Economic Stimulus: Incentives for using an EHR
Learn about the Stimulus incentive program.
Discover how TeamPraxis will help you earn the bonuses.
Take Action Now.
Introduction
President Barack Obama’s signing of the American Recovery and Reinvestment Act of 2009, (i.e., the economic stimulus), marked a major turning point in American healthcare. This bill included the HITECH Act, which commits $19 billion to provide incentives to physicians or hospitals who use Electronic Health Record systems in a “meaningful way,” beginning in 2011. With this investment, the Administration all but removed the number-one barrier to EHR adoption: cost. But more importantly, it is providing an incentive that will benefit patient care, as it is not simply rewarding the adoption of an EHR, but its use.
How the Incentive Programs Work
The $19 billion provided for Healthcare Information Technology is divided between $2 billion of discretionary funds for the Department of Health and Human Services (HHS), and $17 billion for two incentive programs – one through Medicare and another through Medicaid. Individual physicians may participate in only one of these two programs.
Requirements
For both programs, the physician or hospitals must demonstrate three criteria to receive government bonus payments:
- Use of a certified EHR product with ePrescribing capability that meets current HHS standards.
- Connectivity to other providers to improve access to the full view of a patient’s health history.
- Ability to report on clinical quality measures to HHS.
Click here to find out how TeamPraxis can help you meet these criteria.
Incentives: The Time to Act is Now!
The Medicaid program offers up to $64,000 paid out over 5 years to physicians who see more than 30% of patients paying with Medicaid, (20% for pediatricians). The specific incentive amount will be calculated through a formula that factors in the exact Medicaid mix seen by the provider. The incentives will be “front-loaded,” with bonus amounts ranging from $25,000 in the first year to $10,000 in subsequent years.
The Medicare program offers individual physicians up to $44,000 to be paid out over 5 years, with the majority of the funding coming at the beginning. The actual bonus is worth 75% of a physician’s total Medicare allowables, capped at the following levels each year:
To better explain this chart, consider the following examples:
Example 1:
A physician with an average of $50,000 in annual total Medicare allowables demonstrates that she meets all 3 criteria in 2011.
- Because she meets all three criteria, she earns a bonus worth 75% of her $50,000 of Medicare allowables, or $37,500, in 2011.
- However, this amount is capped at $18,000, so she will receive a bonus check of $18,000 from CMS in 2011.
- This physician will earn similar bonuses the next years, which will be capped as displayed in the chart above: at $12,000 in 2012, $8,000 in 2013, $4,000 in 2014 and $2,000 in 2015.
- In total, this physician earns $44,000 from 2011 through 2015.
Example 2:
A physician with $22,000 in annual total Medicare allowables demonstrates that he meets all 3 criteria in 2012.Because he meets all 3 criteria, he earns a bonus worth 75% of his $22,000 of Medicare allowables, or $16,500 in 2012.
- Note: the chart above lists a possible bonus of $18,000 in 2012 for this physician, but this is actually a bonus cap. Because the 75% of Medicare allowables bonus does not exceed the cap, it simply remains a bonus of $16,500.
- Thus, the physician will receive a check from CMS for $16,500 in 2012.
- In 2013, this physician earns the same bonus, but it is capped at $12,000, (per the chart above).
- From 2014 through 2016, the physician will earn capped bonuses of $8,000, $4,000 and $2,000, respectively.
- In total, this physician earns $42,500 from 2012 through 2016.
Example 3:
A physician with $75,000 in annual total Medicare allowables demonstrates that she meets all 3 criteria in 2014.
- Because the physician meets all 3 criteria, she earns a bonus worth 75% of her total Medicare allowables, or $56,250.
- However, because she started in 2014, her bonus is capped at $12,000; she will receive a check from CMS for $12,000.
- In 2015 and 2016, this physician will earn the same bonus, capped at $8,000 and $4,000, respectively.
- In total, this physician will earn a total of $24,000 from 2014 through 2016.
- Observation: If this physician began demonstrating she met the criteria in 2011 or 2012, just 2 or 2 years earlier, she would have earned $44,000 - $20,000 more.
The Big Takeaway: Physicians earn significantly more money by starting earlier, regardless of their total Medicare allowables.
