Incentives over time
About 40 percent of office-based physicians are already using fully integrated EHR systems, according to our survey. A 2009 survey conducted by the Centers for Disease Control and Prevention found similar numbers, although other estimates put the number of EHR adopters lower. One problem is that EHR adoption seems to have stalled: our first Technology Survey in 2005, for example, found the same 40 percent rate. The bonus payments to physicians and hospitals are seen as necessary to jumpstart EHR systems, which in turn is seen as crucial to moving Americans into a system of care that’s comprehensive and, eventually, cheaper.
Medicare offers physicians a bonus of up to $44,000 paid over a five-year period starting in 2011 (a separate program for hospitals begins Oct. 1, 2010). The payments are tied to 75 percent of your annual allowed Medicare Part B charges that year. If you start in 2011 or 2012, you can capture the maximum $18,000 bonus in your first year of participation by billing at least $24,000 in Medicare allowed charges. Participation in the bonus program ends in 2015, so waiting until 2013 to begin drops your cumulative take to $39,000 and to $24,000 if you start in 2014.
The Medicaid bonuses are geared to patient volume and there’s no penalty for not participating. At least 30 percent or more of your patient volume must be Medicaid beneficiaries (but only 20 percent for pediatricians) measured over any continuous 90-day period in the program’s first calendar year. Eligible professionals for Medicaid bonuses include nurse practitioners, certified nurse-midwives and some physician assistants such as those working in rural health clinics or provider shortage areas.
For both programs, CMS will make bonus payments to each eligible professional in your practice. In other words, a group of three internists could receive $132,000 in total if each successfully participates in the Medicare program. But can they get there in time?
To earn the bonuses, you’ll first need to meet the criteria set by CMS — from maintaining medication and allergy medication lists electronically for the majority of your patients (from all payers, not just Medicare and Medicaid) to providing patients with electronic copies of their health records upon request. Find the full criteria and other rules on the CMS Web site. Blumenthal, the ONC director, compiled a helpful, user-friendly chart for the New England Journal of Medicine that contains the full list of mandated and elective criteria.
The rule calls for attesting in writing to using your EHR to those capabilities for at least a 90-day period if you start during 2011 and for a full year if you start in 2012 or later. Plus you’ll need to submit quality data electronically. Seems reasonable. Or is it? If you aren’t close to purchasing your EHR now, consider this: 40 percent of our survey’s respondents said they spent four months to a full year shopping for the right EHR — and one in four spent more than a year. And that’s just getting to the purchase decision. More than half (56 percent) of you said it took six months to a year to complete implementation, while one in 10 needed up to 18 months.
Do the math from today and it could be a challenge to hit all of the required CMS targets for meaningful use by the end of 2011.
“The problem with setting these across-the-board thresholds is that the government is requiring the eligible provider to rely on the cooperation of a third party,” says Robert Tennant, senior policy adviser for the Medical Group Management Association. For example, the proposed rules would have required that 75 percent of physicians’ prescriptions be generated and transmitted electronically. Tennant complained that such a high hurdle “could be a problem when practices deal with small pharmacies that haven’t set up e-prescribing, or with patients who want paper scripts because they don’t have a “regular pharmacy.” Other physicians’ advocates voiced similar complaints. The final rule, released in mid-July, lowers the e-prescribing threshold to 40 percent.