By: CRISSA SHOEMAKER DeBREE
The Intelligencer
August 22, 2010
Stimulus legislation put aside $20 billion to encourage doctors to adopt electronic medical records. Several local companies stand to benefit.

Patients will begin seeing more electronic records at their doctors’ offices and hospitals over the next few years, as health care providers rush to implement systems under a deadline imposed by economic stimulus legislation.

The Health Information Technology for Economic and Clinical Health, or HITECH, Act includes about $20 billion to help doctors and hospitals offset the costs of the systems, which require software and hardware designed to capture and share patient information with other doctors and the patients themselves. And several local companies are competing for a piece of that monetary pie.

“It’s truly a gold rush right now,” said Doug Wallace. “And it’s on the clock.”

Wallace is executive vice president of business development solutions for MyEMRChoice.com, a Doylestown company that helps doctors research and choose record systems. Wallace and a partner started the business three years ago, long before health care reform was on the radar. Over the next year, they expect to hire six more employees.

Doctors can receive up to $44,000 if they implement electronic medical records by 2014. Starting in 2015, those who don’t implement an EMR system stand to lose a percentage of their Medicare reimbursements. Hospitals stand to receive an average of $5 million.

The HITECH Act also includes millions of dollars to create regional extension centers to educate doctors and hospitals about electronic records and for studies on how the use of electronic data impacts patient treatment and care.

Proponents of electronic health records say they will cut down on costly inefficiencies in the health care system and encourage more communication. But doctors have balked at the costly – and sometimes confusing – systems, while patients have expressed privacy concerns about having medical information available online or on portable computer drives.

But security has become a priority, Wallace said. And the adoption of electronic medical records is inevitable.

“The scales will tip,” Wallace said. “EMR is coming.”

Adoption of electronic health records has lagged, however, as doctors waited for the U.S. Department of Health and Human Services to detail “meaningful use” criteria that spell out exactly what features are needed for a system to qualify under the act.

Those rules were approved only recently.

“The growth process has been somewhat more modest than what has been projected by the federal government, largely because there’s a lot of confusion and lack of information out there,” said Charles Jarvis, vice president of health care services and government relations for NextGen Healthcare Information Systems of Horsham. “The regulations have been somewhat slow. Many doctors and community health centers and some hospitals were saying, ‘We’re just going to wait until the regulations are done.’ ”

NextGen, a division of Quality Systems Inc. of California, expects its system to meet the meaningful use criteria, Jarvis said.

Doctors also have been hesitant to adopt the systems because of their cost, Jarvis said. NextGen has made financing packages available to help defray that, he said.

“But there has been a growth process, and we at NextGen have done our part to stimulate that,” he said. “The growth is going to be steady. It’s going to take several more years than originally suggested. You’re going to see this process happen over a four- to six-year period of time.”

Wallace, whose firm works mainly with small medical practices, agreed that adoption could take some time.

“It’s going to take a while,” Wallace said. “You can’t jam this down people’s throats.”

Crissa Shoemaker DeBree can be reached at 215-345-3186 or cshoemaker@phillyBurbs.com

Many physicians and and medical professionals remain confused (if not completely unaware) that the HITECH Act calls for doctors to use Electronic Medical Records EMR to accomplish healthcare initiatives. Let’s clear up some confussion as quickly as possible. Consider these eight points to get your footing on what is required and available in making the move from paper medical records to Electronic Health Records:

1. The EMR/EHR system must demonstrate “meaningful use” as defined by the final ruling of EMR system requirements. Not to worry, the EMR vendor should be responsible for keeping your system compliant.

2. Now what about these EMR companies? There are hundreds of them, all claiming to be the best. On top of that there are resellers for the same products. In short, lots of choices. However, company consolidation and mergers are becoming frequent.

3. When selecting a EMR provider, it should be approached the same as you would examine a patient before prescribing a course of action. Expect this from any EMR representative.

