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Stimulus Center

 

Keeping up with the ever-changing world of healthcare technology can be challenging. Aquarius makes it easy for physicians by synthesizing the most up to date healthcare regulations and certification information so you don’t have to.

What is the Stimulus Package (ARRA)?

The American Recovery and Reinvestment Act of 2009 (ARRA) set aside $787 billion with the intention of creating jobs and promoting investment in consumer spending during the recession. Often referred to as the Stimulus Package, the Act includes federal tax cuts, expansion of unemployment benefits and other social welfare provisions, and domestic spending in education, health care, and infrastructure.


What is HITECH?

The Health Information Technology for Economic and Clinical Health Act (HITECH Act), enacted as part of the Stimulus Package, addresses the privacy and security concerns associated with the electronic transmission of health information. HITECH issued guidance on how to secure protected health information appropriately and allocated $19 billion in Medicare and Medicaid incentives to hospitals and physicians who purchase health information technology and demonstrate “meaningful use” over the next five years.


Why Should I Care?

In exchange for demonstrating “meaningful use” of certified health information technology, or electronic medical records (EMR), the government has committed to paying $44,000 - $64,000 per physician as a percentage of Medicare and Medicaid charges. The government structured this incentive program by offering bonuses for 5 years to physicians who adopt EMRs, followed by penalties that get increasingly steep each year for those slow to adopt the technology.

Amount Physicians Will Receive Each Year (Medicare)
Year EMR is adopted 2011 2012 2013 2014 2015 2016 Total
2011 $18,000 $12,000 $8,000 $4,000 $2,000 $0 $44,000
2012 $0 $18,000 $12,000 $8,000 $4,000 $2,000 $44,000
2013 $0 $0 $15,000 $12,000 $8,000 $4,000 $39,000
2014 $0 $0 $0 $12,000 $8,000 $4,000 $24,000
2015 or later $0 $0 $0 $0 $0 $0 $0
               
Amount Physicians Will Receive Each Year (Medicaid)
Year EMR is adopted 2011 2012 2013 2014 2015 2016 Total
2011 $25,000 $10,000 $10,000 $10,000 $10,000 $0 $65,000
2012 $0 $25,000 $10,000 $10,000 $10,000 $10,000 $65,000
2013 $0 $0 $25,000 $10,000 $10,000 $10,000 $55,000
2014 $0 $0 $0 $10,000 $10,000 $10,000 $45,000
2015 or later $0 $0 $0 $0 $10,000 $10,000 $35,000

It's important to remember, you won't get any cash for simply purchasing an EMR; you have to show that you're using it in a "meaningful" way.

 

Do I qualify for the HITECH money?

If you have Medicare or Medicaid patients, you may qualify for the HITECH incentives.

To qualify for $44,000 or more in HITECH stimulus incentives you must be a:

Doctor of Medicine or Osteopathy – M.D. or D.O.
Doctor of Dental Surgery or Medicine – D.D.S or D.D.M
Doctor of Podiatric Medicine – D.P.M.
Doctor of Optometry – O.D.
Chiropractor – D.C.
Physician assistant, nurse practitioner, or clinical nurse specialist
Certified registered nurse anesthetist
Certified nurse-midwife
Clinical social worker
Clinical psychologist
Registered dietitian or nutrition professional

Working for one of the following:

Hospitals
Skilled nursing facilities
Nursing facilities
Home health entities
Long term care facilities
Health care clinics
Community mental health centers
Renal dialysis facilities
Blood centers
Ambulatory surgical centers
Emergency medical service providers
Federally qualified health centers (FQHC)
Group practices
Pharmacists
Laboratories
Physicians
Practitioners
Indian Health Service providers
Rural health clinics
Therapists

In one of these locations:

All 50 US states
The District of Columbia
Puerto Rico
The Virgin Islands
Guam
American Samoa
The Northern Mariana Islands

What is Meaningful Use (MU)?

In order to receive the HITECH incentives, physicians must meet the above criteria and prove that their healthcare information technology (HIT) is being used in a meaningful way.

There are three stages of Meaningful Use. Stage 1 criteria was release on July 13, 2010. Stage 2 and Stage 3 are not yet defined.

Stage 1Criteria:

* Begins 2011
* 15 core objectives/measures plus 5 additional tasks from a menu of 10 for eligible providers
* Focus on capture of health info in coded format
* Use that information to track key clinical conditions
* Communicate that information for care coordination purposes
* Initiate reporting of clinical quality measures and public health information
* First payment year allows EHR meaningful use for any continuous 90-day period within the payment year
* Second payment year and subsequent payment years, the reporting period is over the entire year

The first phase of the reporting period for physicians begins January 1, 2011 with reimbursement funds becoming available May 2011. For the first year only, companies can “attest” that they have met the requirements However, beginning in 2012, electronic reporting of meaningful use measures will be required.

What are the 25 Objectives for Eligible Providers?

