The American Recovery and Reinvestment Act of 2009 (ARRA) includes up to $20 billion for reimbursing Eligible Professionals (EP) in healthcare for the implementation of Electronic Health Record (EHR) systems implemented within the act's stipulated timeframe. EPs are healthcare providers who receive payments from Medicare or Medicaid. To receive federal funding, EPs must have implemented a "certified" electronic EHR and demonstrated "meaningful use" of that EHR within the implementation window.
The legislation calls for the federal department of Health and Human Services (HHS) to administer the program. Within the HHS, the Office of National Coordinator (ONC) for Health Information Technology has been given the task of writing, implementing, and administering the regulations. The ONC released draft copies of the relevant regulations in December 2009 and January 2010; those regulations define what ONC views as "certified" electronic EHR systems and "meaningful use" of them.
On February, 23, 2010, the Center for Medicare and Medicaid Services (CMS) conducted a web-based briefing for service providers on the regulations for the distribution of Recovery Act funds and the implementation status of those regulations. The webcast discussed the recent release of draft regulations concerning "meaningful use" and "certified" EHR, as well as the timeline for the implementation of the regulations (based on the release of the draft regulations). The expectation is that final regulations on "meaningful use" and the requirements for software certification will be completed by the Summer of 2010. CMS anticipates being the vehicle for the distribution of reimbursement funds to EP, but the method and timing of the distribution of funds is still to be determined.
Here is a summary of the facts as of March 31, 2010:
- Of the original $20 billion authorized in the ARRA, only $17 billion remains one year later after staffing up the ONC and creating grant programs for pilot projects totaling nearly $2 billion.
- "Meaningful Use" is defined as (1) use of certified EHR technology; (2) the certified EHR technology is connected in a manner that provides for the electronic interchange of health information to improve the quality of care; and (3) in using certified EHR technology, the EP submits to the Secretary (of HHS) information on clinical quality measures and such other measures selected by the Secretary.
- "Meaningful Use" is defined in granular detail in the regulations, defining the type of use and extent of use that is needed to qualify for "meaningful use" for reimbursement.
- The implementation of "meaningful use" measurement criteria has been broken into three phases to allow for the development of the underlying software and adoption of medical practice procedures.
- The first year of eligibility for reimbursement is 2011. In order to receive reimbursement, an EP must meet the following requirements:
- Use a certified electronic HER:
- for a minimum of 90 CONSECUTIVE days within 2011.
- to complete at least 80% of "orders" with "computerized provider order entry" (CPOE).
- Have Medicare billing of at least $24,000
- Provide quality reporting as defined by the "meaningful use" regulations for a given medical specialty
- None of the current software certifications, like the Certification Commission for Health Information Technology (CCHIT), meet the needs of the ONC, and therefore will not meet the criteria for software being certified. Based on my review, none of the currently released software packages meet the certification requirements as defined in the proposed final regulations from ONC.
- Final regulations for the development of the software are not expected until May at the earliest.
- Only certified versions of the software qualify to be considered for reimbursement. An old version of certified software will NOT qualify
- Reimbursement is a total of $44,000 over five years for practices that have a certified electronic EHR in use by 2012.
- EPs that do not adopt an electronic EHR by 2015 will have their Medicare reimbursement amounts reduced by 3%.
- The funding allocated by Congress is at least 50% less then will be needed to meet the funding requirement if all of the EPs who are able to claim reimbursement in 2011.
Taken in the context of the larger healthcare bill that was just signed into law, medical practices whose business model is based on receiving a substantial portion of their revenues from government sources (i.e., Medicare, Medicaid and any new entity that evolves a result of the new legislation) should plan on implementing electronic EHR as soon as possible in order to qualify for the ARRA medical reimbursement. Quality reporting as called for in the "meaningful use" regulations will undoubtedly become required to receive Medicare and/or Medicaid payments. Electronic EHR may be deferred well into the future for those medical practices that do not currently rely on government funded services (or can modify their business model to avoid relying on that funding).
In conjunction with Trinity Worldwide Technologies LLC, DeckerWright Corporation will be conducting a seminar on this topic on Thursday, May 13th, at the Sheraton in Eatontown, New Jersey.
Click here to Register online
About the Author:
Marshall Wright of DeckerWright Corporation has been providing New Jersey businesses with Technology Consulting Services including HARDWARE, SOFTWARE & NETWORKING solutions since 1984.
For more information please contact DeckerWright.
