By KRISTEN WYATT
ASSOCIATED PRESS WRITER

COLORADO SPRINGS, Colo. — Homeless teenagers at a central Colorado shelter are feeling the effect of the government’s economic stimulus package. It’s the feeling of a dentist’s drill.

The 20 runaway youths living at the Urban Peak shelter had no regular dental care until this spring, when a $1.3 million stimulus grant to a community health center paid for a mobile dental and medical clinic to visit once a month. The residents now get medical and dental screenings, and cavities filled, right from their shelter’s parking lot.

“I knew my teeth needed to be fixed but I had no money,” says Michelle Daulton, 18, who has been living at the shelter for about four months and hadn’t seen a dentist since she was 13.

Now she’s had three chipped teeth repaired. “It was absolute and pure relief, I mean that,” she said.

From the Colorado homeless shelter to rural Pennsylvania clinics that can accept new patients, health centers that serve the poor are among the first places the federal stimulus package is being spent.

The stimulus law sets aside $2.5 billion for free and low-cost health clinics, and a big chunk of it - about $500 million - is already being spent. The White House has promised another burst of money this summer.

“This has really been a boost for us,” said Bob DeFelice, CEO of First Choice Community Health Care. “It’s allowed a level of stability in some very difficult times.” DeFelice’s group runs nine community health clinics around Albuquerque, N.M., and used a $703,000 grant to hire two physicians and four support staffers.

Health clinic executives say the money will allow them to keep their doors open as the rolls of uninsured patients grow. An estimated 64 million people use rural health clinics, a number that is expected to rise as people lose their jobs and health insurance.

“We’re seeing more and more people,” said Edward Michael, president of the Rural Health Corp. in Wilkes-Barre, Pa. The six-clinic group in northeastern Pennsylvania had no room for new patients until it received a $311,000 grant in April. Now, Michael says, his clinics can expand from seeing 18,000 patients last year to 19,000 this year.

“You know, we weren’t there back in the Depression, so we never experienced being back in the ’30s standing in line for food, standing in line for a doctor,” Michael said. “This money is really going to prevent a lot of long-term hardship.”

The health clinic grants are one-time boosts, not long term health care fixes. The stimulus won’t make up for a lack of doctors in poor and rural areas, a shortage the Association of American Medical Colleges says is growing and could reach 159,000 doctors by 2025.

“I look at the stimulus bill as one step to health care reform,” said Maggie Elehwany, vice president for government affairs and policy at the Washington-based National Rural Health Association. “It isn’t everything.”

While Congress considers a health care overhaul, clinic workers hope just to keep up with basic needs such as vaccinations and exams.

“I can’t imagine not having the stimulus money right now because we wouldn’t be able to do any of this,” said Nicole Noll, who drives the mobile health clinic to the teen homeless shelter and rural elementary schools.

The van was provided by Ronald McDonald House Charities. But stimulus money pays for Noll, the doctors and the dentists.

Far more than a brighter smile can be at stake in dentistry. In Maryland, a 12-year-old boy whose Medicaid coverage had lapsed, Deamonte Driver, died in 2007 after bacteria from the abscess of an aching tooth spread to his brain. An $80 tooth extraction might have saved his life.

“I’m so glad they did this,” Michelle Daulton said. “My parents were cheap. They never took me to the dentist. And when you don’t have any money, your teeth, you just leave ‘em alone. Not anymore.”

Above article published on

http://www.seattlepi.com/national/1110ap_stimulus_health_clinics.html

President Obama believes one of the most effective ways to reduce health care costs is to go paperless. Children’s Mercy Hospital is one of a growing number of hospitals relying on electronic records, but recent studies found only nine percent of US hospitals and about 25 percent of doctor offices have gone to electronic records.

Everyone agrees that’s the trend but not everyone agrees it’ll save money and improve patient care.

Kansas City’s Internal Medicine Clinic moved to electronic medical records four years ago.

“We have everything, if we want to look at a lab, we push a button,” Dr. Marianne Hudgins said.

The administrative staff has shrunk by 5 and the clinic is adding a new doctor, but it’s patient quality that really impresses Dr. Hudgins.

