The Reality of Future Health's EHR and the Governmental Stimulus Plan

There have been major developments concerning the electronic health records (EHR) section in the economic stimulus plan. The American Recovery and Reinvestment Act of 2009 is guaranteed to have a significant impact on healthcare with the more than $19 billion dedicated to the implementation of EHR across the nation. Although government officials are still establishing the regulations concerning the distribution of these substantial funds, there have been a few selected policies already determined.

I have done some of the research for you by examining all of the documentation surrounding the introduction of Future Health's EHR into your clinic. Below I have tried to explain the known requirements to assist you in your decision towards adopting a true EHR. What most clinics are focused on is how EHR adoption will affect their bottom lines and clinic management. The greatest impact of this will stem from the incentive payment requirements to capture the maximum amount of $44,000.

Your Clinic Can Receive Up To $44,000 for Adoption of EHR
The EHR incentive packages are designed for physicians, including doctors of chiropractic. This is an important distinguishing point as not all healthcare professionals are eligible for these incentive payments, but DCs are amongst the approved group.

There are two key factors to determining your eligibility:

• 1) Is the EHR product qualified?
• 2) Will the adopted EHR be utilized meaningfully in your practice?

Do I have a qualified product?
Qualified EHR will be able to handle patient demographics and clinical health information. The EHR must also have clinic management capabilities. These will be detailed by an entity that certifies qualified EHR. While this agency has yet to be named, I feel strongly that the Certification Commission for Healthcare Information Technology (CCHIT) will be the selected body as it is currently the only entity approved by Medicare for EHR certification.

Future Health's fully implemented system on their Virtual Office Suite (VOS) contains all of the necessary components to transform your practice into a successful one. VOS includes: electronic documentation, EHR, electronic scheduling, electronic billing, and electronic patient education. These modules can revolutionize your practice with a multitude of exciting benefits.

Will I be using EHR meaningfully?
Meaningful use is defined as:

• 1) Connectivity to health information exchanges (HIEs) and other EHR
• 2) Regular reports on quality to the Centers for Medicare Services (CMS). This will include outcome assessment scores and pains assessments.
• 3) Having E-prescribing capability. As of date, this requirement has not been clarified as to whether this will be a requirement for DCs as they do not have prescribing privileges.

The framework governing this introduction, suggests that the reporting quality measures to CMS will likely be managed by PQRI, the Physicians' Quality Reporting Initiative, a standardized mechanism that already exists. Further explanations of these reporting requirements are to be released at a later date.

Eligibility to Receive the $44,000
If you can sincerely answer 'yes' to both of these questions, then up to $44,000 is available for your clinic by adopting and implementing EHR.  In addition for clinics with multiple physicians, each physician can qualify for incentive payments, as long as a qualified system will be used by these physicians and each will be utilizing it meaningfully. For larger clinics, this could amount to a major cash infusion for their practice; for example, four doctors in one clinic could be eligible for a total of $176,000.

To qualify for the full incentive payment of $44,000, your EHR system has to meet the aforementioned qualifications no later than 2010 to begin earning incentive payments in 2011. If you've already adopted a system that meets these guidelines, then you automatically will qualify for the incentive payment. 

At this current point in time, we know that the Department of Health and Human Services and the Center for Medicare Services will be involved. However their specific roles are still being determined with regards to reporting and eligibility requirements for doctors participating in the incentive program. There are some suggesting minimum billing thresholds such as an annual $25,000 in covered services to CMS be required. However others suggest that if this threshold is not met then proportionate payments should be made. So if you average 16 Medicare patient visits a week, then you would most likely qualify. I will be reporting further on these matters once more specifics details of the incentive program have been made available.

When Should I Start Implementation?
Many are beginning to wonder when the best time to begin transitioning to an EHR system would be. My opinion is you should start this process as soon as you finish reading this article. Statistically it takes 90 days to six months to plan, train, and implement the new EHR system. PQRI currently states you must report on 80 percent of your patients. Assuming this PQRI is a requirement for demonstrating meaningful use it stands to reason that you would have to use the system for the better part of 2010 to begin receiving your first incentive payment in 2011.

In a recent survey of over 800 chiropractors conducted by my company on implementation plans, three out of four doctors indicated they would consider transitioning to an EHR in the next 12 months. Given the information we have available, this is in line with the timeframes associated with accessing the maximum incentive payments available.

Your ideal timeline:

• Implement in 2009
• Use the system in 2010
• Begin receiving incentive payments through Medicare in 2011.

The longer you wait, the more you decrease your chances of receiving the highest amount of payment. Worse yet is if you choice not to hop aboard this revolutionary transition, it is likely your practice could begin to be penalized in 2015 through 2018. These penalties will be subtracted from your normal reimbursement for services from Medicare.

Now is most opportune time to make this momentous transition to EHR. Of DCs, 15 to 20 percent of you have already made this switch. The time has arrived for all chiropractic physicians to adopt EHR today. There is simply no excuse to wait any longer. Once implemented a true EHR will allow you to experience the follow benefits: better quality of care, improved case management for cost efficiencies, and better practice management efficiencies, in addition to achieving a lowering overhead. There are so many great reasons to adopt EHR today!