Saying it’s not logical to complain that the government ‘can’t run anything’ but will put them out of business, he also leaves room for compromise on a public plan as Congress tackles the issue.

By Noam N. Levey and Peter Nicholas

Reporting from Washington — In an effort to maintain control of the healthcare debate, President Obama on Tuesday ridiculed critics of his government-run insurance proposal, saying private insurers have nothing to fear if they are efficient and consumer-friendly.

“If private insurers say that the marketplace provides the best-quality healthcare — if they tell us that they’re offering a good deal — then why is it that the government, which they say can’t run anything, suddenly is going to drive them out of business?” Obama asked. “That’s not logical.”

t the same time, the president left the door open to compromise with the private insurance industry as Congress begins the process of tackling one of the most complex and politically sensitive issues on the national agenda.

In a news conference Tuesday, Obama framed his proposal as the only way to break the cycle of ever-higher medical costs that has sapped the financial stability of families and the government.

At the same time, however, he refused to rule out the possibility that he might sign a healthcare bill that did not include a public-plan option.

“We are still early in this process,” he told reporters at the White House. “We have not drawn lines in the sand.”

The president, who last week both challenged and sought to appease doctors in a speech to the American Medical Assn., will host a healthcare town hall at the White House tonight, the second such event in the last two weeks.

And with help from the Democratic National Committee, Obama supporters plan to hold events around the country Saturday aimed at promoting his healthcare overhaul — including blood drives, medical fairs and sessions on nutrition.

Fifteen years ago, the insurance industry was able to defeat President Clinton’s healthcare proposal by playing on the public’s fears with its “Harry and Louise” ad campaign, which featured a couple fretting about the government making their healthcare choices for them.

Now, Obama’s campaign website is urging people to share stories about their own battles with the healthcare system and to send letters to members of Congress.

“We think there are powerful stories to be told that argue for healthcare reform,” said Hari Sevugan, national press spokesman for the DNC. “Once you hear those stories, it demands reform this year.”

The administration’s push comes amid signs of division over Obama’s plan among some Democrats on Capitol Hill.

In recent days, the legislation being shaped by party leaders has drawn fire not only from Republicans and industry critics, but also from some moderate Democrats concerned about the cost of the overhaul and its potential to disrupt the current healthcare system. Obama’s plan is expected to cost at least $1 trillion over the next decade.

Several centrists, including Sen. Kent Conrad (D-N.D.), have indicated interest in pursuing alternatives to a government plan.

“You can have the greatest plan in the world on paper. If it does not pass, nothing changes,” said Conrad, who is working closely with senior Senate Democrats and Republicans on healthcare legislation and has championed the creation of health insurance cooperatives to compete with private insurers, rather than a government plan.

Illinois Sen. Richard J. Durbin, the No. 2 Democrat in the Senate, acknowledged Tuesday that preliminary work on the legislation would probably not be completed before Congress leaves town this week for its 10-day July 4 recess.

Senate Finance Committee Chairman Max Baucus of Montana, who is leading one of the two Democratic healthcare efforts in the Senate, sounded a sanguine note Tuesday. “I feel much more hopeful and encouraged,” he said. And Conrad noted that lawmakers were making progress in containing costs by reducing the size of the subsidy that the government would give people to help them buy insurance.

But neither would say when the negotiating might yield a bill.

noam.levey@latimes.com, peter.nicholas@latimes.com

Above article published on

http://www.latimes.com/features/health/la-na-obama
-healthcare24-2009jun24,0,3575870.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

Scott N. Wolfe

A major focus of the American Recovery and Reinvestment Act (Stimulus Act) that President Obama signed in February is to improve the quality and expand the scope of health information technology in the United States. One of the central goals is to develop a nationwide health IT infrastructure and transfer all Americans’ health records to electronic format by the year 2014.

Under the Stimulus Act, the Office of the National Coordinator for Health Information Technology (ONCHIT) received a $2 billion appropriation to achieve these goals. The funds will remain available until expended; however, the law requires that certain portions of the funds must be allocated to specified groups. ONCHIT will be advised by two policy committees comprised of members from the various sectors of the health-care industry. ONCHIT is charged with a number of oversight activities, including the development of uniform health IT standards to allow interoperability among diverse health IT systems. “Making the electronic health records dream a reality will depend upon the successful development of uniform HIT standards,” said Andrew Gantt, a partner in the Health Care and Life Sciences Group at the Washington D.C. office of Latham & Watkins. “This is critical to ensuring that multiple electronic health records technologies are able to communicate effectively with each other.”