“I think one of the beauties of this is that if it’s 2:00 in the morning and I get that call, I jump on my computer and I know everything about that patient,” Dr. Hudgins said.

Another obvious advantage of going paperless is more space, that become exam rooms.

“There are some benefits to the old paper way of doing it such as you can go through a 200 page chart in a matter of a minute,” Dr. Scott Kuennen with the Clay Platte Family Medicine Clinic said.

Dr. Kuennen’s clinic has plans to go electronic, but not until it absolutely has too.

“You’ll save money, in the sense that you’ll have less staff, you’ll be more efficient, not the case with anybody I’ve ever talked to,” Dr. Kuennen said.

He said the upfront costs are huge and adds too often doctors and hospitals aren’t on the same computer system until they are, he prefers paper.

The Obama administration is offering stimulus money to partially reimburse doctors who go electronic. One of the biggest benefactors could be Kansas City-based Cerner.

Above article published on

http://www.fox4kc.com/news/wdaf-clinics
-paperless-records,0,7058639.story

By Rosemary D’Amour/Daily News correspondent

GHS

The $4 billion in federal stimulus health care money headed to the Bay State over the next three years will help provide care for those who can’t afford it and it is hoped help stem hemorrhaging costs by funding new technologies.

The bulk of the health care stimulus funding - some $3.5 billion - will keep mostly safety-net programs afloat with Medicaid/Federal Medical Assistance Percentage funds.

But a portion of federal stimulus money is targeted for cost-saving innovation. Massachusetts is expected to receive $1.3 billion in technology and research funds, with more than $500 million slated for initiatives to help create electronic patient records in the commonwealth.

State officials hope the federal investment will lead to a secure statewide database of patient information.

Nationwide, some $19 billion will go to electronic records programs with a goal of freeing health workers from an paper-based system by 2014. President Barack Obama has touted the potential costs-savings from the program.

Stimulus funds will be used to reward those who have already installed the record system and provide money to hospitals and physicians who implement it. The state would also penalize those who fail to upgrade.

Physicians who meet the state criteria for electronic files could receive reimbursements of up to $44,000 each over four years directly from the federal government. There are about 20,000 physicians in the state, according to Health and Human Services.

Partners Healthcare could be a big winner in the stimulus sweepstakes because it has already implemented an electronic records system. With individual reimbursements for its 3,000 members, including teaching hospitals Brigham and Women’s and Massachusetts General Hospital, the health care consortium could receive $10 million to $50 million.

The state’s Health Care Quality and Cost Council estimates that it takes a small medical practice an average of four months to adopt an electronic system at an up-front cost of up to $40,000 per physician.

Up-front costs have been one of the biggest obstacles in creating an electronic system. But Massachusetts, which has nearly twice the national average of doctors using these systems, could face an easier transition with quicker federal reimbursements.

“The adaptation in Framingham was smoother because there wasn’t an existing paper record, so our advisors picked it up very quickly,” said Paula Kaminow, executive director of the Framingham Community Health Center, which began using electronic records when it opened five years ago.

Community health centers are important sources of medical information, Kaminow said, because they serve a wide population that doesn’t have personal physicians. Installation of electronic records in 12 centers could increase staff productivity, allow for expansion in the number of patients and ensure easier and faster sharing of patient information with hospitals.

“From a risk-management standpoint it’s much easier for providers to find the information they need,” Kaminow said. “The handwriting is clean, you can find different chart notes very quickly, and can integrate information from different sources.”

The electronic system could save the nation $530 billion over 10 years, according to the Health Care Quality and Cost Council, which estimates that the stimulus’ initiative could reduce the nation’s health care spending by up to 30 percent.

Kaminow said the most important characteristic for an electronic record is the ability to interface with other types of records.

“The challenge is to make sure that all the different pieces can speak to each other, such as a management system that can speak to an electronic health record, or a lab report,” she said.

The central project for the state is the Health Information Exchange, which is not funded by federal dollars. The state’s newly-established Health Information Technology Council will provide $15 million in initial funding to help install the exchange by 2014.

