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Stimulus bill offers docs big incentives for technology, but demands effective use

6a00d8341c909d53ef010537105c50970b-800wiThe economic stimulus bills are a great step forward for health information 
technology and medicine.

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. 

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AlexRaindrop TechniqueGinekologijos KlinikosMD as HELLDiana Cholakian Recent comment authors
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Alex
Guest

I agree with Raindrop Technique. Since there are types and types of doctors there will be types and types of opinions.
I’ve read a post above about e-mails vs. phones that illustrated just that.

Raindrop Technique
Guest

The stimulus package/plan might do wonders for health care but unfortunately, looking the comments above, has been met with diverse opinions. At the end of the day, we just hope it will do better than harm.

Ginekologijos Klinikos
Guest

Seems like a waste of tax money…

MD as HELL
Guest
MD as HELL

A doctor at a computer keyboard as part of his/her practice is a very expensive secretary, whether measured in lost opportunity or diluted productivity. Have your EMR, but not in real time. A doctor’s staff needs to be at the box, not the doctor. It also needs to advance the practice of the doctor or it will be a bomb. As far as the consumer, most patients are only occasional patients. Hopefully they have lives. Uopefully they have not turned their healthcare into their hobby. Hopefully it will not be addicting like reading this blog. They will rarely access this… Read more »

Diana Cholakian
Guest

The stimulus bill seems to be not only good for the economy, but good for health care, as well. Although the term ‘bonus’ has received a negative connotation throughout this whole process, an incentive for physicians is something that has been needed for much time. Graduating medical students have been raised and live in a generation in which e-mails are more frequent than letters and search engines trump the library in trying to find the latest research developments. Therefore, it is not only timely for this technology use; it is necessary. I agree with your view that this bill’s language… Read more »

Diana Cholakian
Guest

The stimulus bill seems to be not only good for the economy, but good for health care, as well. Although the term ‘bonus’ has received a negative connotation throughout this whole process, an incentive for physicians is something that has been needed for much time. Graduating medical students have been raised and live in a generation in which e-mails are more frequent than letters and search engines trump the library in trying to find the latest research developments. Therefore, it is not only timely for this technology use; it is necessary. I agree with your view that this bill’s language… Read more »

John Haughton MD, MS
Guest

Thanks for all the great comments. Many veins of thought: 1) Lots of Money in the Bill, 2) EMRs have been and will be a work in progress. 3) Seniors and others with chronic diseases need help with finances and care. 4) Primary care physicians need help with finances and care. 5) The bill is good. 6) The bill is bad. Since writing the post 2 weeks ago, the Stimulus bill has now passed. It does offer the $40K + bonus for “effective use” of a “qualified EHR” (DISTINCT FROM CURRENT DEFINITIONS OF EMRS / EHRS) – The bill specifically… Read more »

Donald
Guest
Donald

As some commenters have noted, there is a huge unacknowledged gulf between the reality (what is available) and the fantasy (what could be) when it comes to HIT and HIT standards. The large risk here is that the $20 B will be wasted on feeding the fantasy instead of supporting needed tranformation of what we really do have into what we really need.
Best,
Don

cal
Guest
cal

25% of all US Bankruptcies filed today are by senior citizens. Does anyone here think elder people are dying because they may not have enough money? Its not because seniors do not have an EHR. The issue is purely economics and the politics of redistributing wealth. I agree with the man above who wrote we need an EHR that truly is debugged and not something that runs on a Windows. And “Ok” to another good fellow! Mentioning computers as a means of communication, you are exactly correct without giving credit to Professor Licklider (MIT, 1960) – it was he who… Read more »

Janet
Guest
Janet

My husband was in the doctor’s lounge and got infected by the fear that they are going to “make us” get EHR. So I decided to spend some time actually reading the bill. That’s no small task and I can say that I have not read it completely and comprehensively. But at a glance it seems like a plan to study and promote the development of EHR with an incentive to apply it. Actually it seems to me like a nod to the fact that EHR are very much a work in progress but there needs to be some standardization… Read more »

Kris Sargent
Guest
Kris Sargent

This stimulus package is NOT going to fix a healthcare system where patients are no longer responsible for their health. EMR is great but how is that really going to fix the entire healthcare system? They eat their hot dogs/burgers/fries and large coke then swallow down their statin and H2 blocker. When their glucose level is too high – they drink another coke and take their metformin and their anti-hypertensive meds. Money thrown on to force EMR is not really going to change how health care is delivered…And this package wants to do that as well. The least expensive way… Read more »

Imee
Guest

I do think the economic stimulus/recovery plan will do wonders for health care around the nation. I just hope it will go on smoothly so positive results will be achieved.

Jay
Guest

While a move to EMR is a necessity to reduce medical costs for the country, I don’t believe that providing purely financial incentives for individual doctors is going to bring about the desired change. So many doctors are already operating as small business owners so going through the selection, procurement, integration and ongoing maintenance of an EMR system is going to be both time consuming and expensive, much more so than the $40K in incentives. How many doctors are going to be a position to effectively wade through the sea of EMR systems to find one that will integrate as… Read more »

cindy
Guest
cindy

Its the first step in the government controlling which treatments are medically necessary. As in other socialized medicine the elderly will have to die sooner. I just hope congress and the executive members will have to live by the same criteria, or is that just a stupid thought.
Ruin Your Health With the Obama Stimulus Plan
http://www.bloomberg.com/apps/news?pid=20601039&refer=columnist_mccaughey&sid=aLzfDxfbwhzs

disgusted
Guest
disgusted

Just ask your friendly neighborhood physician how much he/she really has to pay for an EMR?
Ask him/her if he/she can have someone pay 85% of the cost for him/her and then he/she gets these “grants” from the government to the tune of 40k over the next few years….
Then ask them if they feel dirty when they lie in bed at night….