4. How much will a EMR cost and who pays? $20 BILLION has been allocated for physicians to say bye-bye to paper charts. So, the sooner you use a EMR system, the more you gain. This totals up to $44,000 per physician, not group. Purchase, install and use a EMR right now, you will receive $18,000 in 2011, $12,000 in 2012, and so on. If you put off EHR adoption for a year or two, you lose out on incentives to go electronic now.

5. Do you have a EMR already? You will receive payments as long as the system demonstrates meaningful use.

6. Financing options and paying for upfront EMR costs are numerous. Many EMR vendors have plans ready to gain your business. In addition, the US Small Business subcommittee is considering a EMR/EHR loan program which awaits approval from the Senate.

7. Consider offering your patients access to their personal health records (PHR). You might as well. Soon, there will be widespread demand for immediate patient access to their charts. More on that later.

8. Other Healthcare Information Technology programs to encourage EMR adoption are Regional Extension Centers, Health Information Exchanges and Beacon Communities. Funds are provided to these programs through various Federal and state sources.

States will receive millions in federal funds over the next four years to fund Electronic Medical Records (EMR) projects that will allow hospitals, doctors and health insurance companies to share medical data in real time over secure networks.

This initiative is known as Health Information Exchanges, Regional Extension Centers and Beacon communities.

States will work with the healthcare industry to create Regional Health Information Exchanges (HIEs) that will share information such as lab results and ePrescribing information among health care providers in a statewide HIE system state. HIEs hold the promise of improving health care quality and efficiency by eliminating duplicative testing, avoiding dangerous medication interactions and providing information about patient histories with other facilities that will help physicians improve care.

The funding, awarded under the federal American Recovery and Reinvestment Act of 2009 (ARRA) and Healthcare Infromation Technology for Economic and Clinical Health (HITECH) can move a state closer to the national initiative of achieving interoperable EMR systems data sharing capabilities by the year 2014.

8. Show Me the Incentive Money

Incentive payments totaling $44,000 are calculated as $18,000 for 2011
$12,000 for 2012
$ 8,000 for 2013
$ 4,000 for 2014
$ 2,000 for 2015

9. Can a physician be penalized for not utilizing an EHR by 2015?

Yes. Failure to adopt a “meaningful use” EMR beginning in 2015 will have doctors facing penalties in the form of reductions to their Medicare fees schedule reimbursement rates. The penalty will equal 1% in 2015, 2% in 2016, and 3% in 2017 and each subsequent year. Under the bill, the Secretary can increase the penalty to 5% if fewer than 75% of eligible physicians are not utilizing an EMR by 2018.

10. Under Medicaid who is eligible to receive incentive payments and what is the timeline for payments?

The intended Medicaid program offers up to $64,000 to providers who see more than 30% of patients paying with Medicaid, (20% for pediatricians). Beginning in 2011, the Medicaid incentive payment will be based on a calculation that includes the provider’s Medicaid mix and qualifying IT related expenses. Payments could amount up to $25,000 the initial year and $10,000 each subsequent year for a total period of five years. The eligible professional under Medicaid must first demonstrate certified EHR usage by 2015 to be eligible for payments and after 2021 will not be eligible for payments. Pediatricians, who only meet the lower threshold of 20% Medicaid patients, would be eligible for 66% or the payments described above. The current bill also provides a cap for total payments under the Medicaid Plan. Once the funds have been depleted, payments will no longer be available under the Medicaid plan.

11. So my group has 5 physicians. Will the group qualify for total incentive payments of $220,000 under the Medicare incentive program?

Yes. If each of the physicians meets the ability to demonstrate meaningful use of a certified EMR system by 2012, the group could be entitled to a total of $220,000 in incentive payments under the Medicare program (5 x $44,000=$220,000).

