Tuesday at 10 am, CMS and ONC released the final rules that will guide electronic health record rollouts for the next 5 years.

Here’s my analysis of the key changes in the Final Rule:

1. HHS has adopted the HIT Policy Committee recommendation to frame Meaningful Use as core requirements and discretionary requirements. In so doing, they have reduced the total number of requirements and introduced choice.

In the NPRM there were 25 requirements for Eligible Professionals and 23 for hospitals.

In the Final Rule there are 15 core requirements for Eligible Professionals and 14 for hospitals.

There are 10 discretionary requirements from which 5 must be chosen.

2. Thresholds have been reduced in many cases. For example, CPOE had a threshold of 80% of orders for Eligible Professionals and 10% of orders for hospitals. The language in the final rule focuses on order entry of medications and requires that 30% of patients with medication orders to have at least 1 medication order entered electronically. This requirement applies to both Eligible Professionals and Hospitals.

3. Administrative Simplification has been postponed to Stage 2.

4. Decision Support rules changed from 5 to 1

5. Required Clinical quality measures have been reduced to 6 for professionals and 15 for hospitals. For professionals, there are 3 core measures required, 3 alternative core measures, and a choice of 3 from a pool of discretionary measures. Reporting by attestation is required in 2011, electronic reporting is required in 2012. Clinical quality measurements for specialists have been eliminated for stage 1. There has been great effort to align meaningful use with PQRI measures.

6. The NPRM did not include the recording of advanced directives or a provision for providing patients with educational materials. The final rule includes these as discretionary meaningful use requirements.

Overall this final rule maintains a balance between the policy objectives sought and the technology changes possible that are achievable now. There will still be 3 stages of meaningful use and later stages will be more demanding. All the original stage 1 requirements will still be part of meaningful use by stage 2.

In January of 2011, the clinicians may begin the 90 day process of using a certified record per meaningful use requirements. Attestation of this use begins in April 2011. CMS payments will begin May 2011.

ONC also released the final rule on Standards and Certification today. They have done a remarkable job adding detailed implementation guidance specificity for patient care summaries, public health laboratory reporting, syndromic surveillance, and immunizations. It’s a tricky balance to ensure there is enough specificity to test and certify EHRs and modules for interoperability while at the same time encouraging innovation. The final rule issued today achieves that balance perfectly, ensuring that only mature implementation guides are specified, leaving room for innovation in such as areas as how to transport data from point to point via NHIN Direct and other demonstration projects.

Overall, a very good day for ONC, HHS and stakeholders. The final rule means Meaningful Use will be achievable by many. The Standards and the process to certify their use are sufficiently specific. I’m impressed.

Source :- http://www.healthcareitnews.com/blog/meaningful-use-and-standards-are-finalized

The law offers bonuses for health IT adoption but will penalize physicians who don’t have adequate systems by 2015.

By Doug Trapp, AMNews staff.

Washington – President Obama on Feb. 17 signed a $787 billion stimulus bill that directs about $150 billion toward speeding adoption of health information technology and maintaining health care coverage, among other provisions.

The sweeping measure — the American Recovery and Reinvestment Act of 2009 — provides nearly $90 billion in temporary increased federal Medicaid funding, delays four cost-cutting Medicaid regulations and spends a net of about $19 billion to encourage physicians and others to adopt health IT.

Obama said the enactment of the stimulus package and the Feb. 4 enactment of the Children’s Health Insurance Program reauthorization are big steps in health care. “We have done more in 30 days to advance the cause of health care reform than this country has in a decade.”

The American Medical Association applauds the investments in health IT and coverage for the poor and newly unemployed, wrote AMA Executive Vice President and Chief Executive Officer Michael D. Maves, MD, MBA, in a Feb. 11 letter to Sen. Max Baucus (D, Mont.), chair of the Senate Finance Committee.

The stimulus also provides $500 million to help train physicians through the National Health Service Corps, a provision widely supported by physician organizations. “This program is integral to rebuilding the primary care physician pipeline,” said Ted Epperly, MD, president of the American Academy of Family Physicians.

$19 billion of the stimulus bill is for incentives to encourage health IT adoption.

But few Republicans backed the stimulus measure. The House adopted the bill Feb. 13 with no Republican support. The Senate approved it the same day with votes from only three moderate Republicans: Sens. Olympia Snowe and Susan Collins of Maine and Arlen Specter of Pennsylvania. The final bill is a compromise between earlier versions adopted by the House and Senate.

Many Republicans, including Senate Minority Leader Mitch McConnell (R, Ky.), lambasted spending in the measure that they said would not stimulate the economy quickly. McConnell also criticized Democrats for not accepting more GOP input on such a massive spending bill.

