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FIRST SET OF RULES FOR ELECTRONIC HEALTH RECORD
INCENTIVE PAYMENTS UNVEILED
On December 30, 2009, the Department of Health and Human
Services ("HHS") issued two
proposed rules related to the adoption and "meaningful use"
of certified electronic health records ("EHR").
The proposed rules implement provisions of the American
Recovery and Reinvestment Act of 2009 ("ARRA")
which provide reimbursement incentives to eligible professionals and
hospitals who successfully become "meaningful users" of
certified EHRs. Under the Health
Information Technology for Economic and Clinical Health Act (the
"HITECH Act") provisions of ARRA, both Medicare and Medicaid providers are
eligible to receive incentive payments for "meaningful use"
of certified EHR technology.
The first proposed rule, issued by the Office of the
National Coordinator for Health Information Technology ("ONC"), describes the initial standards,
implementation specifications, and certification criteria for EHR. The other proposed rule from the
Centers for Medicare & Medicaid Services ("CMS")
involves the mechanics of implementing the Medicare and Medicaid EHR incentive programs. The two proposed
rules along with a future third regulation form the preliminary
implementation strategy for EHR technology
and incentive payments. This summary focuses on the CMS
proposed rule.
Incentive payments available for EHR
adoption require that the EHR system be
used in a meaningful way. According to the CMS Fact Sheet, CMS
intends that the definition of meaningful use be consistent with
applicable provisions of Medicare and Medicaid law while continually
advancing the contributions certified EHR
technology can make to improving health care quality, efficiency, and
patient safety. Essentially, Congress specified three (3)
requirements for meaningful use: (1) use of certified EHR technology in a meaningful manner (for
example, electronic prescribing); (2) the certified EHR technology must be connected in a manner that
provides for the electronic exchange of health information to improve
the quality of care; and (3) in using certified EHR
technology, the provider must submit clinical quality measures
and such other measures to the Secretary of HHS.
To demonstrate "meaningful use" of certified EHR technology, all eligible professionals and
hospitals must achieve a series of specific objectives, each of which
is tied to a proposed measure. The CMS proposed rule would
phase in criteria for demonstrating meaningful use in three (3)
stages. The proposed Stage 1 criteria for meaningful use will
focus on capturing health information in a coded format
electronically, using that information to track key clinical
conditions, communicating that information for care coordination
purposes, and initiating the reporting of clinical quality measures
and public health information. Stage 1 is scheduled to begin in
2011 and CMS has proposed 25 objectives/measures for eligible
professionals and 23 objectives/measures for eligible hospitals that
must be met to satisfy the definition of a meaningful EHR user.
Stage 2, scheduled for 2013, and Stage 3, scheduled for
2015, will be addressed through the future rule making process.
However, according to CMS, Stage 2 would expand upon the Stage 1
criteria in the areas of disease management, clinical decision
support, medication management, support for patient access to their
health information, transitions in care, quality measurement and
research, and bi-directional communication with public health
agencies. Furthermore, Stage 3 would focus on achieving
improvements in quality, safety and efficiency, focusing on decision
support for national high priority conditions, patient access to self
management tools, access to comprehensive patient data, and improving
population health outcomes. Thus, "meaningful use"
will also require reporting of specified clinical quality indicators
by Medicare and Medicaid providers.
Medicare Incentive Payments.
Under the proposed rule, a qualifying eligible
professional will receive an incentive payment equal to 75% of
Medicare Part B allowable charges for covered professional services
furnished by the eligible professional in a payment year, subject to
maximum payment limits and other limited exceptions. Generally,
the maximum amount of incentive payments that an eligible
professional may receive during the entire length of the program is
$44,000.
A qualifying eligible professional may receive an annual
incentive payment as high as $18,000 if the eligible professional's
first payment occurs in 2011 or 2012. Thereafter, annual
incentive payment limits diminish during subsequent years to $15,000,
$12,000, $8,000, $4000, and $2,000 respectively. The table
immediately below demonstrates the maximum total amount of EHR incentive payments for a Medicare eligible
professional who does not predominately furnish services in a Health
Professional Shortage Area ("HPSA"):
Calendar Year First CY in which eligible
professional receives an incentive payment:
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Calendar
Year
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First CY in which eligible professional receives
an incentive payment
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2011
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2012
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2013
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2014
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2015 and beyond
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2011
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$18,000
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$0
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2012
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$12,000
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$18,000
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2013
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$8,000
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$12,000
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$15,000
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2014
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$4,000
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$8,000
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$12,000
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$12,000
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$0
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2015
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$2,000
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$4,000
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$8,000
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$8,000
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$0
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2016
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$0
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$2,000
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$4,000
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$4,000
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$0
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TOTAL
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$44,000
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$44,000
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$39,000
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$24,000
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$0
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Eligible professionals predominately furnishing services
within HPSAs are eligible for a 10% percent
increase in the maximum incentive payment amounts described in the
table immediately above.
Eligible professionals who are not meaningful users of EHRs will be subject to lower Medicare payment
updates for their covered professional services beginning in
2015. Additionally, eligible hospitals can qualify to receive
payments from both the Medicare and Medicaid EHR
incentive programs based on the formula provided in the proposed rule.
Comment Period.
Comments for the CMS proposed rule must be received no
later than 5 p.m. on March 15, 2010.
To view a copy of the CMS proposed rule, click here.
If your organization has
questions regarding the proposed rules or your organization is
beginning to implement EHRs, please contact
Gregory W. Moore directly at (248) 988-5842 or by email at
gmoore@clarkhill.com
or contact Michael W. Matthews directly at (248) 988-5870 or by email
at mmatthews@clarkhill.com.
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To find out
more about Clark Hill and our Health Care Practice Group, visit clarkhill.com
or call 800.949.3124
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