13. What constitutes a “Certified” EHR system?

What constitutes a “certified” EHR is to be determined. However, many believe that CCHIT will be instrumental in the certification process and that HHS will likely be basing much of their standards on the current work of CCHIT. Private certification groups should serve as an option to CCHIT.
To view a list of current CCHIT certified companies, visit www.myEMRchoice.com

14. Are NPs/RNs/MAs covered by the incentive programs?

Nurse practitioners and nurse mid-wives should be able to file for incentive payments under the Medicaid program. Physician Assistants may qualify if the PA is practicing in a rural health clinic that is led by the PA or who is practicing in a FQHC. Mid-level providers do not qualify under the Medicare portion of the incentives.

15. Is there a separate bonus payment for hospitals that utilize an EMR?

Yes. The Stimulus Bill includes a separate Medicare incentive payment for hospitals efficiently utilizing an EMR. The calculation is much more complicated. It includes a $2 million base payment plus an amount from a formula including various factors such as the discharge volume, inpatient-bed-days for different Medicare patients and total patients, and total hospital charges.

16. My practice has been utilizing an EMR system since prior to the date the Stimulus Bill was signed into law. Can the providers in my practice still qualify for the incentive payments?

Yes. Only 20%-30% of practices had implemented an EMR prior to the enactment of HITECH. Because of the relatively short time frame and the sheer number of practices that still need to implement an EMR, it may be a challenge for some of these non-early adopters to qualify for the maximum payments. If your system is certified and you can demonstrate meaningful use of the system prior to 2012 you should generally qualify for the incentive payments under the Medicare Plan

17. My existing EMR system was only $12,000. If I qualify, will my incentive payment be limited to $12,000 under the Medicare Plan?

No. Under the Medicare Plan, the requirement to receive the maximum incentive payments is a utilization standard and is not dependent upon the actual cost or purchase method of the EMR system. If you meet all qualifications for the incentive payment, you should receive the maximum payment regardless of the actual cost or purchase method of your EMR system.

18. My practice does not currently utilize an EMR. When is the right time to start planning for an EHR implementation?

Now. Why leave money on the table? And if you are retiring or selling, buy the cheaqpest EMR you can, earn the stimulus funds and ad 20% to your selling price for a medical practice that has a fully implemented, productive and trained EMR staff!

19. Is there any benefit for early adoption of the certified EMR system?

Yes. Early adopters would stand to gain, as about 70 percent of the Medicare payments would be received in the first two years.

20. Is there any additional benefit for PQRI and electronic prescribing?

Those engaged in Physician Quality Reporting Initiative (PQRI) and electronic prescribing can earn an additional $ 6000 – $ 8000 per year, beginning now.

21. How will the EHR Stimulus payments actually be distributed to the physicians?

The timing and distribution process for the incentive payments is to be determined and finalized by the Secretary of the Health and Human Services and the federal rule making process.

22. Will the public know whether or not I practice with a qualified meaningful EHR?

Real possible. CMS will post the names, addresses, and phone numbers of eligible professionals who are meaningful EHR users and group practices receiving incentive payments.

1. What is this EMR law all about?

The HITECH Act (part of the $787B Stimulus Bill) provides that qualified physicians who utilize a certified electronic medical record system that demonstrates “meaningful use” will receive incentive payments through additional reimbursements through either Medicare or Medicaid depending upon the individual doctors’s payer mix. Incentive payments ranging from a maximum of $44,000 under the Medicare incentive option or $ 64,000 under the Medicaid option are available to each qualifying physician, regardless of group practice size. The payments are made over a five year period beginning in 2011. Penalties apply after 2015.

2. So what defines “meaningful use”?

With 300 EMR systems and countless resellers to select from, some safeguards had to be created. “Meaningful Use” (MU) is simply a stamp of approval, like having your car inspected. It includes eprescribing, data sharing and medical reporting. We are currently under a ‘temporary ruling” for MU.

3. So we have to move from paper to Electronic Medical Records?

The American Recovery and Reinvestment Act was signed into law in February 2009 and an appropriation of $ 19.2 billion dollars has been made towards Health Information Technology to encourage the adoption of EMR systems. This is known as the HITECH Act, or Healthcare Information Technology for Economic and Clinical Health.

