Category: News

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.

Certification

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.

The Health Information Technology Policy Committee (HITPC) published for comment its recommendations for stage 2 and stage 3 meaningful use guidelines in order for health care providers that are using a certified electronic health record to continue to receive incentive payments throughout the full five/six years of the incentive program.  A copy of these recommendations are here: MU Stage 2-3.

The Stage 1 final regulations were published last year.  Depending on the track and facility type, (whether through Medicare or Medicaid, and whether you are an eligible provider or eligible hospital), there are a number of “core” and “menu” requirements that must be met for an organization or individual provider to receive incentive payments for the first 2-3 years of the incentive program.  HITPC’s proposal would define the additional requirements that must be achieved by providers/hospitals in order to receive the balance of the incentive payments that are available.

In some cases, stage 2 and 3 goals are for the same thing (such as electronic prescribing), but the target is higher to achieve the goal (for example, in stage 1, an eligible provider is supposed to send prescriptions electronically at least 40% of the time, while stage 2 and stage 3 proposed goals are 50% and 80% respectively).  In other cases, HITPC has suggested that a “menu” requirement transition to a mandatory or “core” requirement for stage 2.  An example is the patient reminder that is on the stage 1 menu list for eligible providers at § 495.6(e)(4).  If patient reminders become a “core” or required objective, providers today should probably plan to try to comply with this menu item now if feasible, particularly if this is easier to implement as part of the core EHR package.

There are also some proposed new objectives for stage 2 and 3, such as the goal that 30% of patients have at least one electronic note in the EHR (which, if the practice has implemented the system in 2011, by definition, all patients seen would have one or more electronic notes in the system).

A simple google search on these proposals will turn up many comments and criticisms of these proposed stage 2 and stage 3 objectives.  Importantly, for those practices that wait until 2013 or later to implement an EHR, these practices will have to comply with the then-current meaningful use stage immediately to be considered a “meaningful EHR user” under section 495.6.  See § 495.314.  Based on the present HITPC recommendation, waiting to implement an EHR will make it harder to be a “meaningful EHR user” as compared to those practices that have implemented this year and have had a chance to work out the bugs with the system and their workflows.