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Executive Summary by William C Biggs MD FACE
THE BILL
HR 1 contains 4 sections relating to EMR user
4201 Incentives for healthcare professionals
4202 Incentives for hospitals
4205 Study on application of HER payment incentive for providers not receiving other incentive payments
4206 Study on availability of ‘open source’ HIT systems
This summary will discuss only section 4201 relating to healthcare professionals.
DETAIL INCLUDED IN THE BILL ITSELF
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.
ELIGIBILITY FOR PAYMENT
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 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.
There are three requirements to be met:
1) Use of certified EHR technology including electronic prescribing.
2) The EHR technology is connected in a manner that provides electronic exchange of health information.
3) The eligible professional submits information for the period on the clinical quality measures and other measures selected by the Secretary.
The Secretary is also empowered to accept individual State determinations of meaningful 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.
AMOUNT OF PAYMENT
The incentive payments will equal to 75% of the amount paid to eligible professionals by Medicare. Payments are limited to the following schedule:
a) Year 1:
a. $18,000 if the first payment year is 2011 or 2012
b. $15,000 if the first payment year is 2013
c. $12,000 if the first payment year is 2014
b) Year 2: $12,000
c) Year 3: $8000
d) Year 4: $4000
e) Year 5: $2000
The final payment year is 2015.
The method of payment is up to the discretion of the Secretary. It may be made as a lump sum or by incremental payments. Claims for a specific reporting year must be submitted within two months of the end of the year in order to be eligible for EHR bonus payment.
The above payment limitations are 25% higher for eligible providers in areas designated as health professional shortage areas.
PROOF OF ELIGIBILITY
Professionals may satisfy the requirements proving use of the EHR and electronic health exchange by methods to be determined by the Secretary which could include:
a) an attestation
b) submission of claims with a CPT code indicating the use of certified EHR technology
c) a survey response
d) submission of quality measure data
e) other methods determined by the Secretary
Satisfaction of the quality measures is to be determined by the Secretary these measures must be published in the Federal Register for a period of public comment. The Secretary is instructed to avoid redundant or duplicative reporting.
PUBLIC REPORTING
CMS will post on a public website, in an understandable format, the names, business addresses, and business phone numbers of eligible professionals and group practices who are meaningful EHR users and receiving incentive payments.
PENALTY FOR NOT USING AN EHR
Beginning in 2015 there will be a reduction in Medicare payments for professional services furnished by in an eligible professional if that professional is not a meaningful EHR user. The amount of Medicare payments (with some exceptions) will be
a) 2015 – 99%
b) 2016 – 98%
c) 2017 and beyond – 97%
MEDICARE ADVANTAGE PLANS
In general the provisions also apply to physicians delivering most of their services through a Medicare advantage plan. Eligible professionals in this category would be those who are employed by the organization, are a member or employee of an organization which furnishes 80% of its patient care services to a Medicare advantage plan and furnishes 75% of the services of the eligible professional to the organization and furnishes at least 20 hours per week of patient care services. There are limitations to avoid duplication of payment and the maximum number of physicians per organization is capped at 5000.
SUMMARY
Outpatient practitioners who wish to qualify for the full benefit of the $44,000 in EHR incentive payments should have a certified EHR in place by 2011 capable of eprescribing, interoperability, and quality measure reporting. Detailed specifications from CMS have not yet been developed to implement this act.
William "Reddy" Biggs, MD
Managing Partner, 23 physician Internal Medicine group
"Live on eClinicalWorks since 2/1/2007" http://tinyurl.com/reddybiggs
From www.anncoulter.com:
"...bureaucrats at Health and Human Services will electronically collect every citizen's complete medical records and determine appropriate medical care. Judging by the care that the State Department took with private visa records last year, that the Ohio government took with Joe the Plumber's government records, that the Pentagon took with Linda Tripp's employment records in 1998, and that the FBI took with thousands of top secret "raw" background files in President Clinton's first term, the bright side is: We'll finally be able to find out if Bill Clinton has syphilis -- all thanks to the stimulus bill! HHS bureaucrats will soon be empowered to overrule your doctor. Doctors who don't comply with the government's treatment protocols will be fined. That's right: Instead of your treatment being determined by your doctor, it will be settled on by some narcoleptic half-wit in Washington who couldn't get a job in the private sector. And a brand-new set of bureaucrats in the newly created office of "National Coordinator of Health Information Technology" will be empowered to cut off treatments that merely prolong life. Sorry, Mom and Pop, Big Brother said it's time to go."