4. What is the difference between the Medicare and Medicaid incentive options?

The HITECH Act outlines two separate incentive payment programs, one through Medicare and one through Medicaid. Providers can only receive incentive payments from one of the programs and will need to determine where they stand to benefit most.
Overall, the Medicaid program offers up to $64,000 to physicians who see more than 30% of patients paying with Medicaid, (20% for pediatricians). The Medicare program offers individual physicians up to $44,000 in incentive payments from HITECH.

5. Are all physicians in The U.S. eligible for incentive payments from Medicare and Medicaid?

Physicians that do not accept Medicare or those that do not have a threshold patient payer mix of greater than 30% Medicaid (20% for pediatricians) will not qualify for the HITECH EMR payments. In addition, physicians operating solely in a hospital environment, such as pathologist, anesthesiologist, or emergency physicians are not eligible.

6. Are groups that do Medicare Advantage also eligible for the stimulus dollars?

Yes, there are provisions of the Bill related to groups accepting Medicare Advantage.

7. How are Pediatricians and Family Physicians going to be able to participate?

If a physician does not meet the Medicaid payer mix threshold and does not accept Medicare, they will be able to apply for grants and/or loans to offset the upfront costs of the purchase of an EMR but will not be eligible for incentives as currently delineated.
Additionally, the Secretary of HHS will be assessing utilization levels beginning in 2011, and if he or she believes that there is a need to offer other incentives to prompt adoption among those populations of providers, that will be addressed then.

The Office of the National Coordinator(ONC) for Health Information Technology has released rules for temporary certification for Electronic Medical Record providers (EMR), effective June 24, 2010. On that date and under the temporary EMR providers provisions, EMR providers may submit to ONC an application to become a Authorized Testing and Certification Body (ATCB). The ONC will rule on applications within 30 days of a ATCB filing. This timelined temporary initiative is intended to ensure the availability of approved EMR systems for October, when some physicians/providers become eligible for Electronic Health Record (EHR) meaningful use stimulus payments.

The Centers for Medicare and Medicaid Services (CMS) expects to soon release two final regulations related to EMR and the HITECH Act.

Much more to come. Please check back with www.myEMRchoice.com.

Healthcare IT stocks are up and the HITECH Act is providing billions for EMR and healthcare IT. Health Information Exchanges (HIE) and Regional Extension Centers are mushrooming. If the US is in a recession, then the healthcate IT vertical market ain’t participating.

The marketplace for Electronic Health Records and its sequel, consumer Personal Health Records (PHR) is a gathering storm, ready to engulf 310 million patient/consumers and their healthcare providers and staff. Throw in EDI and insurance payers, and you have one wildly interdependent healthcare delivery system. Healthcare IT service providers that offer smooth transition to EMR will be seen as trusted advisors.

And don’t forget about Personal Health Records. Each patient will have access to their PHR “anywhere, anytime, on demand”. Patient control and instant collaboration from many physicians can hasten and heal…fast and more efficiently.

Stay tuned.

The American Recovery and Reinvestment Act of 2009 has been passed. Physicians are required to move from paper based medical charts to computerization. Sorry, docs.

The cost of incentives is estimated to be $19 billion in increased Medicare and Medicaid payments. Probably a moving target.

The Act includes a portion known as HITECH (Healthcare Information Technology for Economic and Clinical Health to encourage electronic medical records (EMR). The incentive portion starts in 2011: a physician who is a “meaningful user” of EMR is eligible to receive additional payments under the Medicare program that can extend over five years. The penalty portion starts in 2015, when physicians who are not meaningful EHR users will begin to see declines in their Medicare payments. The incentive payment schedule is as follows for encouraging EMR adoption:

2011 $18,000
2012 $12,000
2013 $ 8,000
2014 $ 4,000
2015 $ 2,000

The loger you wait, the more you lose out. Thinking of retiring or selling your practice, missing out on the whole need to participate in the HITECH program and the change to EMR? Consider this: buy a EMR in 2011 and have a fully implemented EMR in place, adding 20% to your sell price!

