Updates on Meaningful Use, Certified EHR Technology and the Stimulus Bill

by

Market Analyst

On December 30, 2009, the Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare & Medicaid Services (CMS) released documents shedding light on what physicians and hospitals must do to qualify for electronic health records (EHR) incentive payments under the HITECH Act. To qualify for incentives, physicians and hospitals must be using "certified EHR technology" in a "meaningful manner."

These documents give us the clearest picture yet on what features physicians and hospitals need to look for in their EHR technology. They also tell us how that technology needs to be used to meet the definition of meaningful use during the Stage 1 (2011) EHR adoption period.

Among other things, these documents show us:

  • How physicians and hospitals can achieve meaningful use;
  • What software features you need; and,
  • What the final rulings mean for CCHIT certification.

We'll also look at a few points that the rulings didn't address.

How to Achieve Meaningful Use in Stage 1

In the table below, we've combined the meaningful use objectives for both eligible professionals (physicians) and hospitals for the Stage 1 adoption year, the required EHR technology criteria to accomplish those objectives and what criteria the government will use to measure meaningful use.

CMS defines "meaningful use" as using an EHR for the objectives listed in the first column. The objectives fall under these general topics:

  • Improving quality, safety, efficiency, care coordination, population and public health;
  • Reducing health disparities;
  • Engaging patients and their families; and,
  • Ensuring adequate privacy and security protections for personal health information

For the first time, CMS has also outlined specific measurements for how the government will determine if an EHR is being used in a meaningful manner for the Stage 1 (2011) adoption year. Updated definitions of meaningful use for Stage 2 (2013) and Stage 3 (2015) EHR adoption periods will be released in the year before those periods begin.

This table outlines what Stage 1 objectives define meaningful use, what software features are necessary to accomplish those objectives and what criteria the government will use to measure meaningful use. EP refers to eligible professional.

Meaningful Use Objectives
Corresponding EHR Software Features
Meaningful Use Measures
Use Computer Provider Order Entry (CPOE)
Enable a user to electronically record, store, retrieve, and manage, at a minimum, the following order types: Medications; Laboratory; Radiology/imaging; Provider referrals; Blood bank; Physical therapy; Occupational therapy; Respiratory therapy; Rehabilitation therapy; Dialysis; Provider consults; and Discharge and transfer.
CPOE is used for at least 80% of all orders; 10% for hospitals
Implement drug/allergy checks
(1) Real-time, alerts at the point of care for drug-drug and drug-allergy contraindications; (2) Electronically check if drugs are in a formulary or preferred drug list; (3) Provide certain users rights to deactivate, modify, and add rules for drug-drug and drug-allergy checking; (4) Track number of alerts users respond to
Function is enabled
Maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM or SNOMED CT®
Electronically record, modify, and retrieve a patient’s problem list over multiple visits
At least 80% of all unique patients have at least one entry or an indication of none recorded.
E-prescribing (EP only)
Electronically transmit prescriptions
At least 75% of all permissible prescriptions written by the EP are transmitted electronically
Maintain active medication/allergy list
Electronically record, modify, and retrieve a patient’s active medication/allergy list
At least 80% of all unique patients have at least one entry or an indication of “none”
Record demographics
Electronically record, modify, and retrieve patient demographic data
At least 80% of all unique patients have demographics recorded
Record and chart changes in vital signs
(1) Enable a user to electronically record, modify, and retrieve a patient’s vital signs; (2) Automatically calculate and display body mass index (BMI); (3) Plot and electronically display, upon request, growth charts for patients 2-20 years old.
For at least 80 percent of all unique patients age 2 and over seen by the EP or admitted to the eligible hospital, record blood pressure and BMI; additionally, plot growth chart for children age 2 to 20
Record smoking status for patients 13 years old or older
Electronically record, modify, and retrieve the smoking status of a patient
At least 80% of all unique patients 13 years old or older have “smoking status” recorded
Incorporate clinical lab-test results into EHR as structured data
(1) Electronically receive clinical laboratory test results and display such results in human readable format; (2) Electronically display in human readable format any clinical laboratory tests that have been received with LOINC® codes; (3) Electronically display all the information for a test report; (4) Electronically update a patient's record based upon received laboratory test results
At least 50% of all clinical lab tests results are incorporated as structured data
Generate lists of patients by specific conditions
Electronically select, sort, retrieve, and output a list of patients and patients’ clinical information
Generate at least one report listing patients with a specific condition
Report ambulatory quality measures to CMS or the States (EP only)
(1) Calculate and electronically display quality measure results as specified by CMS or states; (2) Electronically submit calculated quality measures
For 2011, an EP/hospital would attest this has been done
Send reminders to patients for preventive/follow-up care
Electronically generate a patient reminder list for preventive or follow-up care
Reminders sent to at least 50% of all unique patients that are 50 and over
Implement five clinical decision support rules relevant to specialty or high clinical priority
(1) Implement automated, electronic clinical decision support rules according to specialty or clinical priorities; (2) Automatically and electronically generate real-time alerts and care suggestions based upon clinical decision support rules and evidence grade; (3) Automatically and electronically track, record, and generate reports on the number of alerts responded to by a user
Implement five clinical decision support rules relevant to the clinical quality metrics the EP/Eligible Hospital is responsible for
Check insurance eligibility electronically
Electronically record and display patients’ insurance eligibility, and submit insurance eligibility queries
Insurance eligibility checked electronically for at least 80% of all unique patients
Submit claims electronically to public and private payers.
Electronically submit claims
At least 80 % of all claims filed electronically
Provide patients with an electronic copy of their health information upon request
Enable a user to create an electronic copy of a patient’s clinical information and provide to a patient on electronic media, or through some other electronic means
At least 80% of all patients who request an electronic copy of their health information are provided it within 48 hours
Provide patients with an electronic copy of their discharge instructions and procedures at time of discharge, upon request (Hospital only)
Enable a user to create an electronic copy of the discharge instructions and procedures for a patient, in human readable format, at the time of discharge to provide to a patient on electronic media, or through some other electronic means
At least 80% of all patients who are discharged from an eligible hospital and who request an electronic copy of their discharge instructions and procedures are provided it
Provide patients with electronic access to their health information within 96 hours of the information being available (EP only)
Enable a user to provide patients with online access to their clinical information
At least 10% of all unique patients are provided timely electronic access to their health information
Provide clinical summaries to patients for each office visit. (EP only)
(1) Enable a user to provide clinical summaries to patients (in paper or electronic form) for each office visit; (2) If the clinical summary is provided electronically (i.e., not printed), it must be provided in: 1) human readable format; and 2) and on electronic media, or through some other electronic means.
Clinical summaries provided to patients for at least 80% of all office visits
Exchange key clinical information among providers of care and patient authorized entities electronically and provide summary care record
(1) Electronically receive a patient summary record, from other providers and organizations; (2) Electronically transmit a patient summary record, to other providers and organizations
Provide summary of care record for at least 80 % of transitions of care and referrals; Perform at least one test of certified EHR technology's capacity to electronically exchange key clinical information
Perform medication reconciliation at relevant encounters and each transition of care and referral
Electronically complete medication reconciliation of two or more medication lists into a single medication list that can be electronically displayed in real-time
Perform medication reconciliation for at least 80 % of relevant encounters and transitions of care
Submit electronic data to immunization registries and actual submission where required and accepted
Electronically record, retrieve, and transmit immunization information to immunization registries
Performed at least one test submission to immunization registries and public health agencies
Provide electronic submission of reportable lab results to public health agencies and actual submission where it can be received (Hospital only)
Electronically record, retrieve, and transmit reportable clinical lab results to public health agencies
Performed at least one test of certified EHR technology capacity to provide electronic submission of reportable lab results to public health agencies
Provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice
Electronically record, retrieve, and transmit syndrome-based (e.g., influenza like illness) public health surveillance information to public health agencies
Performed at least one test of certified EHR technology's capacity to provide electronic syndromic surveillance data to public health agencies
Protect electronic health information through the implementation of appropriate technical capabilities
(1) Assign unique user names; (2) Permit certain users to access health information in an emergency; (3) Terminate an electronic session after a predetermined time of inactivity; (4) Encrypt and decrypt electronic health information that is stored and exchangd; (5) Record actions (e.g., deletion) related to electronic health information; (6) Track alterations of electronic health information; (7) Set up user verification measures; (8) Record disclosures made for treatment, payment, and health care operations
Conduct or review a security risk analysis and implement security updates as necessary

How long does EHR software have to be used in a meaningful manner to qualify for incentive payments? In the first year of adoption, CMS states that a physician or hospital must be using an EHR in a meaningful manner for a minimum of 90 days in order to qualify for incentives. In subsequent years, the EHR must be used in a meaningful manner for the entire year.

The ONC's interim final ruling details what software features EHR technology must have to become certified. Those criteria are listed in the second column. These criteria form the basis for the definition of "certified EHR technology," which we discuss next.

To summarize, the government now has told physicians and hospitals what tasks they should be using their EHR for (meaningful use); what EHR software features are needed to accomplish those tasks (certified EHR technology); and how the government is going to measure those tasks to determine whether or not they are being performed to their satisfaction.

What EHR Technology Will be Certified?

Here is the ONC's latest definition of certified EHR technology:

"A Complete EHR or a combination of EHR Modules, each of which (1) meets the requirements included in the definition of a Qualified EHR; and (2) has been tested and certified in accordance with the certification program established by the National Coordinator as having met all applicable certification criteria adopted by the [ONC]."

In a nutshell, as long as the EHR software meets the software certification criteria laid out in the table above, an integrated EHR software suite or combination of best of breed EHR modules is going to fall under the ONC's definition of "certified EHR technology."

CCHIT Certification

Within the available EHR universe are a number of EHRs certified by the Certification Commission for Health Information Technology (CCHIT). The ONC feels that 90% of the EHRs that are CCHIT-certified (~80) will become certified under their proposed certification criteria. The ONC also feels that a significant number of the remaining EHRs will require only minor upgrades to comply.

Reviews of CCHIT certified EHRs

As we've noted before on the Software Advice blog, CCHIT-certified systems are a good bet if you want to qualify for incentive payments. If you want to find out more about these systems, take a look at our list of CCHIT-certified EHRs.

What was left out of the final rulings?

What body will be doing the certifying? This wasn't made clear and is already a point of contention between the ONC and many healthcare organizations.

Who will enforce the meaningful use measures? Again, this is not clear in the documents released. The measures are clearly defined. What body will enforce them is not.

This is the original post on the topic from early March 2009.

By now you've heard about the $850 billion American Recovery and Reinvestment act of 2009 – the stimulus bill recently passed by Congress. The bill is aimed at spurring economic growth across multiple industries by way of government spending.

What's in it for you?

Well if you are a healthcare provider, you can take advantage of the $51 billion that has been allocated to the health care industry, $19 billion of which will be used to incentivize medical practices to adopt and implement Electronic Health Records (EHRs), also known as Electronic Medical Records (EMRs).

How does the subsidy work?

Starting in 2011, providers deemed to be "meaningful users" of EHR systems will be eligible to receive $40,000 – $60,000 in incentive payments paid out over five years in the form of increased Medicare and Medicaid premiums.

For the first year a physician is deemed to be a meaningful user, he or she will be eligible for payments of 75% of that year's Medicare and Medicaid charges, up to a maximum of $15,000. The maximum payment is increased to $18,000 if the first year is 2011 or 2012. The incentive payments decline for each subsequent year within the five year period; $12,000 will be paid in year two, $8,000 in year three, $4,000 in year four, and $2,000 in year five.

No incentive payments will be available after 2015, and no payments will be offered to physicians who first become eligible after 2014. This creates a decreasing incentive for late adopters.

What is a "meaningful user"?

To qualify as a “meaningful user,” eligible providers must demonstrate use of a “qualified EHR” in a “meaningful manner.” The bill defers to the secretary of Health and Human Services (HSS) to set specific guidelines for determining what constitutes a "qualified EHR"; however, it does specify that e-prescribing, electronic exchange of medical records, and interoperability of systems will be determining criteria.

HSS will be working throughout 2009 to set the necessary criteria for certifying systems, and is expected to have a final report by January of 2010. Many expect CCHIT certification to play a major role in setting standards of interoperability. (See “Should CCHIT Influence Your EHR Selection” for more information). After all, HHS funded the creation of CCHIT to start certifying EHRs a few years ago.

View a list of CCHIT Certified EMRs/EHRs

How do I qualify for the maximum payment?

In order to receive the maximum payment, physicians must qualify as a meaningful user in 2011. Eligible physicians will receive a first year bonus of $18,000 (up from $15,000) and will max out the payment schedule over the next five years.

The table below illustrates the amount of a subsidy paid each year (columns) based on the year the provider first becomes eligible (rows):

No payments will be offered to physicians who first become eligible after 2014.

Practices with multiple physicians will be eligible to receive incentive payments for each provider. Remember that payments will be based on 75% of the correlating year’s Medicare and Medicaid charges. Therefore, in order to qualify for the maximum payment of $18,000 in the first year, each provider must bill Medicare or Medicaid a minimum of $24,000.

Should I purchase an EHR now or wait until 2010?

An obvious concern is whether an EHR implemented in 2009 will meet the standards set by HHS in 2010. Although a legitimate concern, waiting until 2010 to implement a system may be a mistake. Researching and selecting the right EMR can be a lengthy process, and many providers who wait may find it difficult to have a system in place in time.

Practices would be well-served to begin the research process now, allowing ample time to create a short-list of systems, perform demos with several vendors, check references, meet with vendors in person, negotiate terms, and complete the implementation and training process. To alleviate buyers' concerns, vendors may provide binding agreements, guaranteeing their system will comply with all emerging standards.

Furthermore, buyers' should consider CCHIT an important Certification relative to the requirement for "qualified EHRs." While we have discussed the many opinions for and against CCHIT, we expect it to play a critical role in the EHR subsidy qualification.

What if I choose not to purchase an EHR?

Unfortunately, for physicians who choose not to implement an EHR, the stimulus bill is a double-edged sword. Not only will they forego thousands in incentive payments, but starting in 2015, they will be penalized by way of decreased Medicare and Medicaid payments. Physicians who fail to qualify as meaningful users will face decreases of 1% in 2015, 2% in 2016, and 3% in 2017, with a maximum reduction of 5% by 2020.

Bottom Line

Although each physician’s individual situation will dictate whether or not they choose to implement an EHR, the unique opportunity offered within the stimulus bill should not be overlooked.

 
  • D. Kellus Pruitt

    Tyranny.

  • Jana Aagaard

    Your readers need to know that the HITECH Act has hugely increased the penalties for violation of the HIPAA Privacy Rule, and has simultaneously added a number of new requirements that demand EHR functionality that is currently either weak or missing.

    Those considering adoption of EHRs MUST be sure that the system they are considering has the functionality to: 1) restrict disclosures to health plans of PHI for payment or operations purposes if the patient requests such a restriction and also pays out-of-pocket for the service. That’s not easy to do even if a patient requests a restriction of one discrete service, but will be much more tricky if a patient pays for a service that is provided along with other services during an encounter.

    Physicians need to know that their EHRs must have the functionality to produce information for a patient-requested “accounting of disclosures,” which after the HITECH Act, must include all disclosures from the EHR for treatment, payment and healthcare operations purposes! Note that the content of the accounting has yet to be determine by DHHS (regulations due no later than June 30, 2010), but any system purchase between now and Jan. 1, 2011 will need to be able to produce the accounting starting on Jan. 1, 2011.

    When the HIPAA civil penalties have gone up 49,900% (from the former $100/violation to the current range of $100 to $50,000/violation at the lowest level of culpability), violation of HIPAA’s Privacy or Security Rules can now be a bankruptcy-inducing event. It will be extremely important for physicians to be sure of the capabilities of EHRs. Check out the new HITECH Act privacy and security requirements very carefully.

  • Bill

    This is a great article. However, like most articles, it only describes the incentive payments starting in 2012 for physician providers. I’m having trouble finding any corresponding incentive payment information for hospitals, particularly small rural hospitals and critical access hospitals. They must, I assume, be getting higher levels of incentive payments. Can you publish any of these figures, or point to a website or source that does?

    Thanks!

  • Tim

    What type of paperwork or process does the physician need to produce to start receiving payments in 20011?

  • Chris

    My question is this, say I implement a qualified EMR system into my practice through my billing company at a cheaper rate then most vendors. Is this incentive package designed solely to offset the cost of implementing the EMR system or is it designed to reward me for going digital? Simply put, is the goverment offering me a rebate or a reward?

  • Ray C

    Don’t see how ones gets $60,000. The most I see is $44,000. Can someone clarify this? Thanks.

  • Nancy Biernacki

    What happens to the physicians that are already on EMR do they receive the incentive?

  • Silvia Laws

    How do you know if your system qualifies for stimulus grant?

  • http://www.kessco.net Gary

    As a Health IT Provider, I can tell you that choosing a good PM/EMR is critical to your organization. Forget the stimulus money, put the EMR in to help your organization. A good EMR can save thousands of dollars a month on transciption costs, billing code errors and mamimize your re-embursements. This is what it all about. Choose wisely.

  • http://www.alveris.com Derek Cahill

    Great article! It will be interesting to see how many physician offices / businesses qualify for these funds in 2011. I see this question in other parts of your blog, it will be interesting to see if labs, hospitals, imaging centers, retirement centers, etc. will qualify for these funds.

    • http://www.SoftwareAdvice.com Chris Thorman

      @ Derek

      Thanks for reading it Derek. I’m also curious to see just to what extent the HITECH Act will drive EHR adoption. 2010 should be a big year, if not the biggest year ever for EHR implementation.

  • http://healthcareitstrategy.com paul Roemer

    Nicely done. Too bad the ONC has set up MU like a lottery for which nobody is buying tickets

  • alison

    Question for Jana Aagaard, regarding the restriction on PHI disclosures and disclosure accounting. Can this not be a separate centralized system, does it have to belong to the EHR?

  • JDP

    How do eMARs fit into this picture for long-term care facilities? Is there any government stimulus money available for implementing an eMAR (electronic medication administration record) system?

  • http://www.emrandhipaa.com John Lynn

    JDP,
    I think you’ll find this post useful since it explains what the EMR stimulus money can be used for: http://www.emrandhipaa.com/emr-and-hipaa/2010/06/23/arra-qa-are-imaging-costs-recoupable-under-the-hitech-act/

    Long term care facilities in particular are an interesting beast altogether. From what I’ve seen the jury is still out on whether they’ll qualify for stimulus, but I think it’s likely to need further expansion of the EHR stimulus for LTC.

  • Allan

    If I am already USING a certified EHR (eClinical Works, Alscripts clearing house), HOW do I MAKE SURE I get the $$?? Are there online articles about this? Thanks,
    AZ

    • Chris Thorman

      @ Allan

      Are you talking about a CCHIT certified EHR? No EHRs have been certified by the government yet.

  • Vishal

    Great post andf the comments which have helped elaborate on this critical issue which I feel is doing to be important in defining the future of healthcare in our country.

    On the point of usability and defining the term ‘meaningful use’, I would add further that the medical practitioners are looking to avail of this federal incentive by trying to comply with the definition of meaningful use but at the same time EHR providers are looking at their own set of profits.
    This misunderstanding is mostly I believe as a result of wrong interpretation of the federal guidelines. The EHR providers need to look at these guidelines from the prospective of the practitioners who deal with different specialties.
    Each specialty EHR has its own set of challenges or requirements which I believe is overlooked by im most EHR vendors in a effort to merely follows federal guidelines. This is resulting in low usability to the practitioners, thus less ROI, finally redundancy of the EHR solution in place.
    I think ROI is very important factor that should be duly considered when look achieve a ‘meaning use’ out of a EHR solution. Though one may get vendors providing ‘meaning use’ at a lower cost, their ROI / savings through the use of their EHR might be pretty low when compared to costlier initial investment. Found a pretty useful ROI tool [http://www.waitingroomsolutions.com/wrs/emr-ehr-roi-calculator] that is pretty customizable and easy to use. It also accounts for the different specialty EHR’s too.
    There are other good references on the topics of:
    Usability/meaningful usehttp://www.waitingroomsolutions.com/wrs/arra-stimulus-money-44k-arra-emr-stimulus-bill-arra-ehr-stimulus-incentives”
    Certification criteria for EHR:
    http://www.waitingroomsolutions.com/wrs/arra-stimulus-money-44k-arra-emr-stimulus-bill-arra-ehr-stimulus-incentives#Certification_Criteria_EHR

    Also the introduction of REC’s through the HITECH act. is a great way to avail of quality EHR solutions at competitive prices. The stiff competition among not only these REC’s but also among EHR vendors ( to become a preferred vendor of a given REC) will result in lot of positives to medical practioners.
    Looking the funding provided to the REC’s, the staggered grant allocation system also promises to be an unbiased way of allocating funds. It will also help in the concept of REC’s helping out each with their own unique business models. It can be one of the possible answers to the
    ’safe vendor challenge’ as discussed by many critics.

  • tom

    Does anyone know how incentive payments will work for organizations like laboratories or dialysis clinics? Will incentives be paid based on how many medicare or medicaid patients they serve? Will the payments be made to the eligible professionals who work there, or will they be made to the corporation? What is the incentive payment formula for such an organization?

  • jim

    what happens to those practioners who do not have a medicare patient population.
    will we be out of the stimulus package.

  • Kara

    So where can I find the EHR software?????

    • Chris Thorman

      @ Kara

      Take a look at our EMR Buyer’s Guide for help. We have quite a few EHR software products listed there. Feel free to e-mail me with any questions (chris@softwareadvice.com).

  • Tim

    Do Physical therapists qualify for the incentive? there is conflicting information as follows:

    ‘‘(3) HEALTH CARE PROVIDER.—The term ‘health care provider’
    includes a hospital, skilled nursing facility, nursing
    facility, home health entity or other long term care facility,
    health care clinic, community mental health center (as defined
    in section 1913(b)(1)), renal dialysis facility, blood center,
    ambulatory surgical center described in section 1833(i) of the
    Social Security Act, emergency medical services provider, Federally
    qualified health center, group practice, a pharmacist, a
    pharmacy, a laboratory, a physician (as defined in section
    1861(r) of the Social Security Act), a practitioner (as described
    in section 1842(b)(18)(C) of the Social Security Act), a provider
    operated by, or under contract with, the Indian Health Service
    or by an Indian tribe (as defined in the Indian Self-Determination
    and Education Assistance Act), tribal organization, or
    urban Indian organization (as defined in section 4 of the Indian
    Health Care Improvement Act), a rural health clinic, a covered
    entity under section 340B, an ambulatory surgical center
    described in section 1833(i) of the Social Security Act, a therapist
    (as defined in section 1848(k)(3)(B)(iii) of the Social Security
    Act), and any other category of health care facility, entity,
    practitioner, or clinician determined appropriate by the Secretary.

    Section 1848(k)(3)(B)(iii) of the Social Security Act
    (3) Covered professional services and eligible professionals defined.— For purposes of this subsection:
    (A) Covered professional services.—The term “covered professional services” means services for which payment is made under, or is based on, the fee schedule established under this section and which are furnished by an eligible professional.
    (B) Eligible professional.—The term “eligible professional” means any of the following:
    (i) A physician.
    (ii) A practitioner described in section 1842(b)(18)(C).
    (iii) A physical or occupational therapist or a qualified speech-language pathologist.

    THEN, THIS INFORMAITON HAS BEEN PUBLISHED –

    What types of medical practices do not qualify for HITECH incentives?
    The following types of practices do not qualify for incentives based on our current understanding of the program:

    • Free clinics that don’t bill Medicare or Medicaid
    • Physical therapists
    • Hospital-based physicians such as pathologists, anesthesiologists or emergency physicians
    • Acupuncturists and other holistic providers
    • Any practice not eligible for Medicare or Medicaid payments

  • lenora

    You listed physical therapists among those types of practices that do not qualify for incentives — do private practice medical speech-language pathologists who are Medicare Part B providers also belong in that list? Do you know whether there are plans to expand the scope of types of practices that do qualify for incentives?

  • lenora

    I apologize. . .I just read the last response posted. I guess what I am hoping is that there has been some form of update since that last post. Any elucidation that you may provide will be appreciated.

  • Jessica

    I would also like to know the deal with therapists (PT OT SLP). There seems to be a fair amount of conflicting language around whether they qualify for incentives. It makes sense that non-medicare providers would not be included in the incentive package, but it is odd that credential medicare therapists would be excluded.

  • Paul

    Government approvals of EMRs must be FREE. Physicians should know that CCHIT costs vendors near $30,000 just to become certified…PLUS 4% of every sale!! Where does one this this cost will be pushed?…you got it, physicians.

    As far as I know, our Government has no money to fund this. A “golden carrot” that cannot be achieved.

    These “officials” need to find another way. Medicare/Caid reimbursements have been static or decreasing over the years. So this incentive offers nothing new.

  • Brent

    Paul has hit it on the head. Does anyone really believe we will get any of this incentive money? The regulations on “meaningful user” are out, as a neurosurgeon, there is no way I can meet the criteria without doing a lot more work to capture information and use EHR’s in a way I have no need to do now. CCHIT actually costs $37,000 plus $1,000 more to put the certification on the web, plus another $9,000 or so per year to keep it certified. I was unaware there was a percentage of each sale too! This from a “non-profit” who some how decided they were the certifying authority several years ago even before certification had any real meaning. The government is providing an incentive which is such a morass (think JACHO) that I doubt many will “qualify”. Furthermore, now that there is “$44,000″ available, all the EHR/EMR companies are advertising this and the prices have skyrocketed for these products. I have been an EMR user for 10 years now, been through three systems, and this business for the most part has taken advantage of physicians with outrageous prices and beware: Once they get you on their system, the fees only go up. Been there done that. I for one have had enough. I am developing my own system for surgeons in general (all specialties) that will take care of the basics and work great, and I have told my computer partners it has to cost $2,000 flat fee, no yearly/monthly fees, be server/web based in office or cloud (doctors choice) for Mac and PC, not delve into billing (too many “combo” systems out there that do not work well (plus lots of billing systems out there already at cheap prices), have new HIPAA/HITECH privacy standards (ability to track where records are sent/log them), and specifically NOT address all the silly feel good programs the government wants me to do, as this will bog down my particular practice. I think we are all ready for this type of product, by the doctors and for the doctors. I am not going to use a product tailored to the governments idea of what I need to do (I have no need for growth charts, immunization records, reporting labs to the government, capturing labs as data strings) nor do I want to shoulder the cost of “certification”. Flat rate, reasonably priced, ergonomic and easy to use, does what I need and nothing more. Unfortunately, nothing out there yet that is bucking the system. I will.

  • http://www.physiofitpt.com Kim

    Can you please clarify whether outpatient private practice physical therapists are eligible for the incentive or not?

  • http://www.meditask.com Sarah

    I’ve read all the above posts – very interesting. Disclosure: I’ve owned a medical transcription service since 1989, so I’ve watched the whole EMR/EHR, HIPAA-HITECH contrivance with great interest – since many aspects of it may affect my business. I’m not in government, do not sell EMR systems, and am not a physician – so my vantage point is a little different than most people posting here. I do, however, have some first-hand knowledge of how this government-induced spectacle is playing out…

    The latest post (Brent) seems to best reflect the feelings of the majority of my clients: private practice/clinics. While we all see the benefit of electronic health records for patients and practices, physicians need to consider carefully the CIRCUS of performers who hawk the loudest, all trying to get their hands on a piece of our pie. Just look at the number of companies popping up, offering their EMR/EHR product, a panacea promised to be tailored to your practice (right…), or the doomsday criers with the penalty scare tactics designed to panic you into compliance. Even my industry is plagued by TASP companies telling us we’re going to lose our businesses if we don’t buy their product and save our clients. (Sigh…)

    Some of my clients have hired CHC (Certfied Health Care Compliance)personnel, handing the practice reins over, clinching their teeth, but taking their medicine – often with a bitter bottom line dollar-wise – in hopes of avoiding penalties that might bankrupt them. Some have spent exorbitantly, just to realize that compliance doesn’t require the many, many bells and whistles they’ve just purchased, nor do those bells and whistles add to the efficiency or efficacy of their practices. It’s a sad story I keep seeing repeated.

    Physicians need to keep a wary eye, realizing that rushing into any quick cure could very well kill the patient (practice) if careful weighing of the pros and cons isn’t done. First, isolate what you do DO need to be compliant; it’s probably much less intrusive, less costly, and much less painful than you’ve been led to believe. Read the post above (thank you, Brent!) and consider taking a more personal pro-active position in terms of compliance, and certainly in terms of purchasing a system promising to streamline your office and put you in 100% compliance in a short, painless period of time. I haven’t heard of one painless transition yet, but I’ve heard and seen of many disruptive and finally abandoned attempts. Sales talk in the EHR/EMR sales industry seems to be geared to the “get them scared-sick, then offer a simple solution” worm on the end of the hook – and doctors are biting. That’s why the industry is booming and raising a huge litter of wolf pups whose aim is your monetary jugular.

    Strong words, I know. But someone has said it more clearly: Beware of false knowledge; it is more dangerous than ignorance. (George Bernard Shaw.

    Good luck to you all in doing the things that COUNT. :-)

  • Karen

    How does a PT, OT or Speech Pathologist get certified software when we can not do prescriptions, write orders, etc?

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