The push for healthcare reform, computerization of medical records and the entire HITECH Act may be in for some rough sailing.

Earlier this week, US election results indicated a fundamental backlash to sweeping government mandates, with healthcare reform being cited as flash point for voter frustration. The House Republican whip described it this way: “If all of Obamacare cannot be immediately repealed, then it is my intention to begin repealing it piece by piece, blocking funding for its implementation and blocking the issuance of the regulations necessary to implement it.”

What this means for the private sector is an opportunity to be the architects in achieving better patient medical care, healthcare cost containment and gains in productivity through the adoption of Electronic Medical Records (EMR) and patient Personal Health Records (PHR).

The Healthcare Information Technology for Economic and Clinical Health Act (HITECH) and its $20 billion in funding has been met with polite applause from doctors, but holds great appeal for its potential for job creation. But the sales pitch to doctors to move away from their current methods of patient record keeping and adopting Electronic Medical Records is moving slowly, even with timelines and incentives in place. Doctors stand to receive $44,000 in incentives from HITECH for using a EMR system by 2014, but four years does not exactly create a feeling of urgency.

Already we have seen development of scores of Regional Health Information Exchanges (HIE) that will act as pilot sites for EMR adoption and information sharing. Can the widespread application for consumer Personal Health Records and access to medical information be far behind?
Not according to giants like Microsoft, Google and Verizon, all of whom are aggressively developing consumer products and services catering to, you guessed it, Personal Health Records. With 309 million US patients and consumers, the potential for business is too great to be left exclusively to the government.

Doug Wallace, co-founder and Executive VP of My EMR Choice, sees consumer demand as the next phase of successful Electronic Medical Record adoption and widespread sharing of information. “Consumers have the ability and tech savy to insist on access to their medical information, options and choices. The desire to participate with their own healthcare needs will be the catalyst to delivering the benefits that HITECH is trying to achieve. Empowerment and interest by patients will make HITECH come to life in a meaningful way.” Adds Wallace, “What is more important than the health of you and your family? With the new technologies, collaboration and successful outcomes will be reality”.

In the US, 360,000 CPA’s may be smiling over new opportunities and job security…the HITECH Act.

Incentive payments for the “meaningful use” of Electronic Medical Record systems (EMR) are taxable by the Internal Revenue Service, according the Center for Health IT.

Under the 2009 economic stimulus package/HITECH Act, health care providers who demonstrate meaningful use of certified EMRs are eligible to earn incentive payments from the Medicare and Medicaid programs.

Physicians may want to seek the advice of their tax advisors on how to manage taxes related to the incentive payments.

THE BASICS

The Electronic Medical Records/Electronic Health Records (EMR & EHR) incentive program was created by the Health Information Technology for Economic and Clinical Health Act (HITECH) as part of the federal stimulus package signed by President Obama in 2009. The legislation provides incentives to each physician (and certain other providers) who meet HITECH’s requirements for EMR systems that demonstrate “meaningful use” (MU).
Separate programs exist for Medicare or the Medicaid participants; you must participate in one of these programs to be eligible for the incentive of up to $44,000. If you participate in both, you may choose to participate in either incentive program — but not both. You may switch between incentive programs after you start, but only once.

Medicare offers physicians the bonus of up to $44,000 paid over a five-year period starting in 2011.The payments are tied to 75 percent of the physician’s annual allowed Medicare Part B charges that year. If you start in 2011 or 2012, you can capture the maximum $18,000 bonus in your first year of participation by billing at least $24,000 in Medicare allowed charges.

Why leave money on the table? Physician participation in the bonus program ends in 2015, so waiting until 2013 to begin drops your cumulative take to $39,000 and to $24,000 if you start in 2014. After that, physicians who still aren’t using EHRs will begin to see their Medicare payments reduced; the penalties will go as high as 5 percent in 2019.

The Medicaid bonuses are geared to patient encounters and there is no penalty for not participating (initially). To qualify for the “MU” EMR/HER incentives, 30 percent or more of your patient volume must be Medicaid beneficiaries (but only 20 percent for pediatricians) measured over any continuous 90-day period in the program’s first calendar year. Eligible professionals for Medicaid bonuses include nurse practitioners, certified nurse-midwives, and some physician assistants such as those working in rural health clinics or provider shortage areas.

For both programs, CMS will make bonus payments to each eligible professional in your practice. In other words, a group of four internists could receive $176,000 in total if each successfully participates in the Medicare program.

