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

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

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

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.

Fortunately, if you attest that any core reporting measure is not clinically relevant to your practice, you can delete it from your list.

• For clinical quality metrics, you must select six of 44 dimensions of care for reporting purposes, including three core measures and three alternate measures
• Physicians who work only with hospitalized patients and do not have an outpatient practice—for example, internal medicine hospitalists and ObGyn laborists—are, currently, ineligible
• If you bill Medicare with point-of-service codes 21 and 23 for more than 90% of your patients, you are ineligible for this program
• You will be paid within 46 days of attesting to meaningful use of the EHR. Payments will be made to your billing entity’s taxpayer identification number.

Then, there are the penalties

What government program doesn’t have hidden penalties? Physicians who do not demonstrate meaningful use of a certified EHR by 2014 will be hit with a 1% reduction in their Medicare fees every following year from 2015 to 2017—and, potentially, after that. The penalty reduction may increase to 2%, annually, if less than 75% of US physicians adopt an EHR.

A transforming event in health care. Maybe.

EHRs generally improve the coordination of health care. At times, however, they can be burden-some—to clinicians and to patients. Furthermore, development of a national grid of interoperable medical records, with oversight by government agencies, subtly changes the relationship between the patient and her physician and increases the power and authority of large health systems, insurers, and government agencies to shape the future of health care.

The prediction among health care experts who are optimists is that HITECH will stimulate rapid adoption and interoperability of EHRs in the United States. In turn, such development of a nationwide system of health records will improve the quality and efficiency of care. They view the HITECH Act, and its consequences, as truly revolutionary.

The pessimists among us have quipped that, if you and your life partner decided to have children because your main goal was to be eligible for the IRS child tax credit, then you will really like HITECH.

The reality? It’s likely found midway between those two extremes of anticipation.

Regardless: Whether you’re optimistic or pessimistic about HITECH, you must decide whether you will participate; optimally, you need to make that decision this year. The accompanying sidebar, “A ‘meaningful use’ how-to-guide”, walks you through the steps of the program in detail.

We want to hear from you! Tell us what you think.

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

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

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.

Fortunately, if you attest that any core reporting measure is not clinically relevant to your practice, you can delete it from your list.

• For clinical quality metrics, you must select six of 44 dimensions of care for reporting purposes, including three core measures and three alternate measures
• Physicians who work only with hospitalized patients and do not have an outpatient practice—for example, internal medicine hospitalists and ObGyn laborists—are, currently, ineligible
• If you bill Medicare with point-of-service codes 21 and 23 for more than 90% of your patients, you are ineligible for this program
• You will be paid within 46 days of attesting to meaningful use of the EHR. Payments will be made to your billing entity’s taxpayer identification number.

Then, there are the penalties

What government program doesn’t have hidden penalties? Physicians who do not demonstrate meaningful use of a certified EHR by 2014 will be hit with a 1% reduction in their Medicare fees every following year from 2015 to 2017—and, potentially, after that. The penalty reduction may increase to 2%, annually, if less than 75% of US physicians adopt an EHR.

A transforming event in health care. Maybe.

EHRs generally improve the coordination of health care. At times, however, they can be burden-some—to clinicians and to patients. Furthermore, development of a national grid of interoperable medical records, with oversight by government agencies, subtly changes the relationship between the patient and her physician and increases the power and authority of large health systems, insurers, and government agencies to shape the future of health care.

The prediction among health care experts who are optimists is that HITECH will stimulate rapid adoption and interoperability of EHRs in the United States. In turn, such development of a nationwide system of health records will improve the quality and efficiency of care. They view the HITECH Act, and its consequences, as truly revolutionary.

The pessimists among us have quipped that, if you and your life partner decided to have children because your main goal was to be eligible for the IRS child tax credit, then you will really like HITECH.

The reality? It’s likely found midway between those two extremes of anticipation.

Regardless: Whether you’re optimistic or pessimistic about HITECH, you must decide whether you will participate; optimally, you need to make that decision this year. The accompanying sidebar, “A ‘meaningful use’ how-to-guide”, walks you through the steps of the program in detail.

We want to hear from you! Tell us what you think.

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

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

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.

Fortunately, if you attest that any core reporting measure is not clinically relevant to your practice, you can delete it from your list.

• For clinical quality metrics, you must select six of 44 dimensions of care for reporting purposes, including three core measures and three alternate measures
• Physicians who work only with hospitalized patients and do not have an outpatient practice—for example, internal medicine hospitalists and ObGyn laborists—are, currently, ineligible
• If you bill Medicare with point-of-service codes 21 and 23 for more than 90% of your patients, you are ineligible for this program
• You will be paid within 46 days of attesting to meaningful use of the EHR. Payments will be made to your billing entity’s taxpayer identification number.

Then, there are the penalties

What government program doesn’t have hidden penalties? Physicians who do not demonstrate meaningful use of a certified EHR by 2014 will be hit with a 1% reduction in their Medicare fees every following year from 2015 to 2017—and, potentially, after that. The penalty reduction may increase to 2%, annually, if less than 75% of US physicians adopt an EHR.

A transforming event in health care. Maybe.

EHRs generally improve the coordination of health care. At times, however, they can be burden-some—to clinicians and to patients. Furthermore, development of a national grid of interoperable medical records, with oversight by government agencies, subtly changes the relationship between the patient and her physician and increases the power and authority of large health systems, insurers, and government agencies to shape the future of health care.

The prediction among health care experts who are optimists is that HITECH will stimulate rapid adoption and interoperability of EHRs in the United States. In turn, such development of a nationwide system of health records will improve the quality and efficiency of care. They view the HITECH Act, and its consequences, as truly revolutionary.

The pessimists among us have quipped that, if you and your life partner decided to have children because your main goal was to be eligible for the IRS child tax credit, then you will really like HITECH.

The reality? It’s likely found midway between those two extremes of anticipation.

Regardless: Whether you’re optimistic or pessimistic about HITECH, you must decide whether you will participate; optimally, you need to make that decision this year. The accompanying sidebar, “A ‘meaningful use’ how-to-guide”, walks you through the steps of the program in detail.

We want to hear from you! Tell us what you think.