eyecare by the numbers

EHR and You

Brad Rourke, CPA

The Obama Administration's stimulus plan legislation is fast-tracking initiatives and incentives for the adoption of electronic health records (EHR) to reduce health care costs and improve coordination of care, among other objectives. Below is a summary of the primary processes and incentives for EHR adoption.

At the base of the subject is “meaningful use” and certification for same. According to David Blumenthal, MD, MPP, national coordinator for the Health Information Technology (HIT) Policy Committee, U.S. Department of Health and Human Services (HHS), “We will only compensate providers if they're using certified records in a meaningful way.”

What and who is involved?

■ What: $19.2 billion of stimulus plan funding earmarked for the development and promotion of health information technology.

■ Who: Qualifying providers, which includes the category of optometric doctors.

WHAT IT MEANS

The HITECH Act has introduced the concept of “meaningful” EHR use. It includes: using certified electronic health records; e-prescribing; electronic exchange of health information; and submitting “specified” information on clinical quality measures.

There are substantial benefits to ODs to conform. Following are some specifics about the American Recovery #x0026; Reinvestment Act (ARRA) incentives for meaningful use of certified EHRs.

■ Incentives. These are $18,000, $12,000, $8,000, $4,000, and $2,000 for years one through five of EHR usage, respectively, beginning in 2011 and distributed as incentive payments of 75 percent of your eligible Medicare reimbursements. There are no stated restrictions on the use of those payments.

■ Eligibility. To be eligible for the full incentive—totaling $44,000—adoption and demonstration of meaningful use of certified EHR technology is required.

■ Penalty. A reduction of one percent per year of Medicare reimbursements will go into effect if meaningful use in a practice is not adopted by 2015. The annual penalty will occur for a maximum of five years.

ALPHABET SOUP OF EHR A good first step in getting up to speed is understanding the acronyms and abbreviations for terminology involved in this initiative. ARRA American Recovery #x0026; Reinvestment Act (a.k.a., the $787 billion stimulus plan) CPOE Computer physician order entry EHR Electronic health record HHS Health and Human Services. Its secretary, Kathleen Selelius, is a member of the president's cabinet HIT The Health Information Technology's Standards Committee, a group charged with making recommendations IFR Interim Final Rule. These regulation filings took place on December 30, 2009 ONC Office of National Coordinator for Health Informational Technology. Its coordinator, David Blumenthal, MD, MPP, reports to HHS's Selelius

THE SEQUENCE

In terms of sequence of events, the HIT was charged with making recommendations to the Office of the National Coordinator for Health Information Technology (ONC) and Health and Human Services Secretary in order to establish both EHR standards and certification, a process that began last spring.

The Interim Final Rule (IFR) regular filings occurred on December 30, 2009. Two documents were filed at that time (see sidebar).

The first defines requirements to demonstrate “meaningful use,” and has divided them into three implementation stages.

Stage one addresses 2011 criteria for incentive payments.

Stages two and three are not yet fully defined. Definitions regarding the second stage, which will deal with the exchange of clinical data, are expected by the end of 2011.

Definitions of stage three, which will address clinical decision support tools and other requirements, should be available by the end of 2013.

STAGE ONE

There are 25 stage one criteria for providers. They include:

■ 80 percent of orders need to be placed by computer physician order entry (CPOE).

■ 75 percent of prescriptions written by the doctor must be electronically transmitted.

■ Eight out of 10 patients who ask for a copy of the health record to be sent electronically must receive their information within 48 hours.

■ 80 percent of patients must have at least one electronic documentation of allergies or medications, or a notation of none.

NEXT STEPS

There are not yet any HHS-certified EHRs available that qualify for stimulus plan incentive payments. However, there will be likely be certified technology available, either later this year or in early 2011.

To clarify, the Interim Final Rule document distinguishes between “certified EHR technology” and “certified EHRs.” What that means to you is that you can still use multiple vendors of EHR technology, rather than moving to just one, in order to satisfy stage one criteria.

Using certified EHR technology is not and will not be required. Though adoption will continue to be voluntary, providers who don't adopt will incur a one percent “penalty” on Medicare reimbursements and forego up to $44,000 of incentive payments.

For now, it's important to become familiar with the 25 stage one criteria for meaningful use. And if you haven't done so in the past, now would be a smart time to invest in a practice management system that has imbedded EHR.

Just make sure of two things: first, that the vendor you select is working toward certification; and, second, that you have an indefinite contractual right to access patient data with the software.

Brad Rourke is vice president of Practice Director of Software, a division of Williams Group, headquartered in Lincoln, Neb. EB