One of the named recipients under the Stimulus Act is the National Institute of Standards and Technology (NIST). NIST will receive $20 million of the budget allocation to continue advancing the use of health IT. The law also earmarks $300 million to support sub-national and regional efforts in their advancement toward health information exchange.

The Stimulus Act also contains various financial incentives to specified groups who adopt and increase their use of electronic health records and health IT. Medicare providers, for example, are entitled to receive up to $44,000 ($48,400 for providers in a professional shortage area) of funding if they adopt and engage in a “meaningful use” of certified electronic health records technology. The standards that providers must meet to satisfy the “meaningful use” requirement in order to receive incentive payments include, among other things, the ability to connect in a way that provides for the electronic exchange of health information and a willingness to report information on clinical quality measures to the Department of Health and Human Services.

The law also incentivizes Medicare providers by penalizing them if they do not become electronic health users by 2015 through a one to five percent reduction in payment the providers would otherwise receive. Similar financial incentives, which can total $63,750, are available for Medicaid providers who implement electronic health records technology. Providers eligible for both Medicare and Medicaid incentives may only receive incentives from one or the other.

Hospitals are also entitled to receive funding under the Stimulus Act if they can demonstrate that they are “meaningful users” of electronic health records technology. A formula determines the amount that hospitals can receive, with the amount starting at $2 million. Grants will also be available to universities that develop centers designed to generate innovative approaches to the use of health IT.

State or state-designated entities are also eligible to receive grants if they submit a plan describing activities to be carried out to facilitate the exchange of health IT. In addition, regional centers that assist in the promotion and advancement of health IT may receive grants for the continued development of technological approaches. To secure their grants, however, these groups must contribute matching funds up to a certain percentage of the federal funds they intend to receive.

Universities and clinical health education programs that expand educational programs focusing on medical information are eligible to receive grants, if they contribute matching funds of at least 50 percent of the cost of the program. In addition, the Stimulus Act authorizes the establishment of loan programs, administered by states and Indian tribes, to health care providers who facilitate the adoption of certified electronic health records technology. Like many other incentives, however, the entity receiving the grant must match the federal funds received with a percentage of the amount received.

Advancing and expanding the use of electronic health records across the United States is a top priority under the Stimulus Act. With financial incentives being provided to various groups to facilitate the shift to electronic records, and a renewed drive to develop uniform health IT standards, the goal of having all Americans’ health records in electronic format is more likely to be attained.

Scott N. Wolfe is the Chair of the Corporate Department and partner-in-charge of the San Diego North County office of Latham & Watkins LLP

Above article published on

http://www.xconomy.com/san-diego/2009/05/08/
a-brief-guide-to-stimulus-act-funding-for-health-information-technologies/

By now you’ve heard about the $850 billion American Recovery and Reinvestment act of 2009 - the stimulus bill recently passed by Congress. The bill is aimed at spurring economic growth across multiple industries by way of government spending.

What’s in it for you?

Well if you are a healthcare provider, you can take advantage of the $51 billion that has been allocated to the health care industry, $19 billion of which will be used to incentivize medical practices to adopt and implement Electronic Health Records (EHRs), also known as Electronic Medical Records (EMRs).

How does the subsidy work?
Starting in 2011, providers deemed to be “meaningful users” of EHR systems will be eligible to receive $40,000 - $60,000 in incentive payments paid out over five years in the form of increased Medicare and Medicaid premiums.

For the first year a physician is deemed to be a meaningful user, he or she will be eligible for payments of 75% of that year’s Medicare and Medicaid charges, up to a maximum of $15,000. The maximum payment is increased to $18,000 if the first year is 2011 or 2012. The incentive payments decline for each subsequent year within the five year period; $12,000 will be paid in year two, $8,000 in year three, $4,000 in year four, and $2,000 in year five.

