EMR Question & Answer
On February 17, 2009, President Obama signed The American Recovery and Reinvestment Act of 2009, effectively allocating $19.5 billion for electronic medical record (EMR) adoption. Incentive payments to physicians commence in 2011, with anticipated reimbursements exceeding $40,000-$60,000 per physician over a 5-year period.
What impact does the stimulus bill have on physician practices?
Physicians effectively must prove meaningful use of a certified electronic health record according to Health and Human Services to receive up to $44,000 in stimulus incentive payments through the Medicare incentive option, or up to $64,000 through the Medicaid incentive alternative.
What is a certified electronic health record?
At this point in time, to be eligible for stimulus incentive payments, electronic medical records must be certified by the Certified Commission for Healthcare Information Technology (CCHIT), an organization that was created out of the largest Healthcare Information Technology Association, HIMSS.
How do you determine meaningful use?
Meaningful use was initially defined as having an electronic record of health-related information on an individual that-
- Uses e-prescribing
- Can electronically exchange information
- Will submit clinical quality measures
As of 6/16/09 initial recommendations were released expanding the requirements to include Goals, Objectives and Measures to be achieved annually through 2015. The initial 22 objectives fell into the following categories:
- Allow patients to access clinical information;
- Comply with state and federal privacy, security and data sharing regulations;
- Document patient progress and provide clinical summaries;
- Exchange critical information with other care providers;
- Implement drug interaction safeguards;
- Send patient reminders about follow-up and preventive care;
- Submit immunization and laboratory data to relevant public health registries; and
- Use computerized physician order entry systems to transmit prescriptions.
For the entire matrix, go to: http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_11113_872719_0_0_18/Meaningful%20Use%20Matrix.pdf
When will stimulus incentive payments be distributed?
On May 21, 2009, HHS announced that Medicare incentive payments to physicians will begin in January 2011. It is expected that any payment would be distributed as a percentage increase of Medicare/Medicaid reimbursements, not as a lump sum check.
How are the Medicare reimbursements calculated?
The Medicare payments will be calculated by multiplying the submitted allowable charges to Medicare by 75%, up to the capped amount for the year. So a physician aiming to collect the full incentive payment of $18,000 in 2011 will need to submit allowable charges of at least $24,000. Conversely, a physician submitting only $16,000 in allowables would collect $12,000 in 2011, even though the cap is higher.
When would physicians become eligible for incentive payments and how much could be received?
Medicare Incentive payments begin in 2011 and progress according to the following table:
First Year Qualified | 2011 | 2012 | 2013 | 2014 | 2015 | 2016 | Total Incentive Collected |
2011 | $18,000 | $12,000 | $8,000 | $4,000 | $2,000 | - | $44,000 |
2012 | - | $18,000 | $12,000 | $8,000 | $4,000 | $2,000 | $44,000 |
2013 | - | - | $15,000 | $12,000 | $8,000 | $4,000 | $39,000 |
2014 | - | - | - | $12,000 | $8,000 | $4,000 | $24,000 |
2015 or later | - | - | - | - | - | - | $0 |
What is the difference between the Medicare and Medicaid incentive options?
It is important to note that physicians are eligible to receive incentive payments from either Medicare or Medicaid, not both. Each individual physician must assess which option will provide him or her with the greatest benefit.
To qualify under the Medicaid incentive option, physicians must be able to demonstrate meaningful EMR use by 2015, with patient breakdown as follows:
- At least 30% of patients pay with Medicaid
- At least 20% of patients pay with Medicaid (unique to Pediatricians)*
The exact incentive amount each physician can expect to receive under the Medicaid option will be calculated based on the physician’s Medicaid mix, as well as applicable IT expenses. The Medicaid incentive option will not be available after 2021.
*Pediatricians seeing 20% of patients paying with Medicaid are eligible to receive 66% of stimulus payments.
Does the cost of the EMR system affect the reimbursement allocation?
No, reimbursement allocation is based solely on the ability to demonstrate meaningful EMR use by:
- 2011 for maximum reimbursement
- 2015 to avoid Medicare fee schedule and reimbursement rate reductions
Can a practice with multiple physicians receive multiple incentive payments?
Yes, provided each physician in a practice successfully meets all criteria to receive stimulus payments, the practice can collect up to $44,000 (Medicare) per physician in stimulus incentive payments. For example, a 10-physician practice has the potential to collect $440,000.
Are there consequences for not utilizing an EMR system?
Physicians who fail to demonstrate meaningful EMR use by 2015 (must be in place by 2014) will face reductions to Medicare fees schedules and reimbursement rates according to the following table:
Year | 2015 | 2016 | 2017 | 2018 and beyond |
Medicare Fee Schedule payment | 99% | 98% | 97% | 96%* |
*If fewer than 75% of eligible physicians are not utilizing EMR’s by 2018, reductions can jump to 96% of the Medicare Fee Schedule, and then 95% in subsequent years.
When will we know the details of the plan?
Nobody knows for sure, but by the conclusion of 2009, HHS expects to have:
- Coordinated with the Office of the National Coordinator for Health IT to create related policies for the incentive programs, including the definition of meaningful use; Established proposed rules to permit public input on the incentive program policies; Mapped out systems and other requirements to support the incentive programs;
- Planned a national outreach program.
Why should we contact Amnet for additional information regarding the stimulus?
We are committed to meeting all requirements of the stimulus to ensure our clients receive the maximum benefit they are entitled to.
