On July 13, the Centers for Medicare and Medicaid Services (CMS) announced the publication of the final rule for the electronic health record (EHR) incentive program. The final rule announcement ended the holding pattern for providers eager to make the switch from paper to digital medical records.
The news comes a year and a half into efforts to implement the provisions of the Health Information Technology for Economic and Clinical Health Act (HITECH), introduced as part of the 2009 American Recovery and Reinvestment Act. HITECH’s reach extends well beyond EHR adoption to include the development of a strong framework and infrastructure to support health information technology (HIT) adoption and implementation, health information exchange infrastructure, HIT workforce training, and health information and communication systems research and development.
Under the provisions of HITECH, CMS estimates that between $14.1 and $27.5 billion in funding will be distributed through the EHR Meaningful Use incentive program. This program is meant not only to lend support for the acquisition of EHR systems, but also to ensure that systems purchased are capable of meeting the minimum requirements for secondary utilization and exchange of health information. As the name implies, the incentive program focuses on how EHR systems are used in practice, rather than simply providing incentives for their purchase. The requirements for the program are meant to encourage providers to use the system as more than simply an electronic medical chart. By letting go of “paper thinking,” providers can begin to realize the potential for an electronically supported practice transformation leading to greater efficiency, improved quality, and effectively coordinated care.
Are you an eligible provider? The rule defines eligible providers as:
Medicare: A doctor of medicine or osteopathy, doctor of dental surgery or dental medicine, doctor of podiatry, doctor of optometry, or a chiropractor who is not hospital based.
Medicaid: A physician, nurse practitioner, certified nurse-midwife, dentist, or physician assistant who is not hospital based and must meet one of the following criteria:
- Have a minimum 30% Medicaid patient volume;
- Have a minimum 20% Medicaid patient volume, and is a pediatrician; or
- Practice predominantly in a Federally Qualified Health Center or Rural Health Center and have a minimum 30% patient volume attributable to needy individuals.
Are you using a qualified EHR system? The EHR Incentive Programs require the use of certified EHR technology, as established by these new standards. Existing EHR technology needs to be certified by an Office of the National Coordinator for Health Information Technology (ONC) Authorized Testing and Certification Body as meeting these new criteria in order to qualify for the incentive payments. At publication time, there are no certified EHR systems. As systems are tested and gain certification status, they will be populated to a list hosted on the ONC website at www.healthit.hhs.gov.
Are you a meaningful user? The criteria for achieving meaningful use start with certain minimum requirements in 2011 and build gradually, with more requirements added each year. For Stage 1, which begins in 2011, meaningful-use requirements include three core quality, three additional clinical measures most appropriate to the providers specialty, and 15 functionality measures that must be met, along with a menu set of additional measures from which an provider may choose.
Yes, Yes, and Yes! So how do I report and get my incentive payment? In order to participate in the EHR Stimulus program, eligible professionals must register starting in January 2011 at http://cms.gov/EHR IncentivePrograms. For 2011, CMS defines the reporting period for the program as 90 continuous days in which CMS will accept provider demonstrations of all the meaningful use measures, including clinical quality measures.
More than Meaningful Use
The CMS EHR incentive program is only one part of a much larger effort to jumpstart the evolution from siloed paper—and antiquated electronic—medical record systems to a mobile, flexible, and sustainable electronic health environment. HITECH facilitates efforts to reshape the way health information is documented, exchanged, and used, backed by funding and a supporting infrastructure beyond anything the e-health industry has never seen. HITECH has the real potential to move the field beyond talk about what should be done to setting and implementing a drive for change.
HITECH addresses and provides support for the whole of the electronic infrastructure that is required to safely and securely move electronic health data. It is intended to engage all stakeholders—including hospital systems, community health centers, physician practices, healthcare consumers, public health systems, and payors—allowing for continued public discussion and debate on the many healthcare issues that require more sophisticated technology approaches.
Led by the ONC, the foundation for the HITECH programs has been laid with unusual speed and transparency. HITECH-funded grant programs have sparked unexpected collaborations and teamwork, as myriad stakeholders come together to learn from each other and deploy new technologies, mapping the way toward a connected health community established on communication, collaboration, transparency, and access. In addition to strong federal support, there is considerable state support and collaboration with state governor’s offices, state chief information officers, and Medicaid officials working together within and across borders to ensure that state-developed technical infrastructures and governing laws collectively support the spirit of the Act and make inter- and intrastate information movement a reality.
The HIT-Supported Practice Evolution
The electronic evolution of our healthcare system will extend well beyond information technology implementation. It will require teamwork, patience, and support from everyone who comes into contact with the system, including administrative staff, clinical staff, patients, and external business partners such as labs, pharmacies, and payors.
HIT integration into your practice has the potential to bring meaningful improvements if accomplished in a committed and thoughtful way and not simply to fulfill the requirements for the CMS incentive program. The implementation of new information systems will call for the adoption of new processes and redefinition of roles, responsibilities, and tasks. This transformation is never easy, but it brings the potential for substantial gains in the quality of care delivered and clinical and administrative efficiencies.
For more information on the EHR Incentive program, please visit www.rheumatology.org/practice or e-mail Itara Barnes at [email protected]
Use the RCR for CMS PQRI and E-Prescribing Reporting In 2010
The ACR Rheumatology Clinical Registry (RCR) is an easy-to-use tool developed to assist members in practice improvement, local population management, and efficient, successful participation in national quality programs.
In 2009 alone, 240 ACR members participated in the Physician Quality Reporting Initiative (PQRI) using the RCR, realizing the benefits of reporting through the registry.
Use the RCR in 2010 to:
- Identify areas to improve your rheumatology practice by accessing provider- and practice-level data reports, as well as national data for benchmarking;
- Participate in the CMS PQRI program, which provides successful reporters with a bonus payment of 2% of total Medicare Part B Physician Fee Schedule charges for services furnished during the reporting period; and
- New for 2010! Participate in the CMS e-Prescribing Incentive Program, which offers a separate 2% bonus payment for successful reporters.e-Prescribing Reporting in 2010
For more information about the RCR or to register, visit www.rheumatology.org/rcr or e-mail [email protected].