The exchange would combine electronic record projects for individual practices, hospitals, and community health centers, sharing patient information in a secure statewide database. Anyone in the system treating a patient could quickly learn about the patient’s allergy data, medication and test results.

The initiative has another reward: Job creation.

Private-sector jobs could grow among vendors installing database systems, with positions ranging from entry-level programmers to high-level project managers.

Massachusetts has a leg up in this respect with an already developed system of software and hardware vendors.

“We’re looking to bring on more staff and extend our hours,” said Kaminow. “After a start-up period, our costs are covered through billing, so in that way we’d be able to sustain increased employment.”

The other big slice of the health care stimulus package is the $764 million coming to Massachusetts for over the next two years.

Funds will be used primarily to maintain services-securing jobs, meeting health care standards and safety net services, with $190 million going to offset fiscal 2009 budget holes, according to Health and Human Services.

Stimulus money provide a nationwide increase in federal matching dollars to Medicaid/Federal Medical Assistance Percentage funds of 6 percent, with potential increases depending on the state’s unemployment rate during the stimulus period.

Massachusetts receives an increase from 50 percent in federal matching dollars to 56.2 percent. Given the state’s shaky unemployment rate, which rose to 7.4 percent in March - a full point since December - the commonwealth could see an increase as high as 11.6 percent in the medical assistance dollars.

In fiscal 2010, $255 million would go to securing jobs and health care services provided by the state. The breakdown for this portion of funds is as follows:

• $160 million for hospitals
• $10 million to community health centers
• $45 million to nursing homes
• $15 million to community mental health $20 million to the “Community First” initiative, which transitions those with mental and intellectual disabilities from institutional care to community-based care $5 million to other health care providers $222 million toward maintaining coverage and eligibility for members of the state’s MassHealth and Commonwealth care health insurance programs.
• Finally, $97 million would help protect safety-net services by maintaining or restoring portions of funds to the Departments of Mental Health, Developmental Services, Commissions and Veterans, Children and Families, Youth Services, Public Health and MassHealth.

The Executive Office of Administration and Finance will be in charge of overseeing and coordinating spending for Medicaid/Federal Medical Assistance Percentage funding.

Rosemary D’Amour is a reporter in the Boston University State House Program.

Above article published on

http://www.metrowestdailynews.com/state/x2068280815/
Stimulus-cash-gives-health-care-records-technology-a-boost

Washington Business Journal - by Julekha Dash Contributing Writer

Maryland Gov. Martin O’Malley will sign legislation Tuesday that provides incentives for health care organizations to implement electronic health records.

House Bill 706 allows the state to make use of federal stimulus dollars available for electronic health records and coordinate those efforts with the state’s own plan to create a state wide health information exchange.

The federal stimulus money provided $19 billion toward electronic health records. State health officials do not know how much of that money will flow to Maryland.

State and federal health officials are pushing electronic health records because they believe they will reduce medical errors and lower costs by eliminating the need for running multiple tests.

The stimulus package enables physicians to receive incentives between $44,000 and $64,000 over the next five years through Medicare and Medicaid.

It costs, on average, $50,000 for a physician practice to implement electronic health records. The incentive payments begin in 2011, and physicians who do not adopt an electronic health records will be penalized through lower Medicaid and Medicare payments starting in 2015.

In the past, the biggest obstacle in getting physicians to install an electronic health record was cost. The federal stimulus money and the state’s health information exchange overcomes that obstacle by providing incentives to adopt health records.

“It’s trying to create a business model to make [health IT] work,” Department of Health and Mental Hygiene Secretary John Colmers said.

While the federal money provides payments to physician practices, the state is taking its own steps to ensure that hospitals can share electronic information. The legislation requires the Maryland Health Care Commission and the Health Services Cost Review Commission to designate a state health information exchange by Oct. 1. State health insurers will provide incentives to hospitals, which include a lump sum payment or increased reimbursement, to adopt electronic health records.

Erickson Retirement Communities, Johns Hopkins Medicine, University of Maryland Medical System and more than a dozen companies and health care institutions have submitted their own plan to the state’s health care commission to create a health information exchange, known as the Chesapeake Regional Information System for our Patients.