Some Republican lawmakers, such as Phil Gingrey, MD (R, Ga.), also worried that the stimulus is not offset by new revenues and therefore will increase the national debt. “I don’t know how our children and grandchildren are going to pay for this,” Dr. Gingrey said.

“Significant” health IT support

Under the stimulus law, physicians and other health professionals are eligible for tens of thousands in health IT incentive payments via Medicare or Medicaid through 2016. But in 2015, penalties for non-adopters begin.

Medicare-participating physicians who adopt a certified electronic health record system by 2011 or 2012 and use it in a way that the government deems “meaningful” — a term to be defined later — could receive up to $44,000 over a period of up to five years. The incentives will be limited to 75% of the physician’s Medicare charges in any one year.

Health IT grants and loans from the federal government won’t become available until 2010.

Physicians who have caseloads of at least 30% Medicaid patients and who also meet the health IT adoption standards are eligible for nearly $64,000 in support during the same time frame. Medicaid incentive payments are limited to 85% of physicians’ Medicaid charges. Pediatricians can qualify if their patient mix is 20% Medicaid, but they would be eligible for only two-thirds of the incentive payments available to physicians meeting the 30% standard.

This health IT funding is “very significant,” said Robert Doherty, the American College of Physicians’ senior vice president for governmental affairs and public policy. “Our sense is for a lot of physician practices, that may be the tipping point where it begins to make business sense to consider plunging into that pool and buying a certified EHR.”

Physicians cannot apply for incentives in both Medicare and Medicaid, but hospitals can, said Erica Drazen, ScD, managing partner for emerging practices at health IT consultant CSC’s Global Healthcare Sector.

Also, while physicians must use an EHR system to qualify for the stimulus incentive payments, they need not own one. The measure provides $2 billion to the Office of the National Coordinator for Health Information Technology for health IT grants and loans, but those won’t become available until 2010, Drazen said. She expected private firms to offer new financing options for the EHR systems or to offer them through leases.

But the stimulus measure will penalize physicians, beginning in 2015, if they have not become meaningful EHR users. These doctors face a 1% reduction in Medicare fees that year. The yearly cut would phase up to 3% in 2017 and beyond.

The ACP would prefer that the penalties not apply if, for example, a shortage prevents EHRs from being available to physicians or if another factor not in physicians’ control prevents them from meeting the health IT standards, Doherty said.

Drazen said existing EHR vendors and consultants will be strained by the demand created by the health IT stimulus. “We’re going to have a real short supply of people who know how to do this well.”

Sustaining Medicaid

The $87 billion in stimulus going to state Medicaid programs should help avoid health coverage cuts to low-income people. But states still may need to trim other parts of their Medicaid programs, because many have budget shortfalls exceeding their stimulus funding, said Ann Kohler, director of the National Assn. of State Medicaid Directors.

The enactment could be significant for physicians in California. State lawmakers and Gov. Arnold Schwarzenegger have been struggling to close a roughly $42 billion budget deficit.

California’s Medicaid program would receive more than $11 billion in stimulus funding over 27 months, according to the California Medical Assn. But to qualify for the additional funds, states first must maintain or restore Medicaid eligibility and renewal procedures to their status on July 1, 2008. California lawmakers would need to reverse legislation enacted late in 2008 requiring people on Medicaid to re-enroll twice a year instead of once.

“This is another great opportunity for state lawmakers to maximize federal assistance,” said CMA President Dev A. GnanaDev, MD.

The stimulus offers another boost to states by extending moratoriums on three Medicaid rules through July 1, 2009. Those regulations, issued by the Centers for Medicare & Medicaid Services, would have reduced federal Medicaid spending by billions. The new law also delays until July a CMS rule that reduces some states’ Medicaid rates by aligning the program’s hospital outpatient services definition with that of Medicare.

This content was published online only.

Above article published on http://www.ama-assn.org/amednews/2009/02/23/gvl20223.htm

Physicians can earn tens of thousands in IT incentives, but they must act quickly to achieve the biggest benefit and avoid penalties.

By Chris Silva, AMNews staff.

Washington – The recent economic stimulus package provides a significant investment in health information technology that could benefit many physicians. But the government is expecting doctors to do their part to implement health IT and is prepared to penalize those who don’t.

Over the next decade, the federal government is projected to spend more than $35 billion on Medicare and Medicaid bonuses to physicians, hospitals and others that adopt certified electronic health records. Because of the Medicare penalties that eventually will apply to nonadopters, however, the net spending level will be only about $20 billion over 10 years.

