive payments ranging from a maximum of $44,000 under the Medicare incentive option or $64,000 under the Medicaid option are available to EACH qualifying physician, regardless of group practice size. The payments are made over a five year period beginning in 2011.
2. Have necessary laws been enacted and funds appropriated towards this incentive?
The American Recovery and Reinvestment Act was signed into law on February 17, 2009 and an appropriation of $ 19.2 billion dollars has been made towards Health Information Technology (HIT), to encourage the adoption of EHR systems.
3. What is the difference between the Medicare and Medicaid incentive options?
The HITECH Act (part of the American Recovery and Reinvestment Act) outlines two separate and distinct incentive payment programs, one through Medicare and one through Medicaid. Providers can only receive incentive payments from one of the programs and will need to determine where they stand to benefit most.
Generally, the Medicaid program offers up to $64,000 to physicians who see more than 30% of patients paying with Medicaid, (20% for pediatricians). The Medicare program offers individual physicians up to $44,000 in incentive payments.
4. Are all physicians in the U.S. eligible for incentive payments from Medicare and Medicaid?
Physicians that do not accept Medicare or those that do not have a patient payor mix of greater than 30% Medicaid (20% for pediatricians) will not qualify for the HITECH incentive payments. Furthermore, physicians operating solely in a hospital environment, such as pathologist, anesthesiologist, or emergency physicians are not eligible.
5. Are groups that do Medicare Advantage also eligible for the stimulus dollars?
Yes, there are provisions of the Bill related to groups accepting Medicare Advantage. Those organizations and their providers are eligible for the incentives as long as the provider delivers a minimum of twenty hours a week of patient care services and the organization furnishes at least 80 percent of the services of the individual professional to clients of their organization.
6. How are Pediatricians and Family Physicians going to be able to participate?
If a physician does not meet the Medicaid payer mix threshold and does not accept Medicare, they will be able to apply for grants and/or loans to offset the upfront costs of the purchase of an EHR but will not be eligible for incentives as currently delineated.
Additionally, the Secretary of HHS will be assessing utilization levels beginning in 2011, and if he or she believes that there is a need to offer other incentives to prompt adoption among those populations of providers, that will be addressed then.
7. When would I become eligible and what is the time line for payments under Medicare?
The incentives would be received only upon meaningful use of certified EHR Technology and on serving Medicare patients. It is expected that the Stimulus payment will equate to 75% of the physician’s total Medicare allowable capped at the amounts indicated below. Stimulus payments would commence in 2011 and continue according to the following timeline:
*Eligible professional serving “Health Professionals Shortage Area” will receive an incremental payment of 10%.
8. Can a physician be penalized for not utilizing an EHR by 2015?
Beginning in 2015, physicians not demonstrating meaningful use of an EHR will face penalties in the form of reductions to their Medicare fees schedule reimbursement rates. The penalty will equal 1% in 2015, 2% in 2016, and 3% in 2017 and each subsequent year. Under the bill, the Secretary can increase the penalty to 5% if fewer than 75% of eligible physicians are not utilizing an EHR by 2018.
9. Under Medicaid who is eligible to receive incentive payments and what is the timeline for payments?
Generally, the Medicaid program offers up to $64,000 to providers who see more than 30% of patients paying with Medicaid, (20% for pediatricians). Beginning in 2011, the Medicaid incentive payment will be based on a calculation that includes the provider’s Medicaid mix and qualifying IT related expenses. Payments could amount up to $25,000 the initial year and $10,000 each subsequent year for a total period of five years. The eligible professional under Medicaid must first demonstrate certified EHR usage by 2015 to be eligible for payments and after 2021 will not be eligible for payments. Pediatricians, who only meet the lower threshold of 20% Medicaid patients, would be eligible for 66% or the payments described above. The current bill also provides a cap for total payments under the Medicaid Plan. Once the funds have been depleted, payments will no longer be available under the Medicaid plan.
10. My group has 10 physicians. Could the group qualify for total incentive payments of $440,000 under the Medicare incentive program?