THE RULES

The legislation sets four objectives for physicians to get the HITECH incentive, including:

• Use certified EHR technology which demonstrates “meaningful use”
• Utilize electronic prescribing (eRX)
• Use a system that electronically exchanges health information to improve patient quality of care
• Submit information about clinical quality and other measures as required

That first bullet concerning the “meaningful use” of an EHR raises questions about what qualifies as meaningful. CMS recently issued final meaningful use rules: 15 mandatory requirements for providers (and 14 for hospitals), as well as a menu of 10 additional requirements, from which providers must select five. You must attest in writing to using your EHR to those capabilities for at least a 90-day period if you start during 2011 and for a full year if you start in 2012 or later. CMS plans to raise the bar further by adding more criteria in subsequent years of the bonus program.

What are the meaningful use criteria? Here is the full list as compiled by David Blumenthal, MD, director of the Office of the National Coordinator for Health Information Technology (ONC).

EMR Functionality and Requirements:
To achieve meaningful use of an EHR/EHR, providers must meet the following core requirements under the objectives in Stage 1:

Record patient demographics.
Record and chart changes in vital signs.
Maintain active problem, medication, and allergy lists.
Record smoking status.
Give patients an electronic copy of their health information and a summary of clinical data.
Generate and transmit permissible prescriptions electronically.
Use computer provider order entry for medication orders.
Implement drug-drug and drug-allergy interaction checks.
Implement one clinical decision support rule and the ability to track compliance with that rule.
Implement system to protect the privacy and security of patient data.
Report ambulatory quality measure to CMS or the state.
Implement the capability to electronically exchange key clinical information among providers and patient-authorized entities.

MENU

Providers must also meet at least five or the listed ten criteria:
Implement drug formulary checks.
Incorporate lab test results as structured data.
List all patients who have a particular medical condition, for at least one condition.
Identify and provide patient-specific educational materials.
Reconcile medications and provide summary records during encounters and transitions of care.
Show ability to provide data to public health agencies and immunization registries.
Send patients preventive and follow-up care reminders.
Provide patients with timely electronic access to their health information.

The recently passed HITECH legislation by the government requiring physicians to move from paper based medical records to Electronic Medical Records (EMR) has a not so distant cousin that was forged with equal intentions-forced control. A little history:

1933: The National Recovery Administration was formed as an administrative mechanism for the National Industrial Recovery Act resulting in more than 500 codes and requirements and “generated more paper than the entire legislative output of the federal government since 1789″. Businesses were asked to display a Blue Eagle to show their compliance. Failure to do so resulted in fines and…imprisonment. The head of the administration at the time commented “May God have mercy on the man or group of men who attempt to trifle with this bird”.

Now consider HITECH, meaningful use EMR, incentives and penalties for noncompliance. Have doctors been pressed into conformity by the government in it’s quest for control? Is CCHIT EHR certification nothing more than a modern day Blue Eagle? Is it a doctor’s duty as a employer and caregiver to stay up late at night and read the thousands of pages of fine print regarding ARRA, HITECH and meaningful use requirements?

The similarities of 1933 and 2009 are striking. The outcome is uncertain. HITECH is well intentioned. Is it well thought out? Sadly, 60% of physicians have no idea what the HITECH initiative requires, or why.

As the HITECH Act has called for physicians to adopt Electronic Health Records (EHR) and Electronic Medical Records (EMR), physicians are eligible to recieve up to $44,000 as an incentive to adopt EMR quickly. of the $44,000, $18,000 is available if the physician selected EMR provider shows “meaningful use” in 2011. Snooze, you lose.

So what about available programs to finance your jump to EMR EHR from paper based records? There is alot involved in making a EMR choice, converting your paper charts to digital, offering patirnts access to their Personal Health Record (PHR), existing electronic data conversion, training, computer hardware and…FINANCING this monster undertaking.

Many of the hundreds of EMR EHR providers and resellers may offer financing programs to earn your business. In addition, private lenders and banks have created Finance Programs that focus on assisting the physicians adoption of EMR. Rates may be favorable and, needed. Why?

The US Congress introduced a program through the Small Business Administration subcommittee to offer a low interest loan program for physicians and EHR adoption. However, this measure, having passed the US House and referred to the Senate for action, remains just that-buried in a Senate committee. At this moment, it seems unlikely that the measure will be passed in time for assisting those doctors that purchase a EMR system in 2010-2011, resulting in another year passing and forefitting the initial $18,000 available as incentives.

My EMR Choice has insight as to many existing options tio EMR EHR financing programs. Don’t heaitate to ask.

By: CRISSA SHOEMAKER DeBREE
The Intelligencer
August 22, 2010
Stimulus legislation put aside $20 billion to encourage doctors to adopt electronic medical records. Several local companies stand to benefit.

