What the Economic Stimulus Package Means for Physician Practices: Optimizing the Opportunity

Justin T. Barnes, Chairman, EHR Association, VP, Greenway Medical Technologies

Barnes, who has presented to Congress and actually worked on the stimulus package, began his 20-minute session with an overview of the HIT stimulus. The more than $30 billion of direct adoption incentives are broken into $17.7 billion for Medicare and $12.4 billion for Medicaid.

Breaking it down further, $2 billion is for the Office of the National Coordinator for Health Information Technology, the National Institute of Standards and Technology, and health information exchange infrastructure; $2 billion is for distance learning, telemedicine, and broadband program account loan guarantees and grants; $1.5 billion for the Health Resources and Services Administration, $1.1 billion for the Agency for Health Research and Quality, $500 million for the Social Security Administration, and $85 million for Indian Health Services.

“Conservative Congressional Budget Office estimates show that American Recovery and Reinvestment Act (ARRA) funding will save of $15 billion in government spending throughout the health sector through improved quality and care coordination, reduced medication errors, and duplicative care,” continued Barnes.

Key milestones for ARRA, according to Barnes include:

• Sec 3003: HIT policy committee — announced April 3, 2009

• Sec 3003: HIT standards committee — announced May 8, 2009

• Sec 3004: Adopt an initial set of standards, implementation specifications, and certification criteria — set for December 31, 2009

• Sec 4101: Medicare incentives for eligible professionals pay out year begins — starts January 1, 2012

• Sec 4201: Medicaid incentives for eligible professionals pay out year begins — starts as early as 2010, but bulk comes in 2012

When looking at Medicare-eligible professional incentives for meaningful use of a certified EHR, Barnes says the breakdown will be as follows: install in 2009-2010, receive $18,000 in 2011, $12,000 in 2012, $8,000 in 2013, $4,000 in 2014, and $2,000 in 2015, up to $44,000 per provider. For those who don’t meat meaningful use criteria, they can expect a 1% penalty in 2015. Then, a study will be conducted, and if more than 70% of practices don’t have a certified EHR, reductions will continue for 2 years, up to 5%.

The breakdown for Medicaid, says Barnes, looks like this: install in 2009-2010, receive $25,000 in 2011, $10,000 per year through 2014, and then $8,000-$10,000 for 2015, up $63,750 per provider of uninsured, rural, FQHC, and low-income providers/eligible professionals who have a 30% Medicaid population. Pediatricians must have a 20% Medicaid population to receive incentives, but must have over 30% to receive all $63,750. No penalty reductions will be handed out to those who don’t adopt.

One interesting fact that Barnes mentions: for certain eligible professionals who predominantly furnish services in an area that is designated by the secretary as a health professional shortage area, the amount of incentives they receive is increased by 10%.

“Seize the opportunity today,” says Barnes. Begin fostering the EHR discussion, understand the goals for adoption, review the process, and get leadership set in financial, quality, patient satisfaction, clinical research, and community areas, he advises, adding that practitioners need to make sure the EHR meets their practice needs, keeping in mind that now product is perfect and that one may need to meet the system “in the middle.” Properly deploying and EHR system takes time.

Barnes says to begin the move to an EHR by learning all you can at sites such as www.cchit.org, www.mgma.com, www.klaresarch.com, www.himssehra.org, and www.ehrdecisions.com. He notes that although CCHIT won’t be THE certifying body, it will be one of them and that physicians should ask their vendor if they are not only 2008-certified, but 2009-certified as well. He adds that “companies that are CCHIT-certified are committed to success just like you.”

Things to look for in an EHR, according to Barnes, include:

• References from practitioners in your specialty and practice size

• Product workflow that is consistent with your practice requirements

• A product that can be “meaningfully used” at the point of care

• Product certification (he notes that many see the new certification process building from current the CCHIT framework and efforts)

• 2008 CCHIT certification & meaningful use

So, what does meaningful use call for, asks Barnes. It includes the following:

• Use of electronic prescribing

• Information exchange

• Reporting of usage and clinical quality measures using the EHR

Finally, Barnes recommends that physicians reach out to their senators and congressmen and educate them on their daily life.