The two bills, “HR1” and “S1,” continue to barrel down the legislative track and continue being amended, but as currently written they create real incentives for adopting certified electronic health records – upwards of $40,000 per physician starting in 2011.
The legislation emphasizes rewarding designs that improve care and create a path for certification of records with added functions, such as decision support, order entry, connections to other systems and reporting on quality measures. The bill focuses on implementation by tying the physician bonuses to proven, effective use. The stimulus package also formalizes the Office of the National Coordinator for Health information Technology (ONC).
Of the nearly $900-billion stimulus package, about $20 Billion would go to Health and Human Services, with $6 billion for the Office of the Secretary of Health and Human Services. Of that $6 billion, $2 billion would be for the Office of the National Coordinator (ONC) to support information technology.
The package also authorizes the Medicare Trust Fund to offer physicians financial incentives starting in 2011 to adopt and use certified electronic health records (C-EHRs). The incentives – in the form of a 75 percent increase in Medicare Part B fees — could add up to more than $40,000 per physician over a five-year period. But the payments would come only after physicians prove they effectively used the EHRs. In essence, the government says it won’t pay for equipment that never gets used. Physicians that haven’t adopted EHRs by 2016, will face financial penalties starting at 1% and escalating to 3% of Medicare Part B fees.
It looks as if there will be a new set of certification criteria for "qualified electronic health records" that meet the new features defined in the bill. Given the dollars involved, providers will want to adopt products that meet the bonus criteria. To do so, they must understand what is a “qualified record” and what it means to “effectively use” one.
The legislation defines a qualified electronic record as one that:
- Includes patient demographic and clinical health information, such as medical history and problem lists
- Has the capacity to provide clinical decision support; allow physician order entry; capture and query information relevant to health care quality; and exchange and integrate electronic health information with other sources.
The legislation leaves some of the ability to define meaningful use of the certified EHR up to the HHS regulators, but it requires the participating providers to submit clinical quality measures and be “connected for the electronic exchange of health information to improve the quality of health care, such as promoting care coordination."
The bonuses for adoption and use break down to about $15,000 the first year and declining each year to about $2,000 in the fifth year, with a maximum payout of more than $40,000.
This economic stimulus bill offers real incentives for effective adoption of electronic systems designed to improve care. Physicians have meandered toward EHR adoption. It is inconclusive whether the slow uptake is due to reluctant physicians, lack of a business case for adoption of HIT, or insufficient system capabilities to improve care and save time.
Starting next year, we may finally get the answer. With the stimulus, the economy hopefully will get a significant jolt, and health care may reap a massive improvement boost as well.
Dr. Haughton brings over 20 years of experience in health care research and clinical application to DocSite as a physician, engineer and adolescent cancer survivor. As CEO and Chief Medical Officer, he is responsible for research initiatives and applications involving patient workflow and clinical care as well as corporate health.