Physicians with approved EHRs in place before 2011 or 2012 will be eligible for the maximum Medicare incentive payments allowed by the stimulus. They will receive bonuses equal to 75% of their allowed Medicare Part B charges — up to a sliding cap — in each of the five years after adoption. The maximum of $18,000 in the first year phases down to $2,000 in the fifth year for a total five-year bonus of up to $44,000 for early adopters.

Doctors who wait until 2013 or 2014 to have EHRs in place will be eligible for smaller bonuses. The 2013 adopters can capture a maximum of $39,000 over four years, while the 2014 adopters can claim up to $24,000 over three years. Medicaid will have its own five-year bonus schedule that will offer as much as $64,000 to eligible physicians who don’t claim Medicare bonus money.

Once the chance for bonuses ends, Medicare starts penalizing physicians who have not responded to the incentives. Doctors who have not adopted an EHR before 2015 and who fail to obtain a hardship exemption will see a 1% cut to their Medicare pay, a reduction that phases up to 3% for 2017 and remains each year after that.

Simply setting up any paperless system is not enough to earn bonuses and avoid penalties. The stimulus package stipulates that physicians must adopt a qualifying EHR and use it in a “meaningful way.” Meaningful users are defined as physicians who demonstrate to the Health and Human Services Dept. that they are using electronic prescribing; that their technology is connected in a manner that provides for electronic exchange of health data to improve quality of care; and that they submit information to HHS on clinical quality measures.

No longer a question of “if”

Some physicians already have begun to move away from paper, and they would rather act sooner than later to avoid penalties down the road. “The question now isn’t if, but how and when, because physicians are feeling a sense of inevitability,” said Todd Rowland, MD, executive director of HealthLINC.org in Bloomington, Ind., a regional health information exchange that covers a multicounty area. “We need to figure out how to implement it in an economical, management-oriented approach that requires as few work-flow sacrifices as possible.”

Dr. Rowland added that he doesn’t expect physicians to like the implementation process — or the possibility of penalties if they don’t do it right — but that it makes sense for physicians younger than 55 in particular to get on board. He estimates that more than 50% of physicians in Bloomington’s metro area and more than 75% in the rural area have adopted EHR systems.

Early EHR adopters can get up to $44,000 in a Medicare bonus or $64,000 in a Medicaid bonus.

While the stimulus also provides Medicaid incentives, physicians can’t have it both ways — they must choose either Medicare or Medicaid bonuses, said Heidi Echols, a partner at the law firm McDermott, Will & Emery in Chicago.

In an effort to prevent additional “double-dipping,” physicians who report using an EHR system that is also capable of e-prescribing no longer will be eligible for the e-prescribing bonuses that went into effect this year under the Medicare Improvements for Patients and Providers Act. On the other hand, Medicare penalties for those not e-prescribing by 2012 will sunset after 2014, so that no physician will be subject to double penalties for failing to e-prescribe and failing to use an EHR.

Now that Congress has set up the incentive structure for adoption, President Obama and his administration also must promote interoperability of EHR data so the records don’t become information “islands,” said David J. Brailer, MD, in an article published online as part of a series on health IT in Health Affairs’ March/April issue.

Dr. Brailer was the first National Coordinator for Health Information Technology at HHS from 2004 to 2007 and is now chair of Health Evolution Partners, a health care investment firm based in San Francisco. He said physicians particularly need to be wary of vendors from which they purchase IT services, as systems that become obsolete could set back progress.

“What it boils down to is, are you buying EHRs that you can use and keep for a long time, or is it a system that in two or three years goes kaput?” he asked. “We’re trying to avoid doctors having to start over again with electronic records during their career.”

The next steps

The stimulus act requires HHS by Dec. 31 to develop an initial set of standards, implementation specifications and certification criteria for EHR system adoption. It also authorizes the department to provide competitive grants to states for implementation loans to health care entities.

The national health IT coordinator also will be authorized to make available a qualifying EHR system to physicians and others for a nominal fee. Doctors who do not purchase the government’s system can purchase a qualifying system from a vendor of their choice as long as it meets certain standards, including interoperability requirements.

The American Medical Association will seek clarification from HHS on the cost of the government system and when it will be available. The department must determine more details on how it will spend the stimulus dollars and how doctors can access them.

Once those details are available, physicians must examine the cost-benefit breakdown. According to a May 2008 report from the Congressional Budget Office, estimated total costs for implementing a typical office-based EHR are about $25,000 to $45,000 per physician. Each physician would then need to spend about $3,000 to $9,000 per year to maintain the system.

Above article published on http://www.ama-assn.org/amednews/2009/03/16/gvsa0316.htm