Above article published on

http://www.bizjournals.com/washington/stories/2009/05/18/daily1.html

By Rosemarie Nelson

The economic stimulus bill (the American Recovery and Reinvestment Act of 2009, or ARRA) provides incentive payments up to a maximum of $44,000 per physician over five years for “meaningfully using health information technology.”

Although we don’t yet have definition of “meaningful use,” we can be pretty sure doctors will need to be e-prescribing, exchanging information electronically, and reporting clinical quality measures.

Rather than wait for that definition, start your EMR selection and implementation project now. And start it with an educational demo.

An educational demo is an opportunity for a vendor to help you understand what his EMR can do for your practice, so that as you evaluate products and services, you’ll have a better understanding of how to get a good fit.

The demo serves as an introduction to the possibilities that an EMR brings to a practice for improved operational workflow. That workflow includes both the patient flow when the patient visits the practice and the paper flow that occurs in anticipation of a visit or as the result of a visit (follow-up test results, telephone calls, correspondence, etc.).

Technology changes what is feasible and the demo will help open up ideas that you might not be able to anticipate without some background about the potential.

Pay attention to all the “set-up” and “follow-up” work the EMR can help with “around” the patient visit. In other words, do not get too hung up on the use of the EMR inside the exam room.

The chart is handled and touched and prepped and moved about three times as much outside the exam room as it is inside the exam room. This is especially important for the physicians viewing the demo to remember, because there will be a tendency to think about how it effects the doctor in the room with the patient.

You need to look at the breadth of the interaction with that chart around its entire use.

Look at two aspects of how the prescription function works. One being the first time you prescribe a medication and the second being how the reissue of a prescription will work, including the “messaging” between the nurse on the phone and the provider approving the reissue.

Also look at the messaging and communication systems in general — how will the ability to report and communicate in-office lab test results improve the workflow?

Get comfortable with the “home” page or your “desktop” (all vendors call it something different) where you will “run” your day. Look at the incoming messages and how they are highlighted or categorized.

Look at your schedule for the day with patient information, and how that is integrated/passed from the practice management system.

Get a sense of how you can navigate from a message to the patient’s last office visit documentation and then how you can generate an order (in house or outside the practice).

Know where you’ll find information about the patient’s insurer so you know which ancillary services can be provided by which testing centers, etc.

Try to learn, too, about how external documents will flow through the system — where is the point of entry in the practice and then how does the document get into the patient’s record and to the correct person for review?

Keep the 80-20 rule in mind. In other words, you will have instances that pop into mind about that one-off or atypical encounter and you’ll get caught up in the demo about how to accommodate that. Stop and ask yourself, how often is that an issue? Chances are it’s not worth spending time in the EMR demo on such problems. No EMR can accommodate every situation.

These may seem like a lot of things to consider in a 90-minute demo, but they can all be covered.

And be sure to ask questions, especially if things are not obvious or demonstrated for you.

But above all, get started! There’s economic stimulus money to be had.

Above article published on

http://www.medpagetoday.com/Columns/14250

Stimulus funds would help replace paper medical files.

By Kristi E. Swartz

The Atlanta Journal-Constitution

Hurricane Katrina illustrated what can happen when medical records are on paper instead of stored on a computer.

They washed away, rendering thousands of people unable to get prescriptions, notify doctors about allergies or receive medical help.

“We have to bring our best technology to bear in the health care system,” said Dr. David Satcher, former U.S. surgeon general and director of the Satcher Health Leadership Institute at Morehouse School of Medicine.

Federal stimulus money is available for health care providers in Georgia to convert paper medical records to electronic ones, Satcher and others said Thursday at Georgia State University. Though such technology has been available for years, fewer than 4 percent of doctors have made their medical records completely electronic, said Janet Marchibroda, chief health care officer for IBM, who said the stimulus dollars will help with some of the conversion challenges.

Stimulus money will be funneled through Medicare and Medicaid programs as well as through the National Coordinator for Health Information Technology. Marchibroda cautioned that it be spent wisely.

“We could really mess this up by just pushing a lot of money out there but not focusing on improving health information technology,” she said.

