1. What does the bill mean to the typical physician?
The opportunity provided to qualifying physicians is significant. Basically, the Bill provides that qualified physicians who utilize a certified electronic health record in a “meaningful” way will receive incentive payments through additional reimbursements via either Medicare or Medicaid, depending upon the individual physician’s payor mix. Incentive payments ranging from a maximum of $ 44,000 under the Medicare incentive option or $ 64,000 under the Medicaid option are available to EACH qualifying physician, regardless of group practice size. The payments are made over a five year period beginning in 2011.

2. Have necessary laws been enacted and funds appropriated towards this incentive?
The American Recovery and Reinvestment Act was signed into law on February 17, 2009 and an appropriation of $19.2 billion dollars has been made towards Health Information Technology (HIT), to encourage the adoption of EHR systems.

3. What is the difference between the Medicare and Medicaid incentive options?
The HITECH Act (part of the American Recovery and Reinvestment Act) outlines two separate and distinct incentive payment programs, one through Medicare and one through Medicaid. Providers can only receive incentive payments from one of the programs and will need to determine where they stand to benefit most.

Generally, the Medicaid program offers up to $64,000 to physicians who see more than 30% of patients paying with Medicaid, (20% for pediatricians). The Medicare program offers individual physicians up to $44,000 in incentive payments.

4. Are all physicians in The U.S. eligible for incentive payments from Medicare and Medicaid?
Physicians that do not accept Medicare or those that do not have a patient payor mix of greater than 30% Medicaid (20% for pediatricians) will not qualify for the HITECH incentive payments. Furthermore, physicians operating solely in a hospital environment, such as pathologist, anesthesiologist, or emergency physicians are not eligible.

5. Are groups that do Medicare Advantage also eligible for the stimulus dollars?
Yes, there are provisions of the Bill related to groups accepting Medicare Advantage. Those organizations and their providers are eligible for the incentives as long as the provider delivers a minimum of twenty hours a week of patient care services and the organization furnishes at least 80 percent of the services of the individual professional to clients of their organization.

6. How are Pediatricians and Family Physicians going to be able to participate?
If a physician does not meet the Medicaid payer mix threshold and does not accept Medicare, they will be able to apply for grants and/or loans to offset the upfront costs of the purchase of an EHR but will not be eligible for incentives as currently delineated.

Additionally, the Secretary of HHS will be assessing utilization levels beginning in 2011, and if he or she believes that there is a need to offer other incentives to prompt adoption among those populations of providers, that will be addressed then.

7. When would I become eligible and what is the time line for payments under Medicare?
The incentives would be received only upon meaningful use of certified EHR Technology and on serving Medicare patients. It is expected that the Stimulus payment will equate to 75% of the physician’s total Medicare allowable capped at the amounts indicated below. Stimulus payments would commence in 2011 and continue according to the following timeline:

Year First Qualified	2011	2012	2013	2014	2015	Total
2011	$18,000	$12,000	$8,000	$4,000	$2,000	$44,000
2012	$0	$18,000	$12,000	$8,000	$4,000	$42,000
2013	$0	$0	$15,000	$12,000	$8,000	$35,000
2014	$0	$0	$0	$15,000	$12,000	$27,000
2015 or later	$0	$0	$0	$0	$0	$0

*Eligible professional serving “Health Professionals Shortage Area” will receive an incremental payment of 10%.

8. Can a physician be penalized for not utilizing an EHR by 2015?
Beginning in 2015, physicians not demonstrating meaningful use of an EHR will face penalties in the form of reductions to their Medicare fees schedule reimbursement rates. The penalty will equal 1% in 2015, 2% in 2016, and 3% in 2017 and each subsequent year. Under the bill, the Secretary can increase the penalty to 5% if fewer than 75% of eligible physicians are not utilizing an EHR by 2018.

9. Under Medicaid who is eligible to receive incentive payments and what is the timeline for payments?
Generally, the Medicaid program offers up to $64,000 to providers who see more than 30% of patients paying with Medicaid, (20% for pediatricians). Beginning in 2011, the Medicaid incentive payment will be based on a calculation that includes the provider’s Medicaid mix and qualifying IT related expenses. Payments could amount up to $25,000 the initial year and $10,000 each subsequent year for a total period of five years. The eligible professional under Medicaid must first demonstrate certified EHR usage by 2015 to be eligible for payments and after 2021 will not be eligible for payments. Pediatricians, who only meet the lower threshold of 20% Medicaid patients, would be eligible for 66% or the payments described above. The current bill also provides a cap for total payments under the Medicaid Plan. Once the funds have been depleted, payments will no longer be available under the Medicaid plan.

10. My group has 10 physicians. Could the group qualify for total incentive payments of $440,000 under the Medicare incentive program?
Yes. If each of the physicians meets the criteria including the ability to demonstrate meaningful use of a certified EHR system by 2012, the group could be entitled to a total of $440,000 in incentive payments under the Medicare program.

11. Is “Meaningful Use” defined in the legislation?
“Meaningful Use” is described initially in the legislation to include the following aspects:

a) The use of a certified EHR with ePrescribing capability as determined appropriate by the Secretary of HHS
b) The ability to report on clinical quality measures as specified by the Secretary.
c) The use of EHR technology that allows electronic exchange of patient health information.

