From the Editor

What can “meaningful use” of an EHR mean for your bottom line?

It can mean as much as $44,000 from the federal government. Are you prepped to claim these funds, starting this year?


 

When President Barack Obama put his signature to the American Recovery and Reinvestment Act—also known as ARRA, or “Stimulus #1”—on February 17, 2009, he also enacted legislation to accelerate the adoption of electronic health records across the United States: the Health Information Technology for Economic and Clinical Health, or HITECH, Act.

HITECH authorizes substantial payments to physicians, and to hospitals, if they 1) utilize a government-certified electronic health record (EHR) and 2) demonstrate that they are using that EHR in a manner that advances the quality of health care—the so-called meaningful use.

On July 13, 2010, the federal government issued final rules about requirements for eligible EHR systems and reporting criteria for clinicians to demonstrate their meaningful use of the EHR. The program officially began on January 1, 2011.

TABLE 1

The 3 stages of meaningful use of an EHR

Stage of useWhat is the main goal of this stage?By what will attainment of that goal be measured?
Stage 1To capture and share data
  • By use of information in the EHR to track key clinical problems
  • By communication, broadly and seamlessly, of key information to all care providers involved with the patient
  • By reporting of practice-level quality measures
Stage 2
  • To exchange clinical data
  • To advance electronically enhanced clinical processes
  • By use of the EHR for disease management and clinical decision support
  • By management of drug interactions and allergies using the EHR
  • By an increase in patients’ direct access to their EHR
  • By demonstration of bidirectional electronic data sharing with public health agencies
Stage 3To improve clinical outcomes
  • By demonstration of improvements in quality, safety, and efficiency
  • By utilization of advance decision support within the EHR
  • By development of patient self-management tools within the EHR
  • By improvement in population and public health outcomes

TABLE 1 provides an overview of the three proposed stages of the HITECH Act. TABLE 2, page 10, is a timeline of the payment schedule for each year and stage of the HITECH program.

TABLE 2

Schedule of maximum government payments to a qualifying* physician

Year in which you begin meaningful useWhat is the highest annual payment you can receive?
201120122013201420152016Total payments
2011Stage 1
$18,000
Stage 1
$12,000
Stage 2
$8,000
Stage 2
$4,000
Stage 3
$2,000
Stage 3 0$44,000
2012 Stage 1
$18,000
Stage 1
$12,000
Stage 2
$8,000
Stage 3
$4,000
Stage 3
$2,000
$44,000
2013 Stage 1
$15,000
Stage 2
$12,000
Stage 3
$8,000
Stage 2
$4,000
$39,000
2014 Stage 1
$12,000
Stage 3
$8,000
Stage 3
$4,000
$24,000
2015 000
The schedule is “front-loaded”: The largest payments are made in the first 2 years of the program. Physicians receive payments based on when they start the program. The maximum payment that a physician can receive under the Medicare rules is 75% of the professional part B allowable charges you have submitted to Medicare in the calendar year. Example: To collect the full payment of $18,000 in 2011, you must submit $24,000 in allowable professional charges to Medicare. Physicians who practice in a health-care provider shortage area receive an additional 10% of their qualifying amount.
*“Qualifying” refers to those who 1) utilize a certified EHR, in 2) a meaningful manner, under 3) Medicare rules for the program

You must show “meaningful use” of your certified EHR

In the first year of the program, you must be using a certified EHR and must demonstrate meaningful use of that record over any 90-day period within the payment year (2011 or 2012).

In the second year, and beyond, the reporting period will be the entire calendar year.

Here are some of the initial rules for demonstrating meaningful use:

  • You can qualify for the program through either of two mechanisms: 1) participation in Medicare and 2) through Medicaid, if 30% or more of patient encounters are with Medicaid patients. Maximum reimbursements are $44,000 and $64,000 under the Medicare and Medicaid programs, respectively. Under Medicare rules (the more common way to achieve meaningful use), all physicians qualify (midlevel providers do not qualify). Under Medicaid rules, physicians, physician assistants, nurse midwives, and nurse practitioners qualify.
  • Through an Internet portal (yet to be established), you must register your EHR to determine if it is certified by the government
  • 50% or more of your patient record documentation must be in a certified EHR
  • You need to report on 1) functional metrics related to your EHR and 2) clinical quality metrics
  • For functional metrics, there are 15 required core reporting measures and five optional measures that you select from a list of 10 items. Some of those measures include demonstrating that:
  • – at least 40% of your prescriptions are written electronically
  • – 80% or more of your patients have an active medication list
  • – 80% or more of them have a medication allergy list
  • – you perform medication reconciliation during at least 50% of your office visits
  • – you use clinical decision support and electronic alerts
  • – you record vital signs at 50% or more of encounters
  • – 10% or more of your patients have access to their EHR through an Internet portal
  • – you can exchange electronic data with a physician who is not in your organization
  • – you submit immunization reports to a public health department through your EHR.

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