The American Recovery and Reinvestment Act of 2009 (ARRA) authorizes the Centers for Medicare & Medicaid Services (CMS) to provide reimbursement incentives for the adoption and use of Electronic Health Records (EHR). In order to receive these incentives the provider should be successful in becoming “meaningful user” of a certified EHR. For this the provider must use the certified EHR as the primary record of care for the patient, report certain clinical quality measures to CMS, and provide certain attestation regarding their use.
Objectives
Elegible providers must meet aseries of objectives divided in different stages. At the moment stage 1 is the focus of the current proposed rule. Stage 1 criteria will be in effect for reporting year 2011. CMS anticipates that stage 2 will be implemented for reporting year 2013, and stage 3 will be implemented for reporting year 2015.
For stage 1, 25 objectives which have an specific measurement associated with it. These objectives are divided in two groups, core objectives and menu objectives. 15 objectives are included in the Core group which would compromise the basic functions that enable EHRs to support improved health care. On the other hand the menu group is consisted of 10 objectives on which the physician choose 5 to implement giving them latitude to pick their own path toward full EHR implementation and Meaningful Use:
Core Set:
- Record patient demographics (sex, race, ethnicity, date of birth, preffered language)
- Record viral signs and chart changes (height, weight, blood pressure, bloody-mass index, growth charts for children)
- Maintain up-to-date problem list of current and active diagnoses
- Maintain active medication list
- Mantain active medication allergy list
- Record smoking status for patients 13 year of age or older
- For individual professional, provide patients with clinical summaries for each office visit
- On request, provide patients with an electronic copy of their health information (including diagnostic test results, problem lists, medication lists, and medication allergies)
- Generate and transmit permissible prescriptions electronically
- Computer provider order entry (CPOE) for medication orders
- Implement drug-drug and drug-allergy interaction checks
- Implement capability to electronically exchange key clinical information among providers and patient-authorized entities
- Implement one clinical decision support rule and ability to track compliance with the rule
- Implement systems to project privacy and security of patient data in the EHR
- Report clinical quality measurs to CMS or states
- Implement drug formulary checks
- Incorporate clinical laboratory test results into EHRs as structures data
- Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach
- Use EHR technology to identify patient-specific education resources and provide those to the patient as appropiate
- Perform medication renconciliation between care settings
- Provide summary of care record for patients preferred or transitiones to another provider or setting
- Submit electronic immunization data to immunization registries or immunization information systems
- Submit electronic syndrome surveillance data to public health agencies
- Send reminders to patients (per patient preference) for preventive and follow-up care
- Provide patients with timely electronic access to their health information (including laboratory results, problem list, medication lists, medication allergies)
Incentives
For the ONC incentives a Medicare Eelegible Providers (EP) is a doctor of medicine or osteopathy, a doctor of dental surgery or dental medicine, a doctor of podiatric medicine, a doctor of optometry, or a chiropractor, who is legally authorized to practice under state law. A qualifying EP is one who demonstrates meaningful use for the HER reporting period.
A qualifying EP can receive EHR incentive payments for up to five years with payments beginning as early as 2011. In general, the maximum amount of total incentive payments that an EP can receive under the Medicare program is $44,000.
- For the first year an EP applies for and receives an incentive payment, CMS proposes that an EHR Reporting Period is 90 days for any continuous period beginning and ending within the year. For every year after the first payment year, CMS proposes that the EHR reporting period is the entire year.
- A Payment Year equals a Calendar Year (CY). Incentive payments for meaningful EHR use end after 2016.
- A qualifying EP will receive an incentive payment equal to 75 percent of Medicare allowable charges for covered professional services furnished by the EP in a payment year, subject to maximum payments.
- In general, a qualifying EP can receive an annual incentive payment as high as $18,000 if their first payment year is 2011 or 2012. Otherwise, the annual incentive payment limits in the first, second, third, fourth, and fifth years are $15,000, $12,000, $8,000, $4000, and $2,000 respectively. In general, the maximum amount of total incentive payments that an EP can receive under the Medicare program is $44,000.
- An EP who predominantly furnishes services in a geographic Health Professional Shortage Area is eligible for a 10 percent increase in the maximum incentive payment amount. The maximum amount of total incentive payments that such an EP can receive under the Medicare program is $48,400.
- For EPs who begin to be meaningful EHR users in 2014, their payment calculations will be made as if they began meaningful use in 2013. (That is, if an EP were to begin meaningful use in 2014, the EP would receive $12,000 for that year, the second year’s amount as if they had begun in 2013). 2014 is the last year for which an EP can begin receiving incentive payments for meaningful use. Incentive payments for meaningful HER use ends after 2016.
- Maximum Total Amount of EHR Incentive Payments for a Medicare EP is outlined in the table below:
