If you’re thinking about purchasing an electronic health record system, you have undoubtedly heard that the federal government is offering financial incentives to help you do that (see “The EHR Stimulus: A Complete Primer”). You’ve also heard that the regulations on what kind of EHR qualifies for the subsidies are not yet finalized. And you probably have questions about the “meaningful use” of that EHR you will have to show to claim the funds.
The good news is that the interim final rules and proposed regulations published in December are unlikely to change significantly when they’re finalized this spring. It’s already clear that to receive federal incentives in 2011, you’ll need an EHR that meets the published requirements for security, privacy, and interoperability. To demonstrate that you are using the EHR meaningfully in that year, you must employ your system to prescribe electronically and be able to exchange data with other providers, submit quality data to CMS or your state (if you’re applying for Medicaid incentives), and make copies of your electronic records available to patients upon request.
All of this is known, yet physicians have not been beating down the doors of software vendors. Until December, they could plausibly argue that they didn’t want to purchase an EHR until they knew what was required. Despite the guarantees that vendors were offering — and continue to offer — some observers say that that uncertainty effectively froze the market.
Now, it appears that other concerns are inhibiting physicians, including the requirement that they invest in EHRs before receiving any subsidies. Some are also worried that they’ll have to spend more on EHRs later as the government raises the ante to qualify for incentives.
Willarda Edwards, an internist and president of the National Medical Association, says, “When I talk to my colleagues, they’re seeing what I’m seeing. I can’t afford to make that initial investment and also be able to keep up with the changes that might be required for interoperability with other systems. That will require me to upgrade, and I can’t afford that.”
At the opposite end of the spectrum, Jeff Kagan, an internist in Newington, Conn., is confident that his three-provider practice will more than recoup the cost of the EHR it plans to buy through tax write-offs and government incentives. The biggest uncertainty at this point, Kagan says, is how much productivity his practice will lose during the EHR transition period — a concern he shares with many other doctors.
Family physician Chris Peine of Eagle, Idaho, is acquiring an EHR to improve his documentation and make his practice more efficient, not because he hopes to win a government subsidy. “I wanted to make the decision based on the needs of my practice and not on the financial incentives offered by the government,” he says. “Because frankly, I’m not sure when or if I’ll get a check for this. If I do, it will be nice. But for now, I’m making my decision based on what’s right for my practice.”
That’s the right reason, says Steven Waldren, MD, director of the Health Information Technology Center of the American Association of Family Physicians. Nevertheless, he strongly urges physicians to buy an EHR as soon as possible if they want to receive the maximum funds available from Uncle Sam — $44,000 per physician from Medicare or $64,000 from Medicaid, if at least 30 percent of revenue comes from the Medicaid program.
“If you want some money to offset the cost of an EHR, it’s going to take you six months to a year from the time you sign a contract until you’re live as a meaningful user, and before that, it will take six months to a year from when you start the search process to signing a contract,” Waldren says. “So if you don’t do that now, you won’t be ready to pull the trigger by 2011.”
Physicians who are ready to take the plunge need information about what’s happening in the market and what the government rules require. Here’s a basic guide to qualifying for federal EHR subsidies under the American Recovery and Reinvestment Act (ARRA).
Meaningful use maze
To refresh your memory, nonhospital-based physicians who use qualified EHRs meaningfully are eligible for government payments from 2011 to 2015, with the incentives diminishing over time. Those who apply after 2011 may also receive some payments, but the total will be less. Physicians who do not demonstrate meaningful use of an EHR by 2015 will have their Medicare payments cut by 1 percent in the first year, 2 percent in 2016, and 3 percent in 2017 and each year thereafter.
Providers can report on their meaningful use of EHRs for any 90-day period during 2011; thereafter, the reporting period for a particular year will be the full calendar year. Incentive payments can begin as early as 2011 and will end after 2016.
Two advisory bodies of the Department of Health and Human Services (HHS), the Health IT Policy Committee and the Health IT Standards Committee, spent most of 2009 devising criteria for meaningful use and certification of qualified EHRs. The meaningful use criteria for 2011 will be easier to meet than the 2013 criteria, which will become more stringent in 2015.
The most important thing to realize about meaningful use is that nobody can guarantee you will satisfy those requirements. While many vendors include such guarantees in their contracts — and one vendor, athenahealth, even says that if you don’t receive government money, it will refund up to six months’ worth of EHR payments — the fact is that it’s up to you to learn how to use the EHR and do what’s required. On the other hand, if you don’t have an EHR that can enable you to meet the government criteria, you won’t achieve meaningful use, no matter what you do.
