Who Is A “Meaningful EHR User”

You may have heard that the government is giving money away to encourage doctors to start using electronic health records (EHR) in the U.S.  For “eligible providers,” that is true if the provider (a) uses a certified-EHR, (b) in a “meaningful” way, (c) by a certain date (approximately 2015), and (d) is eligible under the Medicare or Medicaid program based on makeup of the provider’s patient panel.  So, I guess that is sort-of giving away money.

The point of providing money to eligible providers is that EHR technology is expensive to acquire, implement, and maintain.  In fact, that is probably true of most computer technology (ever had to call a computer guy to remove a virus from your computer?  I think they are starting to charge as much per hour as lawyers!)  In addition, while eliminating paper systems undoubtedly saves some money to a practice in the longer term, but at least in the short term, these savings will not be seen in physician budgets.  So it helps if Uncle Sam pitches in some taxpayer dollars to get things started.  In this case, several billion over the next five or six years for the early adopters out there.


But, just spending some money on a computer system is not enough to qualify for these incentive payments.  A provider must use a “certified” EHR.  Only certain EHR’s are certified.  The list is available online here.  There are a number of organizations, like CCHIT, that act as certifiers of EHR systems.  These certifiers evaluate EHR software packages to determine if they have the minimum technology and functionality to be useful for practicing providers.  So, if you hire your IT-savvy son-in-law to write you a database to keep track of patient copays, you probably won’t be able to get those incentive payments!

“Eligible Provider”

Have a certified system?  Great.  But are you eligible under the program to receive the incentive payments?  That depends.  There are two basic tracks towards eligibility: Medicare and Medicaid.  You can obtain incentive payments under the Medicare program if you are a physician (including doctor of medicine, dental surgery, podiatric medicine, optometry, or a chiropractor) 45 CFR 495.100.  However, be careful.  If you are a physician, the amount that you can receive in incentive payments is a percentage of your total allowable Medicare charges, up to $15,000 for the first year, and less for the subsequent years.  So, if you have three Medicare patients that you see for $500 of allowable services a year, don’t expect a very large incentive check from the Medicare program.  See 45 CFR 495.102(a).

The other track is through the Medicaid program.  More providers are eligible under the Medicaid program, including physicians, dentists, certified midwives, nurse practitioners, and physician assistants (that lead a rural health center).  In order to receive incentive payments, the provider must have a patient panel where at least 30% of their patients are Medicaid recipients (20% for pediatricians), or the provider practices at a federally qualified health center and has a patient panel of at least 30% are “needy individuals” (which are both uninsured and Medicaid-eligible patients).  See 45 CFR 495.302.

Meaningful Use

You have a certified EHR system and you are the kind of provider that can participate under Medicaid or Medicare.  Great!  But are you a “meaningful user” as defined by the relevant regulations?  Well, that requires more effort on your part.  Namely, you need to meet the objectives that are described in more detail in 495.6.  For eligible providers, you have fifteen objectives listed in 495.6(d) that are “core” or required objectives to be met.  In addition, you must also meet five of the ten possible “menu” objectives that are listed in 495.6(e).  If that seems like a lot, well, you might be right.  And this list comprises the “stage 1” objectives.  Stage 2 and Stage 3 objectives are currently on the drawing board, and are anticipated to become the meaningful use objectives starting in 2013 and 2015, respectively.

Can it be done?  With some effort.

Note: there are different rules for hospitals as compared to providers that work in an outpatient setting.  You can read the complete regulations here (sans the comments and explanations): EHR Final Rule no comments.

Published by


Maryland technology attorney and college professor.

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