Disincentive
If providers do not demonstrate that they meet the 3 criteria before 2015, the positive bonus incentive will turn into a Medicare service fee schedule reduction, beginning in 2015. In 2015, providers who do not demonstrate meaningful use of an EHR will see a decrease of 1% of their fee schedules. An additional 1% decrease will occur in 2016, as well as 2017, down to a total of 97% of the regular fee schedule in 2017. It can further be reduced to 95% if the Secretary determines that total nationwide EHR adoption is below 75% in 2018.
How TeamPraxis can Help Physicians
TeamPraxis can help Hawaii physicians meet all three stimulus criteria and earn the substantial bonus incentives through Allscripts Enterprise EHR and our Clinical Quality Solution tool. The best part is, because of HMSA HI-IQ funding, we can virtually eliminate all of the costs of implementing these powerful, transformative tools.
Enterprise EHR
Allscripts Enterprise EHR is a powerful and award-winning Electronic Health Record. It is currently CCHIT-certified and offers an HHS-qualified e-prescribing module, (meeting the first stimulus criteria). Further, by having Enterprise EHR installed by TeamPraxis, Hawaii physicians will join a connected physician health information community, (meeting the second stimulus criteria). Click here to find out more about Enterprise EHR.
Clinical Quality Solution (CQS)
The Allscripts Clinical Quality Solution Powered by TeamPraxis is a transformative tool that automates clinical quality measure reporting programs, including PQRI and the CMS E-Prescribing Incentive Program. While specific details about the clinical quality measure reporting surrounding the third stimulus criteria have not been released yet, we anticipate that CQS will be able to automate this reporting requirement as well. In the mean time, CQS will already earn Hawaii physicians bonuses in two other CMS incentive programs, (PQRI and E-Prescribing), earning physicians two additional bonuses worth a combined total of 4% of their total Medicare allowables for 2009. Click here to find out more about CQS.
What this all means: Take Action Now
The bonuses for EHR use and fee reductions for non-use are encoded into law. While HHS and CMS will release the final program details during the next year, physicians have a strong incentive to act early and demonstrate meaningful use of an EHR before 2011.
By connecting to TeamPraxis’ physician information network through Enterprise EHR and our Clinical Quality Solution, physicians will not only become equipped with the highest quality clinical tools on the market to empower them at the point of care, but they will also be prepared to demonstrate “meaningful use” of an EHR and capitalize on the incentive bonuses offered by the stimulus package.
Why take action now? While physicians might think they can wait until 2011 to pursue an EHR, the time to act really is now! To earn stimulus bonus payments, physicians must not just have an EHR installed – they must show HHS that they are using it!
The installation and training to use the EHR and CQS take time and coordination by themselves. And with the imminent increase in demand for these installations and our finite personnel resources, we can only guarantee timely installations on a first-come, first-served basis. In other words, acting in 2009 will provide a much greater assurance that a physician will be able to display “meaningful use” of an EHR by 2011 than if a physician waits until late 2010 or 2011. In fact, the longer a physician waits, the more likely he or she might have to wait in a line.
What about the costs if I act now?
With the combination of HMSA HI-IQ funding, (which provides upfront subsidies to purchase an EHR), and the new federal stimulus bonuses, (which reward EHR use), TeamPraxis can virtually eliminate most of the cost of acquiring and using the Enterprise EHR and Clinical Quality Solution. We are currently reviewing financial details, but we intend to offer flexible financing programs to substantially minimize, if not eliminate, any upfront costs. We can share further details with interested physicians at an EHR/CQS demonstration, as soon as they have been determined.
What to do now?
- Hawaii Physicians without Enterprise EHR: Contact our Sales Department at 808-948-9551 or toll-free at 1-800-413-8869 to schedule a demonstration of both our EHR and CQS products, beginning the sales process.
- Hawaii Physicians with Enterprise EHR but not CQS: Contact our Sales Department at 808-948-9551 or toll-free at 1-800-413-8869 to schedule a demonstration of CQS.
- Hawaii Physicians with Enterprise EHR and CQS: Keep using your EHR, E-Prescribing and documenting your selected PQRI measures within Enterprise.
Additional Information Still Forthcoming
Many of the details of this program are still forthcoming from CMS, so check back later for further updates. However, the bonus amounts in the program are fixed and encoded in federal law.
Additional Resource Links
To read the entire American Recovery and Reinvestment Act, (the HITECH Act begins at the bottom of page 112), click here.
To read material from industry leader Allscripts’ website, click here.