Eligible Providers must meet all 15 Core Objectives and 5 out of the 10 Menu Objectives:

Core Objectives:

1. Generate and transmit prescriptions
     * 40% of all prescriptions
2. Electronically exchange key clinical information
     * Performed at least once
3. Enable drug-drug and drug-allergy interaction check
4. Implement EHR security settings to protect PHI
     * Conduct or update security risk analysis and ensure security is updated
5. Implement one clinical decision support rule
6. Record demographics
     * Language, gender, race, ethnicity, DOB for 50% of patients
7. Record smoking status
     * 50% of patients over 13
8. Record and chart vital signs
     * 50% of patients over age 2 need to track height, weight, blood pressure, plot and display growth charts for kids (2-20) and include calculated BMI
9. Maintain active medication list
     * 80% of all patients have an entry recorded, or an indication that there is nothing prescribed
10. Order medication directly from the EMR
     * 30% of the patients who have a medication in their list have had it ordered through the system
11. Maintain active medication allergy list
     * 80% of all patients have an entry recorded, or an indication that there is no medication allergies
     * Doesn’t specify whether data should be kept regarding manifestation of allergy
12. Maintain up-to-date problem list
     * 80% of unique patients seen have at least one entry or indication there is no problem
13. Provide patients with an electronic copy of their health information
     * 50% who request an electronic copy receive it within 3 days
     * Includes diagnostic test results, problem list, medication list, medication allergies
14. Provide clinical summary for patient for each office visit
     * Provided to patients for more than 50% of all office visits within 3 business days
15. Report ambulatory clinical quality measures
     * For 2011, provide aggregate numerator, denominator and exclusions through attestation
     * For 2012, electronically submit the clinical quality measures

Menu Objectives:

1. Provide a summary of care record for transition or Referral
     * Provided for at least 50% of all transitions of care
2. Implement drug-formulary checks
3. Incorporate lab test results
     * Results of 40% of all lab orders are listed
4. Send reminders to patients per patient preference for preventative/follow up care
     * 20% of all patients over 65 or under 5 are sent appropriate reminders
5. Provide patients with electronic access to their health information
     * Includes lab results, problem list, medication list, medication allergies
     * Subject to EP discretion
     * Supplied within 4 business days of being updated
6. Use EMR to identify patient specific education resources
     * 10% of patients are provided with resources
7. Generate lists of patients by specific conditions
     * Used for quality improvement, reduction of disparities, outreach, research
     * Generate at least one report with specific condition
8. Provide a summary of care when transitioning patients to another setting or referring to another provider
     * 50% of transitions include a summary of care record
9. Submit e-data to immunization registries or Immunization Info Systems
10. Capability to submit electronic syndromic surveillance data to public health agencies

 

What do I need to know about Certification?

On July 1, 2010 the Office of the National Coordinator (ONC) began accepting applications from entities who would like to be approved as an ONC Authorized Testing and Certification Body (ATCB). ONC-ATCBs will use ONC established criteria to approve EHRs.

EHR products that were previously certified by CCHIT will not be grandfathered in. However, it is highly likely that that products that are CCHIT 2011 certified will meet the ONC-ATCB criteria.

ONC estimates that entities will be approved by early fall 2011 and EHRs will begin to be certified by the end of the year.

 

Is the Aquarius EMR Certified?

Yes. The Aquarius EMR is powered by NeoDeck Software, which was included in the first round of ONC-ATCB Certification for 2011/2012 technology. For more information, see the CCHIT announcement.

 

Do I qualify for the Medicare and Medicaid reimbursements?

Eligible Providers must:

* Be enrolled in Medicare FFS/MA or Medicaid FFS/managed care
* Have an NPI
* Be enrolled in PECOS

 

What is the difference between the Medicare and Medicaid incentive options?

Physicians can opt for either the Medicare program or the Medicaid program, but not both. Medicare is administered by the Federal government, while Medicaid is largely left to the individual states. Size of grants (or bonuses) paid to doctors is connected to the amount of service doctors provide under the respective programs. Payments will be made on a diminishing scale over five year period with those for Medicare terminating in 2015 while those of Medicaid currently have no established expiration date. Program details and definitions will continue to evolve.

 

What kind of reporting will I have to do in order to get my reimbursement?

Reimbursement are directly tied to reporting. You will be required to report on all patients in a practice to meet the Medicare / Medicaid percentage of total patients. It is likely to include some granularity in the visit, diagnosis and treatment of those patient populations. Granularity will mean provider EMR input. This requirement is to ensure that an EMR must be used, installing and not using or using only certain features of an EMR will not qualify the provider for a reimbursement.

 

How do I file, apply, and send notifications to the Centers for Medicare and Medicaid Services (CMS) in order to receive reimbursement?

Incentive program registration is not yet available. However, visit the monitor site on a regular basis at www.cms.gov/EHRIncentivePrograms for updated information.


When will CMS begin reimbursing eligible providers?

The first phase of the reporting period for physicians begins January 1, 2011 with reimbursement funds becoming available May 2011. For the first year only, companies can “attest” that they have met the requirements However, beginning in 2012, electronic reporting of meaningful use measures will be required.

 

 

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