No incentive payments will be available after 2015, and no payments will be offered to physicians who first become eligible after 2014. This creates a decreasing incentive for late adopters.

What is a “meaningful user”?
To qualify as a “meaningful user,” eligible providers must demonstrate use of a “qualified EHR” in a “meaningful manner.” The bill defers to the secretary of Health and Human Services (HSS) to set specific guidelines for determining what constitutes a “qualified EHR”; however, it does specify that e-prescribing, electronic exchange of medical records, and interoperability of systems will be determining criteria.

HSS will be working throughout 2009 to set the necessary criteria for certifying systems, and is expected to have a final report by January of 2010. Many expect CCHIT certification to play a major role in setting standards of interoperability. (See “Should CCHIT Influence Your EHR Selection” for more information). After all, HHS funded the creation of CCHIT to start certifying EHRs a few years ago.

How do I qualify for the maximum payment?
In order to receive the maximum payment, physicians must qualify as a meaningful user in 2011. Eligible physicians will receive a first year bonus of $18,000 (up from $15,000) and will max out the payment schedule over the next five years.

The table below illustrates the amount of a subsidy paid each year (columns) based on the year the provider first becomes eligible (rows):

No payments will be offered to physicians who first become eligible after 2014.

Practices with multiple physicians will be eligible to receive incentive payments for each provider. Remember that payments will be based on 75% of the correlating year’s Medicare and Medicaid charges. Therefore, in order to qualify for the maximum payment of $18,000 in the first year, each provider must bill Medicare or Medicaid a minimum of $24,000.

Should I purchase an EHR now or wait until 2010?
An obvious concern is whether an EHR implemented in 2009 will meet the standards set by HHS in 2010. Although a legitimate concern, waiting until 2010 to implement a system may be a mistake. Researching and selecting the right EMR can be a lengthy process, and many providers who wait may find it difficult to have a system in place in time.

Practices would be well-served to begin the research process now, allowing ample time to create a short-list of systems, perform demos with several vendors, check references, meet with vendors in person, negotiate terms, and complete the implementation and training process. To alleviate buyers’ concerns, vendors may provide binding agreements, guaranteeing their system will comply with all emerging standards.

Furthermore, buyers’ should consider CCHIT an important Certification relative to the requirement for “qualified EHRs.” While we have discussed the many opinions for and against CCHIT, we expect it to play a critical role in the EHR subsidy qualification.

What if I choose not to purchase an EHR?
Unfortunately, for physicians who choose not to implement an EHR, the stimulus bill is a double-edged sword. Not only will they forego thousands in incentive payments, but starting in 2015, they will be penalized by way of decreased Medicare and Medicaid payments. Physicians who fail to qualify as meaningful users will face decreases of 1% in 2015, 2% in 2016, and 3% in 2017, with a maximum reduction of 5% by 2020.

Above article published on

http://www.softwareadvice.com/articles/medical/
the-stimulus-bill-and-meaningful-use-of-qualified-emrs-1031209/

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 Ken Alltucker

The Arizona Republic

Federal money could accelerate Arizona’s push toward digital health records, making staples such as paper charts, written prescriptions and doctor’s-office clipboards a thing of the past.

As part of its stimulus package, the government will pump more than $19 billion into computers and software systems that promise to connect hospitals, doctors, pharmacies and other health-care players.

Widespread use of electronic health records would save lives and money and eliminate waste in the complex world of health care, medical experts agree.

Arizona doctors appear to be adapting to electronic records faster than the national rate, but getting there can be costly and frustrating.

At Central Phoenix OB/GYN, the three doctors and a nurse practitioner started using a digital system in January. The doctors are still learning the system, and the office staff is on the final leg of scanning 20 years’ worth of patient records into computer records. “We are still in the ‘Oh, my God, what have I done’ (phase),” office manager Tracey Vega said.

Arizona’s medical community is poised to collect as much as $500 million in stimulus funds beginning in 2011, local officials estimate, provided health-care organizations adopt “meaningful use” of such digital systems.

“Automation is eventually going to be everywhere,” said David Landrith, the Arizona Medical Association’s vice president of policy and political affairs. Proponents say electronic health records are superior in many ways. A physician can verify a patient’s prescription-drug regimen, helping to avoid harmful drug combinations. Nurses can use a hand-held scanner to zap a patient’s medication to ensure they are giving the right drug to the right person.

