The American Reinvestment and Recovery Act of 2009 and the HITECH Act

Stimulus Home

eClinicalWorks^® is a leader in ambulatory clinical solutions and has the largest Internet-based EMR system in the country. More than 25,000 providers currently use eClinicalWorks unified EMR/PM system nationwide. Given eClinicalWorks’ extensive knowledge and experience, it is well-positioned to meet any regulations that arise from this stimulus package, and to work with practices and groups as they look to the American Recovery and Reinvestment Act and the HITECH Act (stimulus bill) as the impetus for implementing electronic medical records to improve patient outcomes and reduce costs. This document is eClinicalWorks’ interpretation of the bill and is to be used for informational purposes only.

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1. Overview
2. Incentive Payment Options
3. "Meaningful Use"
4. What are the bonus payments that will be available to physicians under Medicare?
5. What will happen if the provider does not adequately demonstrate "meaningful use"?
6. How is the incentive program structured?
7. Are Medicare Advantage organizations eligible for incentive monies?
8. Who is eligible for Medicaid incentive payments?
9. Eligibility Requirements
10. How are Pediatricians and Family Physicians going to be able to participate?
11. Time Frame for Incentive Payments
12. Ambulatory versus In-patient Solutions
13. Connectivity and Meaningful Use
14. What does this mean to eClinicalWorks’ existing customers?
15. What does this mean to eClinicalWorks’ prospective customers?
16. Why eClinicalWorks?

Overview
The American Reinvestment and Recovery Act of 2009 allocates $2.1 billion for distribution by the Department of Health and Human Services through the Office of the National Coordinator for Health IT (ONCHIT). These funds are intended to assist healthcare providers adopt, implement, and effectively use certified EHR technology that allows for the electronic exchange of health information. Additionally, this funding will provide health information technology assistance in the areas of standards, technology, and health IT research, including regional centers designed to provide technical assistance and disseminate best practices to accelerate efforts to adopt, implement and effectively utilize healthcare information technology.¹

Incentive Payment Options
There are two incentive payment programs outlined under the HITECH Act - one through Medicare and another from Medicaid. Since providers can only submit for payment of an incentive bonus from one of the programs, each practice will need to analyze its public payer mix to determine where it stands to benefit most.

Both require that a provider prove "meaningful use" of an EHR product to qualify for the incentives, as well.

"Meaningful Use"
"Meaningful Use" is defined in three ways in the Bill²:

--Use of a certified product complete with ePrescribing capability as determined appropriate by the Secretary of HHS
--The EHR technology is connected for the electronic exchange of PHI
--Complies with submission of reports on clinical quality measures

The final criteria for standards will be determined by the Secretary of Health & Human Services before the utilization incentives begin. Note that the Secretary of HHS shall seek to improve the use of electronic health records and healthcare quality over time by requiring more stringent measures of meaningful use.

What are the bonus payments that will be available to physicians under Medicare?
Under Medicare, physicians will be eligible for up to the following as soon as they can demonstrate "meaningful use" (beginning in 2011)³:
 

Notes:

--Physicians operating in a "provider shortage area" will be eligible for an incremental increase of 10% in their bonus payments.

--Physicians operating entirely in a hospital environment, such as anesthesiologists, pathologists and ED physicians, are ineligible⁴.

What will happen if the provider does not adequately demonstrate "meaningful use"?
Beginning in 2015, physicians not demonstrating meaningful use will have their Medicare fee schedule reduced as follows:

--For 2015, down to 99 percent of the regular fee schedule
--For 2016, down to 98 percent
--For 2017 and each subsequent year, down to 97 percent

If the Secretary finds that less than 75% of eligible healthcare professionals are utilizing EHR beginning in 2018, the Secretary can further reduce the fee schedule to 96% and then 95% in subsequent years but not further⁵.

How is the incentive program structured?
The payment may be in the form of a single consolidated payment or in the form of periodic installments as the Secretary (HHS) may specify⁶.

Are Medicare Advantage organizations eligible for incentive monies?
Qualifying MA organizations are defined as those Medicare Advantage organizations that are organized as a health maintenance organization. These organizations and their providers are eligible for the incentives as long as the provider delivers a minimum of twenty hours a week of patient care services and the organization furnishes at least 80 percent of the services of the individual professional to clients of their organization⁷.