Further information with regard to required standards, reporting and connectively levels will be determined by the Secretary of Health and Human Services.

HITECH Warranty. eClinicalWorks has made a bold and unique commitment to support its customers’ ability to meet “meaningful use” standards of the HITECH Act by putting the commitment in writing. As part of the eClinicalWorks License Agreement, eClinicalWorks warrants that its software will support “Meaningful Use” criteria as defined by the American Recovery and Reinvestment Act (ARRP). The warranty helps address one of the biggest barriers to early EMR adoption faced by healthcare providers, uncertainty around future standards.

12. What constitutes a “Certified” EHR system?
What constitutes a “certified” EHR is to be determined by the Sec. of HHS. However, many believe that CCHIT will be instrumental in the certification process and that HHS will likely be basing much of their standards on the current work of CCHIT. eClinicalWorks® is a CCHIT certified EHR and the organization intends to ensure that it meets the standards necessary to be certified for the stimulus payments.

13. Are “mid-level” providers covered by the incentive programs?
Nurse practitioners and nurse mid-wives should be able to file for incentive payments under the Medicaid program. Physician Assistants may qualify if the PA is practicing in a rural health clinic that is led by the PA or who is practicing in a FQHC. Mid-level providers do not qualify under the Medicare portion of the incentives.

14. Is there a separate bonus payment for hospitals that utilize an EHR?
Yes. The Stimulus Bill includes a separate Medicare incentive payment for hospitals efficiently utilizing an EHR. The calculation is much more complicated. It includes a $2 million base payment plus an amount from a formula including various factors such as the discharge volume, inpatient-bed-days for different Medicare patients and total patients, and total hospital charges.

15. My practice has been utilizing an EHR system since prior to the date the Stimulus Bill was signed into law. Can the providers in my practice still qualify for the incentive payments?
Yes. In fact you are probably ahead of the curve. Only 20%-30% of practices had implemented an EHR prior to the enactment of HITECH. Because of the relatively short time frame and the sheer number of practices that still need to implement an EHR, it may be a challenge for some of these non-early adopters to qualify for the maximum payments. If your system is certified and you can demonstrate meaningful use of the system prior to 2012 you should generally qualify for the incentive payments under the Medicare Plan.

16. The cost of my EHR system was only $15,000. If I qualify, will my incentive payment be limited to $15,000 under the Medicare Plan?
No. Under the Medicare Plan, the requirement to receive the maximum incentive payments is a utilization standard and is not dependent upon the actual cost or purchase method of the EHR system. If you meet all qualifications for the incentive payment, you should receive the maximum payment regardless of the actual cost or purchase method of your EHR system.

17. What does this mean to practices already utilizing eClinicalWorks?
Those practices that already use the eClinicalWorks unified EMR/PM solution, assuming the provider meets the criteria under Medicare and can demonstrate meaningful use, will be eligible for the utilization incentives. The HITECH Act will reward customers who use of an EMR that meets the criteria, offsetting their purchase costs through the utilization incentives.

eClinicalWorks meets all of the functionality for “meaningful use” as it is defined today.

eClinicalWorks:
• is CCHIT 2008 certified in both ambulatory and child health,
• has ePrescribing capability,
• can be connected for the electronic exchange of PHI, and
• complies with submission of reports on clinical quality measures.

All further details about what type of reporting will need to be submitted, what level of connectivity will be required and the final criteria for standards will be determined by the Secretary of Health & Human Services before the utilization incentives begin.

18. My practice does not currently utilize an EHR. When is the right time to start planning for an EHR implementation?
If you have not already started the process of implementing a system, the time to start the process is now. The transition to a new EHR system can be a timely process, especially with the added requirements of meeting the meaningful use criteria for the incentive payments. Typically, the time requirement of a successful EHR implementation increases in proportion to the size of the group.

Due to the fact that only 20% - 30% of the market has already implemented an EHR system and that many EHR vendors had waiting lists prior to the stimulus act, it will be a challenge for the industry to handle the implementation of the non-early adopters in a timely fashion. Those physician who wait, may have little chance of qualifying as an early adopter.

19. Is there any benefit for early adoption of the certified EHR system?
Yes. Early adopters would stand to gain, as about 70 percent of the Medicare payments would be received in the first two years.

20. Is there any additional benefit for PQRI and electronic prescribing?
Those engaged in Physician Quality Reporting Initiative (PQRI) and electronic prescribing can earn an additional $ 6000 - $ 8000 per year, beginning immediately.

21. How will the EHR Stimulus payments actually be distributed to the physicians?
The timing and distribution process for the incentive payments is to be determined and finalized by the Secretary of the HHS and the federal rule making process.

22. Will my patients or the public know whether or not my practice qualifies as a meaningful EHR user?
Yes they could. CMS will post the names, addresses, and phone numbers of eligible professionals who are meaningful EHR users and group practices receiving incentive payments.

For more information on HITECH, please visit the HealthIT.hhs.gov page

For more answers to your questions, email us at info@InetWareTechnology.com