Patients will begin seeing more electronic records at their doctors’ offices and hospitals over the next few years, as health care providers rush to implement systems under a deadline imposed by economic stimulus legislation.

The Health Information Technology for Economic and Clinical Health, or HITECH, Act includes about $20 billion to help doctors and hospitals offset the costs of the systems, which require software and hardware designed to capture and share patient information with other doctors and the patients themselves. And several local companies are competing for a piece of that monetary pie.

“It’s truly a gold rush right now,” said Doug Wallace. “And it’s on the clock.”

Wallace is executive vice president of business development solutions for MyEMRChoice.com, a Doylestown company that helps doctors research and choose record systems. Wallace and a partner started the business three years ago, long before health care reform was on the radar. Over the next year, they expect to hire six more employees.

Doctors can receive up to $44,000 if they implement electronic medical records by 2014. Starting in 2015, those who don’t implement an EMR system stand to lose a percentage of their Medicare reimbursements. Hospitals stand to receive an average of $5 million.

The HITECH Act also includes millions of dollars to create regional extension centers to educate doctors and hospitals about electronic records and for studies on how the use of electronic data impacts patient treatment and care.

Proponents of electronic health records say they will cut down on costly inefficiencies in the health care system and encourage more communication. But doctors have balked at the costly – and sometimes confusing – systems, while patients have expressed privacy concerns about having medical information available online or on portable computer drives.

But security has become a priority, Wallace said. And the adoption of electronic medical records is inevitable.

“The scales will tip,” Wallace said. “EMR is coming.”

Adoption of electronic health records has lagged, however, as doctors waited for the U.S. Department of Health and Human Services to detail “meaningful use” criteria that spell out exactly what features are needed for a system to qualify under the act.

Those rules were approved only recently.

“The growth process has been somewhat more modest than what has been projected by the federal government, largely because there’s a lot of confusion and lack of information out there,” said Charles Jarvis, vice president of health care services and government relations for NextGen Healthcare Information Systems of Horsham. “The regulations have been somewhat slow. Many doctors and community health centers and some hospitals were saying, ‘We’re just going to wait until the regulations are done.’ ”

NextGen, a division of Quality Systems Inc. of California, expects its system to meet the meaningful use criteria, Jarvis said.

Doctors also have been hesitant to adopt the systems because of their cost, Jarvis said. NextGen has made financing packages available to help defray that, he said.

“But there has been a growth process, and we at NextGen have done our part to stimulate that,” he said. “The growth is going to be steady. It’s going to take several more years than originally suggested. You’re going to see this process happen over a four- to six-year period of time.”

Wallace, whose firm works mainly with small medical practices, agreed that adoption could take some time.

“It’s going to take a while,” Wallace said. “You can’t jam this down people’s throats.”

Crissa Shoemaker DeBree can be reached at 215-345-3186 or cshoemaker@phillyBurbs.com

Many physicians and and medical professionals remain confused (if not completely unaware) that the HITECH Act calls for doctors to use Electronic Medical Records EMR to accomplish healthcare initiatives. Let’s clear up some confussion as quickly as possible. Consider these eight points to get your footing on what is required and available in making the move from paper medical records to Electronic Health Records:

1. The EMR/EHR system must demonstrate “meaningful use” as defined by the final ruling of EMR system requirements. Not to worry, the EMR vendor should be responsible for keeping your system compliant.

2. Now what about these EMR companies? There are hundreds of them, all claiming to be the best. On top of that there are resellers for the same products. In short, lots of choices. However, company consolidation and mergers are becoming frequent.

3. When selecting a EMR provider, it should be approached the same as you would examine a patient before prescribing a course of action. Expect this from any EMR representative.

4. How much will a EMR cost and who pays? $20 BILLION has been allocated for physicians to say bye-bye to paper charts. So, the sooner you use a EMR system, the more you gain. This totals up to $44,000 per physician, not group. Purchase, install and use a EMR right now, you will receive $18,000 in 2011, $12,000 in 2012, and so on. If you put off EHR adoption for a year or two, you lose out on incentives to go electronic now.

5. Do you have a EMR already? You will receive payments as long as the system demonstrates meaningful use.

6. Financing options and paying for upfront EMR costs are numerous. Many EMR vendors have plans ready to gain your business. In addition, the US Small Business subcommittee is considering a EMR/EHR loan program which awaits approval from the Senate.

7. Consider offering your patients access to their personal health records (PHR). You might as well. Soon, there will be widespread demand for immediate patient access to their charts. More on that later.

