Many healthcare providers would have heard about the stimulus package by now, but many are unsure about how it might affect them. Most providers would like to know if they qualify for incentive payments, and if so, what they need to do in order to maximize payments they receive.
The American Recovery and Reinvestment Act of 2009, abbreviated ARRA and commonly referred to as the Stimulus or The Recovery Act, will revolutionize the provider’s usage of information technology. The Health Information Technology for Economic and Clinical Health (HITECH) Act, a component of ARRA, accommodates for incentive payments to encourage information technology across the healthcare community. EMR/EHR systems are principal focus for physician practices and groups of all sizes. Medicare and Medicaid will administer the majority of the billions of dollars that will go to physicians, hospitals, and community health centers to help them compensate their costs.
An eligible healthcare professional who participates early in the program may receive more than $44,000 over five years from Medicare/Medicaid if they are utilizing an EMR/EHR in 2011 and beyond.
This summary will discuss only section 4201 relating to healthcare professionals.
Much of the detail in this measure is undefined and left to the discretion of the Secretary of Health and Human Services. The implementation plans are required to be published in the Federal Register for public comment, thus be actual payment mechanisms and the exact requirements to qualify for payment are not fully defined.
An eligible professional is defined as a physician as defined by section 1861 of the Social Security code. This includes medical doctors, dentists, podiatrists, optometrists and chiropractors.
Payments will be made to outpatient physicians who have demonstrated that they are a meaningful EMR/EHR user.
Hospital-based physicians such as pathologists, anesthesiologists, emergency physicians or hospitalists who furnish substantially all of their services in a hospital setting through the facilities and equipment of the hospital are not eligible. Note however hospitals are provided incentive payments in section 4202.
The Secretary is also empowered to accept individual State determinations of meaningful EMR/EHR usage with Medicaid as meeting these requirements. This provision allows practices that see relatively little Medicare populations but large Medicaid populations such as pediatric offices to qualify.
In addition to grant programs, physician’s incentives are apportioned in two different payment forms of Medicare and Medicaid reimbursements. By demonstrating "meaningful use" of EMR/EHR, physicians can start earning incentives in 2011. Incentive earnings for physicians can be about $2,000 to $18,000 in a given year.
This "meaningful use" can be best described as using the advanced technology to exchange electronic health data to improve quality of care and submitting quality of care measures to the department of Health and Human Services (HHS). In addition within a specified time frame, hospitals and doctors will need to meet these requirements.
HIMSS has a few suggestions in order to provide information about receiving incentive payments, described below:
As per the law defines, eligible providers will be treated as a meaningful user of EMR/EHR technology if they meet the following three criteria:
Physicians will be eligible for up to $44,000 each in incentive payments who implement a certified solution and become meaningful users between 2010 and 2012. Physicians who hold back to become meaningful users between 2012 and 2014 will be eligible for lower payments. Physicians who do not become meaningful users before 2015 will not qualify for any payments and will be subject to increasing penalties. Incentives are based on the lesser of either 75% of the provider’s Medicare Part B billings or the maximum allowable incentive.
| Year-EMR/EHR use is first demonstrate | Medicare Incentive Payment Schedule | ||||
|---|---|---|---|---|---|
| CY 2011 | CY 2012 | CY 2013 | CY 2014 | CY 2015 and later | |
| CY 2011 | $18,000 | ||||
| CY 2012 | $12,000 | $18,000 | |||
| CY 2013 | $8,000 | $12,000 | $15,000 | ||
| CY 2014 | $4,000 | $8,000 | $12,000 | $12,000 | |
| CY 2015 | $2,000 | $4,000 | $8,000 | $8,000 | $0 |
| CY 2016 | $2,000 | $4,000 | $4,000 | $0 | |
| Total: | $44,000 | $44,000 | $39,000 | $24,000 | $0 |
| Year-EMR/EHR use is first demonstrate | Medicare Incentive Payment Schedule | |||||
|---|---|---|---|---|---|---|
| CY 2011 | CY 2012 | CY 2013 | CY 2014 | CY 2015 | CY 2016 | |
| CY 2011 | $21,250 | |||||
| CY 2012 | $8,500 | |||||
| CY 2013 | $8,500 | $8,500 | $21,250 | |||
| CY 2014 | $8,500 | $8,500 | $8,500 | $21,250 | ||
| CY 2015 | $8,500 | $8,500 | $8,500 | $8,500 | $21,250 | |
| CY 2016 | $8,500 | $8,500 | $8,500 | $8,500 | $8,500 | $21,250 |
| CY 2017 | $8,500 | $8,500 | $8,500 | $8,500 | $8,500 | |
| CY 2018 | $8,500 | $8,500 | $8,500 | $8,500 | ||
| CY 2019 | $8,500 | $8,500 | $8,500 | |||
| CY 2020 | $8,500 | $8,500 | ||||
| CY 2021 | $8,500 | |||||
| Total: | $63,750 | $63,750 | $63,750 | $63,750 | $63,750 | $63,750 |
| Not adopting EMR/EHR by the year |
Providers will see reductions in their Medicare reimbursements (%) |
|---|---|
| 2015 | 1 |
| 2016 | 2 |
| 2017 | 3 |
Providers will get incentive either from Medicare or from Medicaid under the stimulus package, because they can not get both as per the law notes.
Physicians are eligible for payments of up to $64,000 over six years who see more than 30% of patients paying with Medicaid (20% for pediatricians). The incentives will be calculated through a formula that multiplies 85% by amounts ranging from $25,000 in the first year to $10,000 in subsequent years. Additionally, those meeting the 30% threshold can begin earning the incentive payments even as they adopt, implement and upgrade their EMR/EHR software; they can begin proving Meaningful Use of the EMR/EHR in the second year of their program participation.