Barack Obama signed "American Recovery & Reinvestment Act" (ARRA) in February, 2009 allocates $19.2 billion for healthcare IT. This is to encourage healthcare organizations to adopt and effectively utilize Electronic Health Record (EHR) products. Government's focus is to make sure that providers should use Electronic Health Record product to exchanged patient’s data between healthcare professionals in secured manner. Additionally this will also reduce medical costs & improve quality of the care provided to patient.
Qualifying criteria to get Incentive bonus
In order to get Federal Reimbursement, EMR products must meet specific standards and include clinical health information, such as past medical history and list of problems, patient’s demographic information and have feature to provide decision support for provider order entry, capture quality healthcare information, and exchange Electronic Medical information with other sources.
Qualifying criteria are:
- Use of a certified EHR product having ePrescribing capability as per current HHS standards.
- Connectivity to health exchange so as to provide access to the patient's health history to other providers
- Ability to report on their use of the technology to HHS
Although the details of “government-certified” EMR and “meaningful use” are not yet decided, Bizmatics being well-positioned in EMR from long time has already identified most of the standards required, and is committed to meet with new standards as soon as they are announced by the government.
Provider’s incentive payment details:
Incentive funds are available only through Medicare and Medicaid. Providers can apply for incentive payments only from one of the programs. Each program has its own set of eligibility criteria, requirements & incentive amounts. Provider has to qualify all criteria for the incentive bonus.
a) Medicare incentive plan details:
Eligible providers using qualified electronic health record products can receive up to $44k over the five years. Cash incentives will be directly paid to care providers or to their employers. In addition to this, providers operating in health provider shortage area will be eligible for 10% incremental increase where as those providing service in hospital environment, such as anesthesiologists, pathologists and ED providers, are not eligible.
b) Medicaid incentive plan details:
Eligible providers can receive up to $63,750 to purchase and use qualified electronic health record products. Additionally Medicaid also offers up to $21,250 per provider to purchase and implement a EHR system (Eligible only for EHR purchased before 2016). Thereafter, program offers up to $8.500 per provider for relevant use of the EHR. Yet the start date of this program is not defined in the stimulus but it is expected to begin on or before October 1, 2010.
Eligible providers for Medicaid are:
- A non hospital based provider who see at least 30% of Medicaid insured patient.
- A non-hospital based pediatrician who see at least 20% of Medicaid insured patient.
- A provider who practices in FQHC with at least 30% needy patients
Fee reduction: Providers who do not demonstrate relevant use of EHR in 2014 will see a 1% decrease in fee schedule in 2015.
Hospital’s incentive payment details:
Like providers, Medicare and Medicaid incentive bonus plans are available for hospitals as well.
a) Medicaid incentive plan details:
Payments for hospitals treating more than 10% of Medicaid insured patients, will be determined by the same calculation used for Medicare algorithm, though for the starting four years payments will be fully weighted, rather than follow the descending weights
b) Medicare incentive plan details:
According to plan, Medicare hospitals can receive up to $11 million through a calculation that considers $2 million as base payment, $200 for 1,150th and the 23,000lh annually discharge, and total number of inpatient bed days in hospital and total charges. Whereas Critical Care Hospitals will be allowed to expense the acquisition cost of health IT in a single year up to $1.5 million.
Fee reduction: Hospitals not demonstrating relevant use of EHR by 2015 won’t see increase in fee schedules.