When President Barack Obama put his signature to the American Recovery and Reinvestment Act—also known as ARRA, or “Stimulus #1”—on February 17, 2009, he also enacted legislation to accelerate the adoption of electronic health records across the United States: the Health Information Technology for Economic and Clinical Health, or HITECH, Act.
HITECH authorizes substantial payments to physicians, and to hospitals, if they 1) utilize a government-certified electronic health record (EHR) and 2) demonstrate that they are using that EHR in a manner that advances the quality of health care—the so-called meaningful use.
On July 13, 2010, the federal government issued final rules about requirements for eligible EHR systems and reporting criteria for clinicians to demonstrate their meaningful use of the EHR. The program officially began on January 1, 2011.
TABLE 1
The 3 stages of meaningful use of an EHR
| Stage of use | What is the main goal of this stage? | By what will attainment of that goal be measured? |
|---|---|---|
| Stage 1 | To capture and share data |
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| Stage 2 |
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| Stage 3 | To improve clinical outcomes |
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TABLE 1 provides an overview of the three proposed stages of the HITECH Act. TABLE 2, page 10, is a timeline of the payment schedule for each year and stage of the HITECH program.
TABLE 2
Schedule of maximum government payments to a qualifying* physician
| Year in which you begin meaningful use | What is the highest annual payment you can receive? | ||||||
|---|---|---|---|---|---|---|---|
| 2011 | 2012 | 2013 | 2014 | 2015 | 2016 | Total payments | |
| 2011 | Stage 1 $18,000 | Stage 1 $12,000 | Stage 2 $8,000 | Stage 2 $4,000 | Stage 3 $2,000 | Stage 3 0 | $44,000 |
| 2012 | Stage 1 $18,000 | Stage 1 $12,000 | Stage 2 $8,000 | Stage 3 $4,000 | Stage 3 $2,000 | $44,000 | |
| 2013 | Stage 1 $15,000 | Stage 2 $12,000 | Stage 3 $8,000 | Stage 2 $4,000 | $39,000 | ||
| 2014 | Stage 1 $12,000 | Stage 3 $8,000 | Stage 3 $4,000 | $24,000 | |||
| 2015 | 0 | 0 | 0 | ||||
| The schedule is “front-loaded”: The largest payments are made in the first 2 years of the program. Physicians receive payments based on when they start the program. The maximum payment that a physician can receive under the Medicare rules is 75% of the professional part B allowable charges you have submitted to Medicare in the calendar year. Example: To collect the full payment of $18,000 in 2011, you must submit $24,000 in allowable professional charges to Medicare. Physicians who practice in a health-care provider shortage area receive an additional 10% of their qualifying amount. | |||||||
| *“Qualifying” refers to those who 1) utilize a certified EHR, in 2) a meaningful manner, under 3) Medicare rules for the program | |||||||
You must show “meaningful use” of your certified EHR
In the first year of the program, you must be using a certified EHR and must demonstrate meaningful use of that record over any 90-day period within the payment year (2011 or 2012).
In the second year, and beyond, the reporting period will be the entire calendar year.
Here are some of the initial rules for demonstrating meaningful use:
- You can qualify for the program through either of two mechanisms: 1) participation in Medicare and 2) through Medicaid, if 30% or more of patient encounters are with Medicaid patients. Maximum reimbursements are $44,000 and $64,000 under the Medicare and Medicaid programs, respectively. Under Medicare rules (the more common way to achieve meaningful use), all physicians qualify (midlevel providers do not qualify). Under Medicaid rules, physicians, physician assistants, nurse midwives, and nurse practitioners qualify.
- Through an Internet portal (yet to be established), you must register your EHR to determine if it is certified by the government
- 50% or more of your patient record documentation must be in a certified EHR
- You need to report on 1) functional metrics related to your EHR and 2) clinical quality metrics
- For functional metrics, there are 15 required core reporting measures and five optional measures that you select from a list of 10 items. Some of those measures include demonstrating that:
- – at least 40% of your prescriptions are written electronically
- – 80% or more of your patients have an active medication list
- – 80% or more of them have a medication allergy list
- – you perform medication reconciliation during at least 50% of your office visits
- – you use clinical decision support and electronic alerts
- – you record vital signs at 50% or more of encounters
- – 10% or more of your patients have access to their EHR through an Internet portal
- – you can exchange electronic data with a physician who is not in your organization
- – you submit immunization reports to a public health department through your EHR.