If you are in a physician practice, please consider as to how your organization can benefit from the EHR incentives.
Fueled by incentives, is now the time to invest in EHR??
The road to electronic health record (EHR) adoption got a little sweeter for physicians with President Obama’s signing of the American Recovery and Reinvestment Act of 2009.
Widely referred to as the economic stimulus package, the act provides approximately $35 billion in Medicare and Medicaid incentives to eligible professionals for “meaningful use” of qualified EHR systems in their practices (use of a hospital EHR does not qualify the physician or provider for these incentives).
To qualify for the incentives, — physicians must actively use an EHR to take advantage of these economic stimulus package incentives or other bonuses noted below. Likewise, beginning in 2015, the Centers for Medicare and Medicaid Services (CMS) will impose penalties for eligible providers who do not begin using an EHR. Eligible practices could miss out on thousands of dollars in potential bonus and incentive payments by postponing their adoption of EHR technology.
The time, therefore, is now to understand the key benefits of EHRs and the various financial incentives that exist to encourage physician adoption.
Medicare EHR incentive
Beginning in October 2010, physicians who meet the following criteria throughout the fiscal year are eligible for Medicare bonuses equal to 75 percent of their allowable Part B charges.
- Use a qualified EHR system in a “meaningful way,” which must include electronic prescribing
- Demonstrate that the EHR is connected in a way to improve care quality, such as promoting care coordination
- Report clinical quality measures (still being defined, but aligned with a nationally-recognized reporting initiative such as the Physician Quality Reporting Initiative)
Physicians may receive up to $18,000 in the first year, $12,000 in the second year, $8,000 in the third year, $4,000 in the fourth year and $2,000 in the fifth year [$44,000 in all for each physician participating in all five years]. Physicians must qualify by October 2013 to receive any payments as part of this incentive program. No payments are available after September 2016 .
Eligible physicians who are not using an EHR by 2015 will be subject to penalties in the form of reduction of Medicare payments.
Medicaid EHR incentive
Qualified physicians, nurse practitioners and nurse midwives whose Medicaid patients comprise 30 percent of their patient volume (or 20 percent for pediatricians) can choose to apply for the Medicaid EHR incentive program instead of the Medicare incentive program.
Healthcare professionals may qualify for these incentives starting in October 2010. Payments end in September 2016. Physicians could receive incentive payments of 85 percent of “any reasonable cost” associated with implementing or maintaining an EHR over five years. Implementation costs cannot exceed $25,000, and maintenance costs per year cannot exceed $10,000.
In addition to the $17 billion for Medicare and Medicaid incentives for HIT, Congress has allocated another $2 billion for HIT grants in the areas of:
- HIT infrastructure
- Dissemination of best practices
- Telemedicine
- The inclusion of health information technology in clinical education
- State grants to promote health information technology
Existing Medicare –based bonus programs.
Qualified physicians using healthcare information technology in their practices may already benefit from two Medicare-based bonus programs- namely Physician Quality Reporting Initiative and e-Prescribing.
A. Physician Quality Reporting Initiative (PQRI)
Physicians may receive up to a 2 percent Medicare bonus for participation in healthcare quality reporting via the Physician Quality Reporting Initiative. The average PQRI bonuses per provider and practice range from $635 to $4,700 per year.
PQRI Background. The 2006 Tax Relief and Health Care Act (TRHCA) (P.L. 109-432) required the establishment of a physician quality reporting system, including an incentive payment for eligible professionals (EPs) who satisfactorily report data on quality measures for covered services furnished to Medicare beneficiaries during the second half of 2007 (the 2007 reporting period). CMS named this program the Physician Quality Reporting Initiative (PQRI). For each program year, CMS implements PQRI through an annual rulemaking process published in the Federal Register.
2009 PQRI. The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) (Pub. L. 110-275) made the PQRI program permanent, but only authorized incentive payments through 2010. EPs who meet the criteria for satisfactory submission of quality measures data for services furnished during the reporting period, January 1, 2009 - December 31, 2009, will earn an incentive payment of 2.0 percent of their total allowed charges for Physician Fee Schedule (PFS) covered professional services furnished during that same period (the 2009 calendar year).
As required by the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) (Pub. L. 110-173), CMS has established 2 alternative reporting periods for the reporting of measures groups and for the submission of data on PQRI quality measures through clinical data registries. The 2 alternative reporting periods are: January 1, 2009 – December 31, 2009 and July 1, 2009 – December 31, 2009. In total, there are 9 options for satisfactorily reporting quality measures data for the 2009 PQRI that differ based on the reporting period an EP chooses to report on, whether an EP chooses to report through claims or an approved clinical registry, and whether an EP chooses to report on individual measures or measures groups. The 2009 PQRI consists of 153 quality measures and 7 measures groups. This year, approximately 105 out of 153 quality reporting metrics are relevant to ambulatory care. Manually capturing and trending this data for quality reporting can be very difficult. EHRs ease this process by tracking and providing care quality reporting as a byproduct of patient care.
EPs do not need to sign-up or pre-register in order to participate in the 2009 PQRI. Submission of quality data codes for the 2009 PQRI quality measures to CMS through claims or a qualified registry will indicate your intent to participate in the 2009 PQRI.
Letter to Medicare Beneficiaries. CMS has posted a letter to Medicare beneficiaries with important information about the PQRI. The letter is from Medicare to the patient explaining what the program is, and the implications for the patient. Physicians may choose to provide a copy to their patients in support of their PQRI participation.
B. e-Prescribing
In July 2008, Congress enacted other legislation, the Medicare Improvements for Patients and Providers Act (MIPPA), to increase the adoption of e-Prescribing. Through this act, CMS offers a 2 percent incentive on the total allowed Medicare charges in 2009 and 2010 to any Medicare Part D provider who chooses to adopt a qualified e-prescribing solution. The average e-Prescribing bonus for a primary care physician ranges from $2,000 to $3,000 per year. The bonus amount will decrease to 1% of total Medicare revenue in 2011 and 2012, and to 0.5% in 2013. Beginning in 2014, physicians who are not prescribing electronically will see their Medicare payments reduced by as much as 2%.
To capitalize on the bonus, providers must electronically prescribe for a certain percentage of Medicare patients. When providers are ready to report that they are e-prescribing, they will use a combination of G-codes in the numerator and CPT codes in the denominator.
From the government's perspective, widespread implementation of the technology could save Medicare from $13 million-$146 million between 2009 and 2013. The savings are expected to be achieved through averted medication errors and the substitution of less-expensive prescription drug alternatives. Specifically, errors associated with illegible handwriting are expected to be eliminated and those linked to oral miscommunications are substantially reduced because the process is automated. Additionally, e-prescribing software provides secure electronic access to each patient's prescription history and automatically alerts physicians to dangerous drug interactions and allergies, thereby minimizing the potential for both.
E-prescribing also promises advantages that are expected to have a positive impact on physician bottom line. Automating the prescribing process should reduce time spent on phone calls and faxes to pharmacies, speed the prescription renewal request and authorization process, increase medication compliance, improve formulary adherence, allow greater prescriber mobility, and improve drug surveillance.
The financial incentives improve the case for converting from traditional to electronic prescribing as the average e-prescribing primary care doctor stands to collect an additional 2% of Medicare Part B revenues [ie an extra $20,000 for each $1,000,000 of revenues in bonuses in 2009] and the cost of an e-prescribing system ranges from $2,500 to $3,000.
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