Yes. If each of the physicians meets the criteria including the ability to demonstrate meaningful use of a certified EHR system by 2012, the group could be entitled to a total of $440,000 in incentive payments under the Medicare program.
11. Is “Meaningful Use” defined in the legislation?
“Meaningful Use” is described initially in the legislation to include the following aspects:
- The use of a certified EHR with ePrescribing capability as determined appropriate by the Secretary of HHS.
- The ability to report on clinical quality measures as specified by the Secretary.
- The use of EHR technology that allows electronic exchange of patient health information.
- Further information with regard to required standards, reporting and connectively levels will be determined by the Secretary of Health and Human Services.
What constitutes a “certified” EHR is to be determined by the Sec. of HHS. However, many believe that CCHIT will be instrumental in the certification process and that HHS will likely be basing much of their standards on the current work of CCHIT. eClinicalWorks® is a CCHIT certified EHR and the organization intends to ensure that it meets the standards necessary to be certified for the stimulus payments.
13. Is there a list of certified companies?
To view a list of CCHIT certified companies, visit www.cchit.org.
14. Are “mid-level” providers covered by the incentive programs?
Nurse practitioners and nurse mid-wives should be able to file for incentive payments under the Medicaid program. Physician Assistants may qualify if the PA is practicing in a rural health clinic that is led by the PA or who is practicing in a FQHC. Mid-level providers do not qualify under the Medicare portion of the incentives.
15. Is there a separate bonus payment for hospitals that utilize an EHR?
Yes. The Stimulus Bill includes a separate Medicare incentive payment for hospitals efficiently utilizing an EHR. The calculation is much more complicated. It includes a $2 million base payment plus an amount from a formula including various factors such as the discharge volume, inpatient-bed-days for different Medicare patients and total patients, and total hospital charges.
16. My practice has been utilizing an EHR system since prior to the date the Stimulus Bill was signed into law. Can the providers in my practice still qualify for the incentive payments?
Yes. In fact you are probably ahead of the curve. Only 20%-30% of practices had implemented an EHR prior to the enactment of HITECH. Because of the relatively short time frame and the sheer number of practices that still need to implement an EHR, it may be a challenge for some of these non-early adopters to qualify for the maximum payments. If your system is certified and you can demonstrate meaningful use of the system prior to 2012 you should generally qualify for the incentive payments under the Medicare Plan
17. The cost of my EHR system was only $15,000. If I qualify, will my incentive payment be limited to $15,000 under the Medicare Plan?
No. Under the Medicare Plan, the requirement to receive the maximum incentive payments is a utilization standard and is not dependent upon the actual cost or purchase method of the EHR system. If you meet all qualifications for the incentive payment, you should receive the maximum payment regardless of the actual cost or purchase method of your EHR system ...
20. My practice does not currently utilize an EHR. When is the right time to start planning for an EHR implementation?
If you have not already started the process of implementing a system, the time to start the process is now. The transition to a new EHR system can be a timely process, especially with the added requirements of meeting the meaningful use criteria for the incentive payments. Typically, the time requirement of a successful EHR implementation increases in proportion to the size of the group.
Due to the fact that only 20% - 30% of the market has already implemented an EHR system and that many EHR vendors had waiting lists prior to the stimulus act, it will be a challenge for the industry to handle the implementation of the non-early adopters in a timely fashion. Those physician who wait, may have little chance of qualifying as an early adopter.
21. Is there any benefit for early adoption of the certified EHR system?
Yes. Early adopters would stand to gain, as about 70 percent of the Medicare payments would be received in the first two years.
22. Is there any additional benefit for PQRI and electronic prescribing?
Those engaged in Physician Quality Reporting Initiative (PQRI) and electronic prescribing can earn an additional $ 6000 - $ 8000 per year, beginning immediately.
23. How will the EHR Stimulus payments actually be distributed to the physicians?
The timing and distribution process for the incentive payments is to be determined and finalized by the Secretary of the HHS and the federal rule making process.
24. Will my patients or the public know whether or not my practice qualifies as a meaningful EHR user?
Yes they could. CMS will post the names, addresses, and phone numbers of eligible professionals who are meaningful EHR users and group practices receiving incentive payments.
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