EHR Federal Stimulus: The Down & Dirty Facts A Must Read for All Chiropractors

The American Recovery and Reinvestment Act (ARRA) is currently a major point of conversation in the health care profession. Doctors, chiropractors and other professionals understand that this "stimulus bill" includes over $19 million dollars to help convert practices from paper clinics to digital clinics over the next decade, but many are wondering what it means for them and their practices. It is obvious there is a strong governmental push to reform our health care system, but how will it affect your practice?

Significant Financial Incentives
What has many health professional interested in the ARRA is the significant financial incentives offered to those practices who adopt and implement a qualified electronic health record (EHR) system like the system offered by Future Health. Doctors who implement qualified EHR systems can expect to receive a maximum of $44,000 through reimbursements from the federal government. Those who demonstrate "meaningful use" of a qualified EHR system in 2010 will begin receiving the maximum of $44,000 spilt up over four years: $18,000 in the first year, $12,000 in the second year, until the maximum $44,000 amount is reached. The maximum amount of reimbursement will continue to decrease each year, until by 2015 (*Check date) no money will be available.

Medicare Program
This program is designed to be issued through the Medicare program and incentives will be distributed through this program. In my meetings with the staff at the US Department of Health and Human Services, they indicated that the federal reimbursements would only be available to those doctors who bill Medicare for at least $25,000 dollars per year in approved services will be eligible. This policy, however, has not yet been finalized and there was also talk of have a portion of the $44,000 available to those clinics who fail to meet this requirement. In order to meet this requirement a practice needs to see approximately 16 Medicare patients a week with an average of $33 dollars a visit in order to reach the $25,000 in annual approved Medicare billings.

Reimbursement will most likely be calculated as 75 percent of Medicare billings, up to the $44,000 cap annually. In addition, doctors must demonstrate "meaningful use" of their qualified EHR system. This means they must have over 80 percent of their patients on an EHR system which has been identified to be interoperable with other certified systems. The EHR needs to be a part of case management and improving quality of care. This will eliminate digital note generators as they fail to meet these requirements and do little more than make a doctor's notes legible.

Why Digital Clinics? Why Now?
The big push towards digital clinics was not initially based on benefiting practices economically, even increase intra-office efficiency, or even due to decreased overhead. In fact the real motivate behind digital clinics stemmed from EHRs offering the ability to increase quality of patient care while simultaneously also decreasing the overall cost of the health care system. EHRs offer the ability of a low cost health care system which allows practitioners to have quick access to well-organized documentation of a patient's health care record. EHRs pose to help connect health professionals of different clinics like between medical doctors and chiropractors strengthening our overall health care system.

This interconnectivity between offices and instant access to health records allows health professional to eliminate all of the time spend maintaining, moving, and copying a patient's health record. Qualified EHR systems are created with efficiency and effectiveness in mind. These qualified EHR systems offer four major benefits to health care professions:

  • 1) More time to see patients - This is thanks to the ability of qualified EHR systems to create lists, reminders, alerts and warnings. This will help to keep busy doctors on track and organized as they see their patients.
  • 2) Reduce the amount of negative drug interactions - With more doctors having access to patients' records, when a patient visits another health care professional they can immediately see what the previous the doctors had done to treat the ailment.
  • 3) Off-site backup - By backing up these EHR off site, doctors are assured of that their patient's files are protected. If a natural disaster, like a hurricane or a flood, were to suddenly destroy a clinic, their patient's documents are securely insured.
  • 4) Interconnectivity between practices - A central resource can allow professionals to receive instant information on what information would be the best for a specific condition. Doctors would be instantly informed that chiropractors are exceptionally good at healing low back pain.

What about Security?
The security of a patient's documents is of the utmost concern for those health practitioners considering the switch to a digital clinic. The security systems involved in a certified EHR system will be able to identify who all has been involved in a patient's documents. According to Joe Brisson of HIT associates, using these documents without permission "would be the last time you ever practiced." These documents are not all stored in one location but rather the EHR rapidly access them from multiple different locations.

I can personally state that the patient is in charge of what gets shared. Patients are in charge of sharing their records and can dictate what is included in any data transmission between offices. Patients are also able to create personal health records (PHR) composed of all their health information. If a patient does not approve the sharing of certain data, then it cannot legally be shared.