Who is eligible for Medicaid incentive payments?
A healthcare provider is eligible for incentive payments from Medicaid who:

--Is not hospital-based and has at least 30 percent of the professional’s patient volume coming from Medicaid patients;
--Who is a pediatrician, who is not hospital-based and who has at least 20 percent of the patient volume coming from Medicaid patients;
--Practices predominantly in a FQHC or rural health clinic and has at least 30 percent of the professional’s patient volume coming from Medicaid patients; --Is a children’s hospital, or an acute-care hospital that is not described in clause (i) and that has at least 10 percent of the hospital’s patient volume coming from Medicaid patients⁸.
Incentive payments will be based on a calculation that factors the physician’s Medicaid mix in combination with up to $25,000 the first year and $10,000 each subsequent year for five years⁹.

Note: Because pediatricians have to meet a lower threshold of only 20% Medicaid patients to qualify for the incentives, they are only eligible for 66% of the incentive payments described above.

Eligibility Requirements
Most physicians stand to earn incentive payments if they can demonstrate meaningful use. However, there are some who will not qualify - those not accepting Medicare, or those that do not have a patient base that is comprised of more than 30% Medicaid patients. Additionally, physicians delivering all care in a hospital, such as anesthesiologists, pathologists or emergency physicians do not qualify.

Note that while most providers must demonstrate that 30% of their patients are using Medicaid in order to qualify for that portion of the program, pediatricians need only prove 20%. This is an effort to facilitate the participation of more pediatricians in the program that would not normally accept Medicare and very well might not have a sufficient Medicaid volume to qualify.

Refer to the Medicaid eligibility guidelines above.

How are Pediatricians and Family Physicians going to be able to participate?
Pediatricians and Family Practitioners must meet the Medicaid payer mix threshold and accept Medicare in order to qualify for Medicaid incentives. If they do not meet these eligibility requirements, they can apply for grants and/or loans to offset the upfront costs of the purchase of an EHR.

Time Frame for Incentive Payments
Qualifying organizations must wait until 2011 to submit for incentive payments¹⁰.

Practices can earn incentives from CMS for ePrescribing utilization, as well as PQRI bonuses without waiting until 2011.

Ambulatory versus In-patient Solutions
The money is not allocated by care setting; the term "certified EHR technology" applies to both ambulatory electronic health records for office based physicians and in-patient hospital electronic health records for hospitals¹¹.

Connectivity and Meaningful Use
At this time, the bill requires only that the certified EHR technology be connected in a manner that provides, in accordance with applicable laws and standards applicable to the exchange of information, for the electronic exchange of health information to improve the quality of health care, such as promoting care coordination¹².

This can be interpreted to mean the ability to exchange data between healthcare providers such as lab and radiology orders, pharmacies and other providers.

What does this mean to eClinicalWorks’ existing customers?
For those practices that already use the eClinicalWorks unified EMR/PM solution, Congratulations!

Assuming they meet the criteria under Medicare or Medicaid and can demonstrate meaningful use, eClinicalWorks customers will be eligible for the utilization incentives. The HITECH Act will reward customers who use an EMR that meets the criteria, offsetting their purchase costs through the utilization incentives.

eClinicalWorks meets all of the functionality for "meaningful use," as it is defined today.

eClinicalWorks:
--Is CCHIT^® 2008 certified in both ambulatory and child health for its EMR Version 8.0
--Has ePrescribing capability
--The EHR technology is connected for the electronic exchange of PHI
--Complies with submission of reports on clinical quality measures

All further details about what type of reporting will need to be submitted, what level of connectivity will be required and the final criteria for standards will be determined by the Secretary of Health & Human Services before the utilization incentives begin.

What does this mean to eClinicalWorks’ prospective customers?
For those practices that do not use an EMR but meet the criteria for incentive payments, this program is motivation to adopt a healthcare IT solution soon, allowing sufficient time to implement and learn how to use the application sufficiently to comply with the "meaningful use" requirement.

Grant dissemination will be prioritized to target organizations that do not currently have an EMR or who have an outdated product that does not meet certification criteria.

Why eClinicalWorks?
eClinicalWorks is a leader in ambulatory clinical solutions. Its solutions create and extend the use of electronic medical records beyond practice walls with the latest technologies and create community-wide records. The company has always devoted all of its efforts to developing, implementing and supporting healthcare software. Unlike other vendors, eClinicalWorks’ sole focus has been on helping physicians improve the quality of care delivered.

eClinicalWorks has an established customer base of more than 25,000 providers and 90,000 plus users across all 50 states. Its commitment to its customers has been reflected in its success and noted by the industry, having been named to Inc. Magazine’s Inc. 500 list of fastest-growing private companies in 2008 and 2007 as well as the Healthcare Informatics 100. Two customers have received the 2008 HIMSS Nicholas E. Davies Award of excellence for their use of eClinicalWorks, proving value from health information technology.

eClinicalWorks has the flexibility and functionality required to deliver healthcare that is both efficient and effective, making informed medical care and transportability of patient health records a reality.