8. Other Healthcare Information Technology programs to encourage EMR adoption are Regional Extension Centers, Health Information Exchanges and Beacon Communities. Funds are provided to these programs through various Federal and state sources.

States will receive millions in federal funds over the next four years to fund Electronic Medical Records (EMR) projects that will allow hospitals, doctors and health insurance companies to share medical data in real time over secure networks.

This initiative is known as Health Information Exchanges, Regional Extension Centers and Beacon communities.

States will work with the healthcare industry to create Regional Health Information Exchanges (HIEs) that will share information such as lab results and ePrescribing information among health care providers in a statewide HIE system state. HIEs hold the promise of improving health care quality and efficiency by eliminating duplicative testing, avoiding dangerous medication interactions and providing information about patient histories with other facilities that will help physicians improve care.

The funding, awarded under the federal American Recovery and Reinvestment Act of 2009 (ARRA) and Healthcare Infromation Technology for Economic and Clinical Health (HITECH) can move a state closer to the national initiative of achieving interoperable EMR systems data sharing capabilities by the year 2014.

8. Show Me the Incentive Money

Incentive payments totaling $44,000 are calculated as $18,000 for 2011
$12,000 for 2012
$ 8,000 for 2013
$ 4,000 for 2014
$ 2,000 for 2015

9. Can a physician be penalized for not utilizing an EHR by 2015?

Yes. Failure to adopt a “meaningful use” EMR beginning in 2015 will have doctors facing 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 EMR by 2018.

10. Under Medicaid who is eligible to receive incentive payments and what is the timeline for payments?

The intended 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.

11. So my group has 5 physicians. Will the group qualify for total incentive payments of $220,000 under the Medicare incentive program?

Yes. If each of the physicians meets the ability to demonstrate meaningful use of a certified EMR system by 2012, the group could be entitled to a total of $220,000 in incentive payments under the Medicare program (5 x $44,000=$220,000).

13. What constitutes a “Certified” EHR system?

What constitutes a “certified” EHR is to be determined. 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. Private certification groups should serve as an option to CCHIT.
To view a list of current CCHIT certified companies, visit www.myEMRchoice.com

14. Are NPs/RNs/MAs 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 EMR?

Yes. The Stimulus Bill includes a separate Medicare incentive payment for hospitals efficiently utilizing an EMR. 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 EMR 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. Only 20%-30% of practices had implemented an EMR 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 EMR, 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. My existing EMR system was only $12,000. If I qualify, will my incentive payment be limited to $12,000 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 EMR 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 EMR system.

18. My practice does not currently utilize an EMR. When is the right time to start planning for an EHR implementation?

Now. Why leave money on the table? And if you are retiring or selling, buy the cheaqpest EMR you can, earn the stimulus funds and ad 20% to your selling price for a medical practice that has a fully implemented, productive and trained EMR staff!

19. Is there any benefit for early adoption of the certified EMR system?

Yes. Early adopters would stand to gain, as about 70 percent of the Medicare payments would be received in the first two years.

20. 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 now.

21. 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 Health and Human Services and the federal rule making process.

22. Will the public know whether or not I practice with a qualified meaningful EHR?

Real possible. CMS will post the names, addresses, and phone numbers of eligible professionals who are meaningful EHR users and group practices receiving incentive payments.

1. What is this EMR law all about?

The HITECH Act (part of the $787B Stimulus Bill) provides that qualified physicians who utilize a certified electronic medical record system that demonstrates “meaningful use” will receive incentive payments through additional reimbursements through either Medicare or Medicaid depending upon the individual doctors’s payer 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. Penalties apply after 2015.

2. So what defines “meaningful use”?

With 300 EMR systems and countless resellers to select from, some safeguards had to be created. “Meaningful Use” (MU) is simply a stamp of approval, like having your car inspected. It includes eprescribing, data sharing and medical reporting. We are currently under a ‘temporary ruling” for MU.

3. So we have to move from paper to Electronic Medical Records?

The American Recovery and Reinvestment Act was signed into law in February 2009 and an appropriation of $ 19.2 billion dollars has been made towards Health Information Technology to encourage the adoption of EMR systems. This is known as the HITECH Act, or Healthcare Information Technology for Economic and Clinical Health.

4. What is the difference between the Medicare and Medicaid incentive options?

The HITECH Act outlines two separate 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.
Overall, 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 from HITECH.

5. 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 threshold patient payer mix of greater than 30% Medicaid (20% for pediatricians) will not qualify for the HITECH EMR payments. In addition, physicians operating solely in a hospital environment, such as pathologist, anesthesiologist, or emergency physicians are not eligible.

6. 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.

7. 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 EMR 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.