In February, President Obama signed the American Recovery and Reinvestment Act of 2009 (ARRA). In part, this law designated $19 billion to the Department of Health and Human Services (DHHS), partner agencies, and the States. The funds are to be used for healthcare information technology (HIT), electronic health records (EHR), and Healthcare Information Exchanges (HIE). DHHS projections show the use of technology will save the Medicare and Medicaid programs $77 billion annually.
The focus of this article is on the Medicare and Medicaid financial incentive programs that will promote "meaningful" use of a certificated EHR.
The Centers for Medicare & Medicaid Services (CMS) intends to publish a rule by the end of 2009 that will define "meaningful" use of a certified EHR technology. They are working with the Office of the National Coordinator for Health Information Technology(ONC) to identify the proposed criteria and a organization(s) who will certificate EHR systems. CMS and ONC have not yet commented about EHR systems certified by the Certification Commission for Healthcare Information Technology (CCHIT).
Eligible medical professional will receive an annual bonus for the "meaningful" use of a "certificated" EHR through Medicare Part B. An eligible professional (EP) is a physician, dentist, chiropractor, certified nurse-midwife, nurse practitioner, and physician assistant. Medical professionals billing services through a hospital are not eligible.
Financial incentives begin in January 2011 for EPs who were meaningful users of a certificated EHR in 2010. The incentive payment is "equal to 75 percent of Medicare allowable charges for covered services" in a year. The maximum Medicare financial incentive in first, second, third, fourth, and fifth years of $15,000; $12,000; $8,000; $4000; and $2,000, respectively. For early adopters whose first payment year is 2011 or 2012, the maximum payment is $18,000 in the first year. EPs who work in a health professional shortage area (HPSA) incentive payments increase by 10 percent.
Doctors who delays implementation of an EHR will have the financial inventive reduced by the number of years delayed e.g. implementing in 2013 doctors will only receive a Medicare inventive for 2014 of $4,000 and 2015 of $2,000. Doctors who have not implement a certificated EHR by 2015 will have their Medicare Part B rate reduced by up to 4%.
As in other ARRA programs, after designated funds are exhausted eligible professionals will not received incentives, and EPs cannot not receive an incentive under both Medicare and Medicaid in a given year.
ARRA places the responsibility for a nationwide Healthcare Information Exchanges on the States, and the legislation designates funds for States to provide incentive payments to Medicaid providers for EHR systems. States can pay up to 85% of the "average allowable costs" for certified EHR technology, including support and training. The maximum financial incentive will be set by States and incentive payments are available for a 6-year period. EPs must waive rights to duplicate Medicare Part B EHR incentive payments.
A few states have created legislation and infrastructure to support the ARRA funded Medicaid financial incentive program. Maryland's governor has already signed a law requiring private state-regulated insurers to build EHR incentives and penalties into their payment structures, and they have designate an oversight agency to implement a statewide health information exchange (HIE). In Vermont, Senator Patrick Leahy secured a $1 million federal grant to support physicians using electronic prescribing, and the State of Vermont has selected a non-profit organization "Vermont Information Technology Leaders" to coordinate the adoption statewide health information technology.
There is a lot of “work in progress”. Communication between federal agencies, state governments and healthcare service providers seem to be moving at glacial speed.
