Electronic Health Records and the Medicare / Medicaid Incentive Program: Five Reasons to Hold Off on Purchasing an Electronic Health Records Product

 

If your health care practice has not yet purchased and/or converted to an Electronic Health Records (“EHR”) product, there are, at minimum, five reasons why your practice should consider holding off on making the purchase for a few more months. 

  1. To date, no EHR product has been certified as capable of meeting the criteria to support “meaningful use and quality eligible providers and hospitals” for funding under the American Recovery and Reinvestment Act (“ARRA”). In fact, it was only on August 30, 2010 that the Office of the National Coordinator for Health Information Technology announced that it had approved two organizations – CCHIT and The Drummond Group - to act as Authorized Testing and Certification Bodies (“authorized body”) to begin certifying EHR products. Eligible professionals, hospitals and critical access hospitals participating in the incentive program must use an EHR product certified by an authorized body to receive benefits.
  2. Providers hoping to participate under the Medicaid Incentive Program will not have complete “meaningful use” criteria until (and unless) each individual State launches its additional requirements for meaningful use. States choosing to launch a Medicaid Incentive Program will do so beginning in January, 2011. In doing so, each State will be required to identify four (4) additional core “meaningful use” objectives for their Medicaid providers. Until each State has identified its individual core objectives, Medicaid providers have no way of knowing whether, and with what functionality, an EHR product can fulfill the practices specific EHR needs.
  3. Most EHR products will require upgrades and/or additions before becoming certified EHR products. Most EHR products on the market today will need to (a) be upgraded and/or (b) add new functionality to meet the criteria of a certified EHR product. For instance, CCHIT certified less than thirty EHR products - there exist three hundred+ vendors on the market today - as meeting “Preliminary ARRA” requirements (“Preliminary ARRA” certification was given to EHR products that were tested against and met the published certification criteria and standards in the HHS Interim Final Rule of January 13, 2010).
  4. Registration for the EHR Incentive Programs does not begin until January, 2011.  Providers will not be able to register for an EHR incentive program until January, 2011 and attestation for the Medicare Incentive Program will not begin until April, 2011. Accordingly, while early use of an EHR product may have distinct and undisputable benefit to any health care practice, in terms of the incentive programs there is no immediate need to commit to any one product until data on certified EHR technology is available.
  5.  Multiple demonstrations and training are critical to making an informed decision. Providers are encouraged to begin conducting their search for an EHR product early on and to audit as many products as possible.  Moreover, once a practice has narrowed its EHR search down to a particular product, it is encouraged to participate in multiple demonstrations and to include its key employees (i.e. medical billers and coders, compliance officers, nurses and intake personnel) for individual feedback and criticism. Keep in mind that demonstrations by sales representatives and individual software testing can take a few hours each time so the sooner providers begin researching and testing these EHR products, the easier it will be to make an informed decision when the time to purchase an EHR product comes.

 

What Does CCHIT EHR Certification Mean For Receiving Financial Incentives Under the ARRA?

The Certification Commission for Health Information Technology ("CCHIT"), a non-profit organization that independently certifies health information technology, has put together a preliminary ARRA certification criteria for EHR (pdf) that it believes will meet the requirements for receiving EHR financial incentives available under the ARRA.

Currently, CCHIT is the only Department of Health and Human Services ("HHS") recognized certifying body.  As such, it will likely determine which EHR software will enable providers to make  "meaningful use" of their EHR when HHS publishes the final definition of  "meaningful use." When the definition is published, certification will be necessary for providers to receive the financial incentives available under the ARRA. 

The preliminary guide focuses on Ambulatory and In Patient EHR, and promises ongoing updates as more information becomes available. 

One Step Closer to a National EHR Certification System

As noted in a previous post, only providers using nationally certified EHR systems will be eligible for the financial incentives available under the ARRA.  Currently, there are no nationally certified EHR systems, and no certification criteria has been named.

The Certification Commission for Healthcare Information Technology (“CCHIT”), a recognized certification body for electronic health records (“EHR”), has submitted its proposed EHR certification criteria(pdf), which maps the requirements of an ARRA qualified EHR, to the HIT Standards Committee for review and approval.  CCHIT anticipates feedback on the proposed certification criteria by August 26, 2009, and will begin accepting applications from EHR vendors shortly after receiving the anticipated “green light.”

CCHIT has already named many EHR vendors as “CCHIT Certified 08,” but this certification does not have any connection to the national certification required under the ARRA, and does not guarantee eligibility for the financial incentives.
 

EHR Incentive Payments Contingent on "Meaningful Use" of EHR Software

The most common question posed by private medical practices concerning the incentive payments available under the American Recovery and Reinvestment Act ("ARRA") goes something along the lines of: "how do you actually get the money"? 

Well, as you can imagine, the government won't just mail you a check.  Non-hospital based providers will be eligible to receive up to $44,000.00 in bonus payments from Medicare, over an above the allowed Medicare charges.  The incentive payments will either be broken down into several partial payments throughout the calender year, or they will be paid in a lump sum; the technicalities are yet to be worked out.

However, in order to be eligible for the incentive payments, providers must make "meaningful use" of their EHR software.  “Meaningful use” is not specifically defined in the ARRA, but the ARRA does give the Secretary of Health and Human Services (HHS) advisory guidance regarding how to determine its meaning.

On April 29, 2009, the National Committee on Vital and Health Statistics, the key advisory panel to HHS on Health Information Technology, held a two-day hearing on "meaningful use" of EHR systems.  To date, no determination as to the definition of "meaningful use" has been made, but an HHS rulemaking determining its statutory definition is expected this year.