Al Borges, M.D.
Obviously, any vendor that wants to survive will have to comply and have Certified Systems up and running by 2011.
Brendon: Obviously, any vendor that wants to survive will have to comply and have Certified Systems up and running by 2011.
Yes. However, nowhere in the bill does it specify exactly what a certified system is and there is no reference to CCHIT. So maybe there's still hope that reason will prevail....
Margalit
Margalit Gur-Arie
On Healthcare TechnologyHealth Tech & Policy Bloghttp://www.onhealthtech.com/Health Tech Discussion Board
Yes, that would be the most certain way of handling the situation. However Congress does acknowledge the existence of other systems, because it included an entire other section of the bill, Section 4206, which is titled "Study on availability of ‘open source’ HIT systems".
I doubt if any 'open source' systems are CCHIT certified.
Sec 4206 requires the study, but doesn't say what to do with it once it has been studied.
An analogous situation existed when doctors clinical lab operations became regulated by CLIA. There was only ASCP in existence to certify labs, and everyone expected that doctors would need to use ASCP. The doctors did not trust ASCP because it was owned and operated by pathologists. The pathologists openly stated that doctors offices shouldn't be allowed to do labs at all.
So other organizations came into existence, most notably COLA, which was sponsored by AAFP and ACP.
My office signed up with COLA early on, we were lab #200 or so. Once the CLIA legislation was complete (around 1988) it took about 5 years to implement, and by 1993 COLA was given 'deemed' status to inspect labs.
My suggestion, for EMR vendors that feel CCHIT certification would actually impair their product, would be to set up a separate certification agency, as we see with ASCP vs COLA.
The rub here is don't expect help from AAFP or ACP. I've spoken to the powers that be at ACP when I complained about their EMR review program missing the boat. They are set on the need for CCHIT. You would have an uphill battle to convince them that there is a need for a second organization.
Reddy
Finally I think they are getting it Reddy.
You know that I have said over and over again, Government will be successful if they provide specifications and requirements. It looks like they are certifying function, and not a specific vendor per say.
In my opinion, this is the best solution. This is more in line with other industries, like Banking, where they give requirements for the systems, not buy this companies software, it is Certified by this agency, and this is the only agency that controls the industry.
I knew when I saw it this Industry ramped and lobbied approach would fail at two levels:
1. It limited ideas, and dictated a approach that Physicians had already rejected overall.
2. It was expensive and overburdensome on the vendors to maintain without any actaul real benefit.
Worse, the above alleged coallation of the vendors could not even agree on real standards and settled for weak standards.
The Government says we expect this:
All vendors will comply.
reddybiggs:I doubt if any 'open source' systems are CCHIT certified.
I thought vista was ...
Graham http://www.synapse-ehr.com/ Synapse - the EMR for the superior physicianhttp://www.onhealthtech.com/Health Tech Discussion Board
gchiu: reddybiggs:I doubt if any 'open source' systems are CCHIT certified. I thought vista was ...
If it is, I can't find it.
BTW, congrats to e-MDs. They got 2008 conditional certification this month. I'm surprised they didn't send out a press release, previously their PR department has been in hyperdrive.
http://www.cchit.org/choose/ambulatory/2006/WorldVistA-EHR.asp
I refuse to participate in this deal. and here is why:
"The eligible professional submits information for the period on the clinical quality measures and other measures selected by the Secretary."