Georgia’s Department of Community Health has received $339.6 million in the first batch of stimulus money. Rhonda Medows, the state’s health officer and commissioner of the community health department, said the agency is waiting for federal guidance on how it can use that money to reimburse health care providers who buy an electronic health record system.

Above article published on

http://www.ajc.com/services/content/printedition/2009/05/15/healthstim0515.html

Care for uninsured, electronic records receive cash

The $4 billion in federal stimulus health care money headed to the Bay State over the next three years will help provide care for those who can’t afford it and - it is hoped - help stem hemorrhaging health care costs by funding new technologies.

The bulk of the health care stimulus funding - some $3.5 billion - will keep most safety net programs afloat with Medicaid/Federal Medical Assistance Percentage funds.

But a portion of the federal stimulus money is targeted for cost-saving innovations. Massachusetts is getting $1.3 billion in technology and research funds, with more than $500 million going toward eHealth initiatives in the commonwealth.

The initiatives will fund the creation of electronic patient records. State officials hope the federal investment will lead to a secure statewide database of patient information, or in government parlance, an interoperable Health Information Exchange.

The program could have a long-standing impact by providing doctors quick, seamless access to patient records, offering the possibility of savings in time, money and lives. Nationwide, some $19 billion will go to e-records programs with a goal of freeing a profession from an archaic paper-based system by 2014. President Barrack Obama has touted the potential costs savings from the program.

Massachusetts, which is ahead of many states in initiating electronic medical records, stands to gain from significant federal reimbursements.

Stimulus funds will be used to reward those who have already installed the record system and provide money to hospitals and physicians who implement it. The state would also penalize those who fail to upgrade to e-records.

Physicians who meet the state criteria for electronic files could receive reimbursements of up to $44,000 each over four years directly from the federal government. There are about 20,000 physicians in the state, according to the Department of Health and Human Services.

Partners Healthcare could be a big winner in the stimulus sweepstakes because it has already implemented a records system. With individual reimbursements for its 3,000 members, including teaching hospitals Brigham and Women’s and Massachusetts General Hospital, the health care consortium could receive from $10 million to $50 million.

The state’s Health Care Quality and Cost Council estimates that it takes a small medical practice an average of four months to adopt an EMR at an up-front cost of up to $40,000 per physician.

Up-front costs have been one of the biggest obstacles in creating an electronic system. But Massachusetts, which has nearly twice the national average of doctors using EMRs, could face an easier transition with quicker federal reimbursements.

“The adaptation in Framingham was smoother because there wasn’t an existing paper record, so our advisors picked it up very quickly,” said Paula Kaminow, executive director of the Framingham Community Health Center, which began using EMRs when it opened five years ago.

Community health centers are important centers of medical information because they serve a wide range of the population that doesn’t have personal physicians. Installation of electronic records in 12 centers could increase staff productivity, allow for expansion in the number of patients and ensure easier and faster sharing of patient information with hospitals.

“From a risk-management standpoint, it’s much easier for providers to find the information they need,” Kaminow said. “The handwriting is clean, you can find different chart notes very quickly and can integrate information from different sources.” The electronic system could save the nation $530 billion over 10 years, according to the Health Care Quality and Cost Council, which estimates that the stimulus’ national eHealth initiative could reduce the nation’s health care spending by up to 30 percent.

Kaminow said the most important characteristic for an electronic record is the ability to interface with other types of records.

“The challenge is to make sure that all the different pieces can speak to each other, such as a management system that can speak to an electronic health record or a lab report,” she said.

The central project for the state is the Health Information Exchange, which is not funded by federal dollars. The state’s newly established Health Information Technology Council will provide $15 million in initial funding to help install the exchange by 2014.

The exchange would combine electronic record projects for individual practices, hospitals and community health centers, sharing patient information in a secure statewide database. Anyone in the system treating a patient could quickly learn about the patient’s allergy data, medication and test results.

The IT initiative has another reward: job creation. Private sector jobs would grow among vendors installing database systems, with positions ranging from entry-level programmers to high-level project managers.