Multiple caregivers can simultaneously view a patient’s medical charts, making care more efficient. Still, there are challenges. Some worry that a wide range of computer systems and standards may block effective communication. Systems that cost $100,000 or more are too expensive for smaller doctor’s offices. Comprehensive hospital systems can range from $20 million to $100 million.

Also, worries about patients’ privacy persist.

Arizona’s progress

Studies show varying degrees of adoption rates for computerized records. A New England Journal of Medicine survey indicated that 17 percent of doctors have some type of electronic health-records system, while another survey indicated hospitals’ use of electronic health records vary widely.

Arizona health-care providers have turned to computerized systems at a faster clip, with at least 30 percent of physicians employing some type of digital system, according to Brad Tritle, executive director of the Arizona Health-e Connection, a non-profit group established to orchestrate Arizona’s digital health initiative. Tritle said that figure comes from an ongoing survey of licensed doctors performed by Arizona State University and funded by the state’s Medicaid program.

Arizona’s digital health push isn’t new. While governor, Janet Napolitano signed an executive order calling for statewide adoption of digital-records systems for prescribing drugs. Arizona Health-e Connection has spearheaded the effort to research and develop model policies in the state.

With federal stimulus dollars providing a tailwind, Tritle said he expects the use of digital health records to accelerate.

Digital doctors

Even the biggest backers of a health-information revolution acknowledge that questions remain about cost, training and standards.

Dr. Bradford Croft, a family practitioner in Flagstaff, is one of Arizona’s digital pioneers, having tossed out paper records a decade ago.

Each room is outfitted with a computer. He chats with nurses or assistants via instant messaging. The conversion has made Croft’s practice more efficient, allowing him to see more patients each day. One reason: He doesn’t waste time writing notes only to have others duplicate note-taking several times.

“We’ve been more productive, without a doubt,” said Croft, who also holds an MBA and completed his master’s thesis on the efficiency of his practice.

Yet even Croft said his current system is less than ideal. He has cobbled together eight software programs to get everything he wants. He plans to spend up to $50,000 on a new system. Regardless, he said he cannot imagine going back to paper records. “Does it make us better doctors? Not necessarily,” Croft said. “But I think it makes us more organized, and it makes us more observant to detail.”

Dr. Lesley Johnstone at Central Phoenix OB/GYN said the conversion will make her office more efficient.

One example: A doctor could access a patient’s records and authorize a prescription refill with a few keystrokes rather than searching the office for a paper file.

Plus, the 24/7 availability of patients’ records will allow the doctors to more easily take care of the other doctors’ patients. When a doctor delivers the baby of a patient he or she is less familiar with, it is essential the doctor has access to the patient’s records.

That typically meant a late-night or early-morning call to locate paper records. Now, the on-duty doctor needs only to access a computer. Despite the knowledge that digital records will help make things easier, Johnstone said the transition has not been simple. “It was always really easy on paper, but for some reason, it is harder with the computer,” she said.

Leaders and laggards

Tritle said other areas of Arizona’s health care are considered leaders in digital health, too.

Banner Estrella Medical Center was among the nation’s first hospitals to go all digital when it opened in January 2005. Other hospitals that have established digital records include Banner Gateway Medical Center, Mayo Clinic, Cancer Treatment Centers of America and University Medical Center in Tucson.

One of Banner Estrella’s most recent initiatives is called “positive patient ID,” which aims to eliminate a common medical mistake: giving the wrong patient the wrong medication.

The system works by requiring nurses to use a hand-held device to scan medications to ensure they match a patient’s records. If the nurse has the incorrect room, they will get an alert from the scanner.

The program has cut down on medication errors, said Richard Schmidt, a registered nurse who serves as the hospital’s interim deployment manager. Banner Health plans to roll out such digital-records systems for all its hospitals over the next 18 to 24 months, spokesman Bill Byron said. Banner Health and other Arizona hospitals likely will seek federal stimulus dollars to help fund the transition. “We view this as an affirmation of what we’ve been doing,” Byron said of the stimulus plan.

Above article published on www.azcentral.com.