Under the penalty provisions, physicians who are not meaningful EHR users in 2015 will see a 1% reduction in their fee schedule amount. The reduction increases to 2% in 2016, and 3% in 2017 and each subsequent year.

As for “meaningful use”, this simply means that the EMR system must be certified by the CCHIT organization or a qualified private validation firm. The EMR must pass inspection, like your care to be recognized. EMR vendors have been paying about $30,000 for the stamp of approval. That’s an expensive stamp.

There are HUNDREDS of EMR systems and resellers to chose from. Expect phone calls.

If HHS finds that by 2017, the proportion of physicians who are meaningful EHR users is less than 75%, HHS may continue to scale back payments by 1% a year (but may not reduce payments below 95%). There will be some exceptions based on socioeconomic and geographical considerations.

To be a “meaningful EHR user”, the physician must satisfy three criteria: e-Prescribing, exchanging information and sending measured/requested data to HHS.

HHS will designate the way in which a physician is recognized as a meaningful user (through attestation, submission of claims with codes indicating that a patient encounter was documented using certified EHR technology, survey responses, submission of quality reports, or other means).

The Act also authorizes state Medicaid programs to provide additional payments to physicians, at least 30% of whose patient volume is services to Medicaid beneficiaries.

In addition to HITECH, $2 billion is available as to ONCHIT Coordinator, Dr. David Blumenthal for implementation of the programs, including grants to states to establish loan programs for physicians seeking to acquire certified EHR systems., Health Information Exchanges (HIEs) and Regional Extension Centers (RECs).

Keep checking back with the gang at MyEMRchoice. The HITECH Act has all the markings of a policy that can change quicker than the weather in Texas.

A baseball player has his entire career summarized on a baseball card. We will attempt to do the same thing here for Electronic Medical Records (EMR), Electronic Health Records (EHR) and Personal Health Records (PHR).

The HITECH Act calls for physicians to move from paper medical charts to EMR by 2014. Financial incentives and data management are at keys of this initiative, not the desire of most doctors. EMR is not a question of if or when.

EMR system adoption is a process, not just a product. EMR vendors once numbered in the hundreds. Massive consolidation is occuring. A EMR must show “meaningful use” as defined by CCHIT which itself may be replaced with private certification organizations.

Technology: Medical practices will have the opportunity to select either a traditional client/server EMR configuration, a web based model (ASP or SaaS) or a downloadable application streamed right to a tablet PC or iPad type device. OCR and voice features can offer patient convenience and physician efficiencies.

Estimation of the cost for a EMR system is just that-an estimate. Pricing varies wider and more often than the weather in Texas.

Successful EMR adoption and its use consists of scanning your current paper records, EMR selection and choices, compliance with time lines, secured financing, patient-physician communication portals and offering patients access to their complete Personal Health Records.

(vist the Glossar at My EMR Choice for definitions)

So what’s the next hot app for your mobile device? The answer: Your complete Personal Health Record, or PHR. And this information will be secure and available by you “Anytime, Anywhere and On-Demand”.

Doctors must move your medical records from paper to Electronic Medical Records (EMR) by law and in a short timeframe. This EMR will serve to populate your PHR data.

We know that currently a PHR application sounds about exciting as watching paint dry. PHR does not have the same appeal as many of the apps available today. But really, what is more important than the life application that is your medical record? Consider:

PHR will allow for faster, accurate communication between you and your doctor. The free flow of information will benefit patients, physicians and caretakers of those with conditions. In addition, forget the redundant paperwork that accompanies every visit to a new physician. Just hand back the paperwork and hand over your PHR. Done and done. Now THAT’s consumer satisfaction.

Who among us much cared about cell phones and ATM cards until they were available, but what would you do without them today?

We would like to hear your thoughts on PHR. Please send comments through http://www.myEMRchoice.com