Massachusetts has a leg up in this respect with an already developed system of software and hardware vendors.

Although federal stimulus funds end after two years, the reimbursements that follow implementation of the systems could create jobs in the long term.

“We’re looking to bring on more staff and extend our hours,” Kaminow said. “After a start-up period, our costs are covered through billing, so in that way we’d be able to sustain increased employment.”

The other big slice of the health care stimulus pie is the $764 million coming to Massachusetts for this year and next.

Funds will be used primarily to maintain services - securing jobs, meeting health care standards and safety net services, with $190 million going to offset fiscal year 2009 budget holes, according to the Department of Health and Human Services.
Above article published on

http://www.thesunchronicle.com/articles/2009/05/12/news/4900258.txt

By TOM BREEN

Health care providers across the country are moving to replace their old paper records with sleek new electronic systems, a process the Obama administration wants to speed along with over $17 billion in stimulus dollars.

That’s a tall order for doctors and hospitals, because an estimated 90 percent of health care offices still stack their records in floor-to-ceiling shelves crammed with manila folders.

The administration’s goal is to implement systems that allow doctors and nurses instant access to patient records and to avoid harmful errors in prescriptions and medical charts. But some worry the software isn’t yet ready to replace the ease of use of paper records, and say the cost of the systems may be too steep.

Dr. Theodore Hole, a family physician in Ventura, Calif., said when he sees patients who have electronic records from other physicians, they’re often a collection of checked boxes and fill-in blanks that are meaningless to doctors outside of the group using the system.

Health care providers such as doctors and hospitals would be reimbursed by higher Medicare and Medicaid payments if they put the systems in place by 2011. Doctors can receive up to $60,000 and hospitals up to $11 million. If they don’t switch, they could see their Medicare and Medicaid dollars decline.

The health care industry has been moving toward electronic records for years, but the rate of adoption has been slow. Some providers are intimidated by startup costs, which can range anywhere from tens of thousands of dollars for a doctor’s office to $100 million for a large hospital.

“It’s not going to be enough to pay for it; it’s going to be enough to make you want to engage with it,” Sentara Healthcare Chief Information Officer Bert Reese said of the stimulus incentives.

The southeastern Virginia network of seven hospitals and hundreds of doctors is in the midst of a decade-long, $237 million conversion project, with all hospitals scheduled to be on board next year. The stimulus plan could mean as much as $40 million to the network, he said.

Though the systems vary, advocates say computerized records are safer and more efficient. There are fewer mistakes that come from trying to read handwriting, and anyone in a medical system can access the information. When a patient comes into the hospital complaining of chest pains, for example, emergency room staffers don’t have to hunt down past medical records for allergies, medications and other information because it’s immediately available on a computer screen.

The idea is also to shorten the time involved in basic procedures. Under a paper system, Sentara’s Reese said, a doctor entering a medication order for a hospital patient can expect to wait up to an hour before the first dose is administered. With electronic records zapping the order directly from the doctor to the hospital pharmacy, Reese said, it can take about five minutes.

The Obama administration believes converting to electronic medical records will improve patient safety and overall health as well as bring down costs across the spectrum from public to private care, according to the DHHS.

“It’s an excellent use of the stimulus money,” said Dr. Margaret Staggers, a Fayetteville physician who, as a member of West Virginia’s House of Delegates, will help determine how the plan shapes the state budget. All seven of West Virginia’s state-owned hospitals have the system in place. “Doctors are interested in getting these systems, but there’s so much upfront cost.”

Trinitas Hospital in Elizabeth, N.J., estimates it can get $11 million in stimulus funds for its $30 million electronic health records system, according to Ken Raske, president of the Greater New York Hospital Association, which represents about 300 hospitals in the Northeast.

“It’s not a bad down payment, but it gives you an idea of the proportion that comes from the stimulus package as opposed to the money they need to invest,” he said.

Still, conversion could be slow. An April article in The New England Journal of Medicine concluded there are no reliable estimates on how many hospitals have electronic records, mainly because providers have implemented systems with a piecemeal approach. But it estimates roughly 7.6 percent have at least a “basic” system. For physician practices, the figure is probably around 4 percent.

