The Department of Health and Human Services has announced David Blumenthal, MD, as the Obama Administration's National Coordinator for Health Information Technology.
Dr. Blumenthal will lead the implementation of a nationwide, interoperable, privacy-protected health information technology infrastructure that has been tasked to:
- Improve health care quality, advances the delivery of patient-centered medical care, reduces medical errors, and health disparities
- Promote a more effective marketplace, greater competition, consumer choice and improved health outcomes
- Facilitate early detection, prevention and improved management of chronic diseases
- Enable the secure and protected electronic use and exchange of health information
- Reduce health care costs resulting from medical errors, inappropriate/duplicative care, lack of information, and system inefficiencies
- Provide appropriate information to help guide medical decisions at the time and place of care
- Improve care coordination and information exchange between hospitals, laboratories, physician offices and other facilities through an effective and secure health information infrastructure.
- Ensure the inclusion of meaningful public input in such development of such infrastructure
- Improve public health capabilities in early detection and response to threats and emergencies, including bioterrorism and infectious disease outbreaks
- Facilitate health and clinical research.
The ARRA legislation also creates three new entities to develop HIT standards, policy, and assist in enforcing privacy regulations:
- HIT Standards Committee – Established to recommend to the national coordinator standards, implementation specifications and certification criteria for the electronic exchange and use of health information.
- HIT Policy Committee – A public/private entity composed from key health-care stakeholder groups, including providers, to make recommendations in a wide variety of HIT areas.
- ONC Chief Privacy Officer – Advises the national coordinator on privacy, security and data stewardship of electronic health information.
While there is much to still be decided by Dr Blumenthal, Sage will provide you with updates to the terms and provisions within the legislation as they become available, specifically: eligible professional, “meaningful use”, Medicare & Medicaid incentive eligibility criteria and comparative effectiveness research.
Eligible Professional
The Centers for Medicare & Medicaid Services (CMS) use the same definition of an eligible professional as that in section 1861 of the Social Security code. This includes medical doctors, podiatrists, optometrists, chiropractors, and dentists.
Meaningful Use
CMS will make Medicare Part B incentive payments to physicians who have demonstrated that they are making “meaningful use” of the software. While the exact definition is still to be determined by the HHS secretary, the legislation outlines three requirements:
- The EHR technology must be connected to provide electronic exchange of health information
- The physician must use certified EHR technology that includes electronic prescribing.
- The eligible professional must submit information for the period on the clinical quality measures and other measures selected by the HHS secretary.
The Secretary is empowered to accept individual state determinations of “meaningful use” for Medicaid as meeting these requirements. This provision allows practices that see relatively few Medicare patients, but large numbers of Medicaid patients, to qualify.
Eligibility for the Medicare Incentive
Physician practices are required to make “meaningful use” of "certified" EHR technology to qualify for the Medicare incentives. The Secretary will determine the definition of "certified" EHR. Under current HHS published rules providing an exception (08/06, physician self-referral prohibition law (Stark) and safe harbor under the antikickback statute), an EHR would qualify if a certifying body, recognized by the Secretary, has certified the software no more than 12 months before the date the software is provided to the practice.
Applied to the Medicare incentive, this definition may be of concern for practices that have EHRs certified more than 12 months before the Medicare incentive program and whose vendors have no plans to recertify. The HHS Secretary will need to further clarify these eligibility requirements.
Practices may satisfy the requirements proving use of the EHR and electronic health exchange by methods still to be determined by the HHS secretary. These may include:
- Response to survey
- Claims submission with CPT code supporting the use of a certified EHR
- Submission of quality measure data
- Attestation
- Other methods the HHS secretary deems necessary
The Secretary is required to develop an initial set of standards, implementation specifications and certification processes by Dec. 31, 2009.
Medicaid EHR Incentives
The incentive program for “Medicaid providers” is very different from the Medicare incentive program, setting out a platform of up-front payments for acquiring the technology. A "Medicaid provider" is defined as:
- A non hospital based “eligible professional” who has a minimum of 30 percent of their patient volume attributable to patients who receive medical assistance under this title.
- A non hospital based pediatrician, with at least 20 percent of their patient volume attributable to patients who receive medical assistance under this title.
- “Eligible professionals” that practice predominantly in a federally qualified health center or rural health clinic and have at least 30 percent of their patient volume attributable to needy individuals.
- Acute care or children's hospitals, and that have at least 10 percent of their patient volume attributable to individuals receiving medical assistance under this title
Note: The term "eligible professional" for Medicaid incentives means a physician, dentist, certified nurse midwife, nurse practitioner; and physician assistant, insofar as the assistant is practicing in a rural health clinic that is led by a physician assistant or is practicing in a federally qualified health center led by a physician assistant.
Note: Patient volume estimates will be in accordance with a method established by the HHS secretary.
Medicaid Incentive Amounts
Up to $63,750 in federal contributions is allowed toward the adoption, implementation, upgrade, operation and maintenance of a certified EHR for eligible professionals. Up to 85 percent of $25,000 (subject to a cap on average allowable costs), would be provided to eligible professionals to help them adopt, implement and upgrade certified EHR systems. Up to 85 percent of $10,000 would be provided to eligible professionals to operate and maintain EHR systems for up to five years. Physicians, non-physician providers and midwives are eligible for 85 percent of costs to adopt an EHR up to $75,000 over six years. Hospitals, community health centers and rural health clinics are eligible for the full payments.
