The $19 billion in funding for health information technology (HIT) in the federal economic stimulus bill offers some big promises to physicians who use electronic medical records (EMRs) in a "meaningful" way. But the bill also leaves many important questions unanswered.
For starters, the U.S. Department of Health and Human Services (HHS) secretary has yet to define "meaningful use." The secretary also must establish standards for certified electronic health record (EHR) technology.
Another complex matter that needs sorting out is how the requirements for Medicare and Medicaid EHR technology will differ operationally from the private, commercial HIT infrastructure in physicians' offices.
The portion of the stimulus package known as the Health Information Technology for Economic and Clinical Health Act doesn't have all the answers to these concerns, but does provide a good starting point for becoming familiar with how HIT funds will be spent.
Texas Medical Association's HIT staff is keeping abreast of these issues and will share intelligence with our members as it comes in.
What we do know is physicians who accept Medicare patients could earn up to $44,000 in incentives over five years. For those who meet the requirements by 2011 or 2012, the first Medicare incentive payment is $18,000. The annual payments amounts drop after that.
Eligible physicians who work in health professional shortage areas will receive a 10-percent increase in incentive payments, which end after 2016.
The legislation imposes penalties for eligible physicians who haven't become "meaningful users" of EHRs by 2015. They'll be subject to reduced Medicare payments, beginning with a 1-percent cut in 2015, increasing to 3 percent by 2017.
To avoid "double-dipping," physicians who report using an EHR with e-prescribing capabilities will qualify for HIT incentives only. They forfeit their eligibility for the e-prescribing bonuses established by the 2008 Medicare Improvements for Patients and Providers Act.
Medicaid incentives for meaningful use of certified EHR technology are even more vague. But the stimulus legislation stipulates the following health care professionals are eligible for incentive payments:
- Non-hospital-based professionals with at least a 30-percent Medicaid patient volume;
- Non-hospital-based pediatricians with at least a 20-percent Medicaid patient volume; and
- Eligible professionals who practice predominantly in federally qualified health centers or rural health clinics and have at least 30 percent of the patient volume attributable to needy individuals.
Although it's unknown the exact incentive payment amounts Medicaid participating physicians could qualify for, the legislation doesn't penalize eligible physicians for failing to adopt a certified technology.
Opportunities for incentive payments and threats of penalties related to adoption and use of EMRs make it tempting to rush into implementing a system. But TMA encourages physicians to proceed with caution and tap into our available resources to make wise decisions.
For tools to help you assess whether your practice is ready to adopt an EMR system and information about HIT, visit the Health Information Technology page on the TMA Web site . Tools available include:
The May issue of Texas Medicine will have more information on what HIT funding in the stimulus package means for Texas physicians.
Action , March 16, 2009