There are also questions about ease of use, maintenance, compatibility with other systems and keeping all that data secure. Perhaps most urgently, no one yet knows what systems will qualify for reimbursements and keep providers from seeing reduced Medicare and Medicaid payments.

Because of the uncertainty, it’s too soon to tell whether the stimulus plan is getting more providers to make the switch, said John Morrissey, spokesman for the Certification Commission for Healthcare Information Technology.

“With so many unanswered questions, it’s kind of ludicrous to go too far into it,” said Joe Letnaunchyn, president of the West Virginia Hospital Association. “You run the risk of spending money inappropriately.”

Above article published on http://www.businessweek.com/ap/financialnews/D9810JVG0.htm

Diana Manos, Senior Editor

WASHINGTON – The economic stimulus package has allotted $17.2 billion to reward Medicare and Medicaid providers who can prove they are using certified healthcare IT “in a meaningful way.”
The incentives are scheduled to take effect starting Oct. 1, 2011. Experts say providers should not waste time getting prepared because there is a shortage of change management experts available to help.

According to Dave Garets, president and CEO HIMSS Analytics, 94 percent of hospitals currently don’t have enough healthcare IT in place to meet the stipulations required to receive bonuses. Under the new law, they must prove “meaningful use,” which will require capturing certain data.

Garets expects that healthcare organizations will adopt healthcare IT “with a vengeance” in 2009. He and other members of the Healthcare Information and Management and Systems Society are concerned there are “precious few” change management experts to help providers make the complicated transition to healthcare IT by 2011.

Garets said it’s not as simple as hiring a software technician to make the transition. There is a need for qualified people who know how to help with workflow adaptation and how to implement software packages so they work for the organization.
“These people are extremely valuable and extremely rare,” he said.

Payments under the American Reinvestment and Recovery Act are graduated in descending amounts for federal fiscal years 2011 and 2015. After 2015, there are penalties for providers that do not use healthcare IT. The sooner a provider is ready to go with healthcare IT, the more likely they are to cash in on the maximum possible, Garets said.

According to HIMSS leaders’ interpretation of the law, physicians can earn from $44,000 to more than $60,000 in extra payments over the five-year period, including $18,000 the first year. Incentives for hospitals will start at a base of $2 million annually.

To qualify for bonuses, providers must have certified electronic health record technology capable of providing clinical decision support to physician order entry and capturing query information relevant to healthcare quality. The system must also be able to exchange and integrate electronic health information with other sources.

The maximum payment for qualifying physicians under the stimulus package is $18,000 for the first year, $12,000 for the second year, $8,000 for the third year, $4,000 for the fourth year and $2,000 for the fifth year.

For those failing to use certified qualifying healthcare IT by 2014, Medicare payments will be reduced to 99 percent in 2015, 98 percent in 2016 and 97 percent thereafter.

Hospitals will have to submit data on clinical quality measures and other measures to be determined by the Department of Health and Human Services secretary.

Payment for hospitals is a complicated formula that includes the discharge amount and Medicare share a hospital receives.

The state is authorized to make bonus payments, beginning in 2011, to physicians who provide Medicaid services, are not hospital-based and have at least 30 percent Medicaid patient volume. Federally qualified health centers or rural health clinics with at least 30 percent Medicaid patient volume can receive up to $63,750 in incentives and will not face reductions in Medicaid payments if they do not adopt certified EHR technology.

The “meaningful use” of healthcare IT is yet to be determined by the HHS secretary under the new law.
On Monday, President Barack Obama nominated Kansas Gov. Kathleen Sebelius to fill this role. If Sebelius is confirmed by the Senate, she will also oversee standards development and select clinical quality measures used to determine providers’ worthiness for receiving healthcare IT incentives under the new law.

http://www.healthcareitnews.com/news/big-money-stimulus-
package-hit-users-prepare-now-experts-say

By John Haughton, MD

The economicstimulus 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.

http://www.thehealthcareblog.com/the_health_care_blog/2009/02/ stimulus-bill-offers-docs-big-incentives-for-technology-but-demand-effective-use-.html