Frequently Asked Questions
What does the Act mean by "qualified product"?
I have a qualified EHR, but what does "meaningful use" mean?
There is so much hype about EHR's because of the stimulus incentive. Why should I buy now instead of wait?
I have a multi-provider clinic, how much of an incentive can I receive?
I already have an EHR system and I'm happy with it. Do I need to change?
Still have questions? Read the latest on the Stimulus.
Dispelling the myths about EHR and economic stimulus
The American Recovery and Revitalization Act of 2009, casually known as the economic stimulus package, has generated a lot of buzz recently across the chiropractic profession. A section of the ARRA is known as the HITECH Act and it deals with health information technology. As I travel to various meetings and conferences, speak to groups about clinic technology, I am discovering that substantial misinformation is floating around, and rumors about the package and its relationship to chiropractors are rampant.
I have been very fortunate to interact and meet at HHS kwith many of the decision and policy makers in Washington, D.C., regarding healthcare reform and technology's connection to it. This article will help dispel some of the myths that are swirling around in the industry, and simplify some of the complexities for my colleagues. Following is a list of the greatest myths I've encountered, and the truth behind them:
MYTH: Chiropractors are not eligible for reimbursement for implementing a qualified electronic health records system.
FACT: The government is using the definition of "physician" from the Social Security code, which includes chiropractic physicians. Thus, doctors of chiropractic are eligible to receive reimbursement for implementing EHRs, as long as they meet the other established guidelines.
MYTH: Any electronic system will qualify me for reimbursement.
FACT: Only qualified EHRs that are used meaningfully will be considered for incentive payments. To be a qualified EHR, the system must have the capacity to handle patient demographics and clinical health information, and have clinic management capabilities, as outlined by the entity that certifies qualified EHRs. Only certified EHRs will be considered for reimbursement, and while the certification entity has not yet been named, most predict it will be the Certification Commission for Healthcare Information Technology, since it is the only federal government recognized entity on EHR certification today.
"Meaningful use" is defined by three key measures: (1) Connectivity to health information exchanges (HIEs) and other EHRs; (2) Regular reporting of quality measures, including outcome assessment scores and pain assessment; and (3) e-prescribing capability (Note: Because chiropractic physicians don't have prescribing privileges, it is unknown whether this will remain a requirement for DCs).
Digital note taking systems and other automated documentation programs that don't meet these criteria will not be considered for federal or state payments.
MYTH: I can't receive reimbursement if I've already implemented EHR in my clinic.
FACT: Early adopters are included, even if it was last year. Any doctor who has transitioned to an EHR system that meets the government requirements for incentive payments is eligible for full payment amounts, as long as the qualified system is implemented and "meaningful use" is demonstrated in 2010. Incentive payments begin to decrease on a sliding scale if implementation occurs after 2011. The chart included with this column outlines the incentive payments schedule based on the year of implementation and assuming meaningful use.
MYTH: If I choose not to implement EHR in my clinic, nothing will happen to me.
FACT: Penalties will be assessed on doctors who opt not to transition to EHRs beginning in 2015 and will continue through 2018. Those penalties are expected to be assessed through Medicare reimbursement payment reductions..
MYTH: I will only get reimbursed for the amount I spend on my EHR system.
FACT: The incentive payment amounts have been set by the federal government and are generally higher than the amount of investment required to implement an EHR system. It has nothing to do with how much you spent on your EHR. The government wants to motivate doctors to implement an EHR as soon as possible, and has created a strong financial incentive plan to move the process forward swiftly. The sooner doctors implement, the more incentive payments they can receive. The chart included with this column shows that incentive payments may be as high as $44,000, a substantially higher benefit than the average cost to implement a system, which can range from $10K to $20K in chiropractic. The federal government recognizes that there are hardware costs, training costs, and possible revenue lost during the initial conversion and phase in of the sytem when extra staff time is needed to convert to a digital HER, and have accounted for those costs in the $44,000 incentive payments.
MYTH: Only the clinic receives incentive payments for implementing EHR, not the individual doctor.
FACT: The incentive payments program has been set up to benefit physicians specifically. This means that several physicians who practice in the same clinic can each qualify for incentive payments, as long as all the individual doctors are using a qualified system meaningfully, according to the incentive payments requirements. For clinics with multiple doctors, this can be a tremendous windfall. Three doctors equals $132,000.00. Hospitals are eligible to receive up to $11 million dollars.
MYTH: Now that the government is incentivising all physicians to adopt EHRs, the government will be able to dictate how we deliver care.
FACT: Nowhere in any of the legislation does it indicate that the government will impose on the methods of delivery of patient care. Rather, an agency called the Office of the National Coordinator of Healthcare Information Technology (ONCHIT) was established in 2004 to facilitate the implementation of EHRs across healthcare entities. The office is only given authority to organize the implementation process, and is not charged with overseeing actual delivery of care and how you treat patients, but rather how you capture information and report on whether or not you collected the information in your case management.
More truth to come
Our friends at ONCHIT are working furiously to establish the rules and standards that will govern the incentive payments for EHR implementation that have been funded by the economic stimulus package HITECH portion of the ARRA of 2009. The final decisions about a qualified EHR and meaningful use, as well as other applicable requirements, will be determined by the end of December 2009.
Meantime, you have my commitment that I will continue engaging these authorities and advocating on behalf of chiropractic physicians, to bring you the most up-to-date information and ensure that our profession enjoys the best outcome from this legislation. Please look for future columns from me that will bring additional clarity to the implementation and incentive payment process as it develops. Start planning your implementation now.