Who will "the Secretary" be in 2012? Will he/she have any legitimate knowledge of dermatology? I doubt it. And what, exactly are the "other measures" the Secretary wants to throw in the mix?
I won't take the money; and I refuse to to waste time submitting more reports to armchair quarterbacks who want to second-guess every procedure done in our office. The "penalty" looks to be too light - just a few percent of Medicare reimbursement. I'll gladly trade my time (not submitting reports) for a 3% revenue hit.
Also - how does this impact ARNPs and PA-Cs? Physician extenders will play an ever-increasing roll in the delivery of patient care. I can't figure out if they have been addressed in this deal.
Count me out.
dagmar: Who will "the Secretary" be in 2012? Will he/she have any legitimate knowledge of dermatology? I doubt it. And what, exactly are the "other measures" the Secretary wants to throw in the mix? Also - how does this impact ARNPs and PA-Cs? Physician extenders will play an ever-increasing roll in the delivery of patient care. I can't figure out if they have been addressed in this deal. Count me out.
They are looking for a Secretary, without any tax problems, as we speak.....
But I doubt the Secretary of HHS picks the quality measures anyway.
One of the top contenders is former Oregon Gov John Kitzhaber.
As in John Kitzhaber, MD, former emergency room doctor. The word is that he doesn't want to move to DC. Other names bandied about are John Dean, MD but he is seen as a loose cannon.
That leaves us with Tenn Gov Phil Bredesen who presided over the Tenn Care meltdown, and Kansas Gov. Kathleen Sebelius. Sebelius seems to be competent and was the former Kansas insurance commissioner for 8 years. She has endured criticism over her support of teaching evolution in schools and was an early Obama supporter.
If I were a betting person, I'd bet on Sebelius right now.
As far as PAs, NP, ARNP providers it would appear that they aren't included in the EHR bonus. The impact may not be as bad as you think. Physician extenders who work for physician practices in the outpatient setting typically have their services billed under 'incident to' rules meaning that they bill under their supervising physicians name and ID numbers. Those working in the hospital are excluded anyway, since hospital inpatient and outpatient practices are not eligible. PA and NP clinic practices that do not have on site MD supervision would appear to be left out.
gchiu: http://www.cchit.org/choose/ambulatory/2006/WorldVistA-EHR.asp
Ahh, very good. http://worldvista.org/
It's still on version 1.0 apparently, so no need to get the certification updated.
I actually have a 1984 version on floppies that I was given by some friends at the West Roxbury VA and Mass General when I worked at the West Roxbury VA as a resident. It uses Mass General's MUMPS, and it wasn't called VISTA at that point. Perhaps I can put the floppies out on eBay for a collector. They consisted of MicroMUMPS and a suite of MUMPS utilties called FILEMAN. Things were quite primitive at that point, each facility's implementation was different. My disks and documents were set up for their ER.
8 inch floppies??
>>> The rub here is don't expect help from AAFP or ACP. I've spoken to the powers that be at ACP when I complained about their EMR review program missing the boat. They are set on the need for CCHIT.
This is interesting- why these organizations don't take a poll of internists and FP docs who work "in the trenches" boggles my mind. Their membership rolls are declining precipitously. The best information can be found for the AMA, which nowadays represent just 17% of practicing internists. Most of its other members are either retired or students. In the ACP nowadays the membership log includes medical students, retirees, and Physician Assistants.
A currently active discussion at sermo was started by an AMA client. Responses ranged from those that were disappointed in many AMA stances to those that utterly "hated" the AMA. I brought up the problem of their advocacy continued support for CCHIT and forced HIT in general. These stances have isolated many of their membership who now have the prospects of further increased costs, increased reporting burdens, and a declining quality of life due to the attempt to force the use of technology under Medicare, when c-EHR systems have been shown time and again to not save any money, to not increase quality, nor do they decrease errors. In fact, the opposite occurs with these 3 parameters with the use of c-EHR systsms.
Al
Can you give us a similar report on section 4202-Incentives for Hospitals?