Return to HITECH 101
This section provides an overview of the ARRA HITECH EHR program. As you may know, this program came about through the passage of the 2009 American Recovery and Reinvestment Act passed on February 17, 2009. Title IV of Division B of ARRA amends Titles XVIII and XIX of the Social Security Act (the Act) by establishing incentive payments to eligible professionals (EPs) and eligible hospitals to promote the adoption and meaningful use of interoperable health information technology and qualified EHR's. OK, so that's the establishment of the program from a legal perspective (Federal Register/vol. 75, No. 8/Wed , Jan 13, 2010/Proposed Rules 1846-1847). Let's understand what the program does...
First of all, HITECH is a funding vehicle to those eligible hospitals and providers who use certified EHR information technology in a "meaningful" manner. That's the long and short of it. Well, almost. The prior sentence has several key words which complicate the ability to get funds. Those words are "eligible" and "meaningful" and "certified". In addition, we need to understand how the "funding" works so here goes my attempt at simplifying all of this:
Eligible -not as "available" but as somehow meeting certain criteria to be considered for the funds. This term encompasses three general types of payers to establish eligibility: 1) Medicare Fee For Services (FFS), 2) Medicare Advantage (MA) and 3) Medicaid. Of course there are exceptions; we'll get to those in a moment. SO who is eligible for the big pay day? For hospitals to be eligible, they can be acute care (excluding long term care facilities), critical access hospitals, children's hospitals. For providers, these include non-hospital-based physicians who receive reimbursement through Medicare FFS program or a contractual relationship with a qualifying MA organization. The Act defines the term "hospital based" eligible professional to mean an EP such as a pathologist, anesthesiologist,or emergency physician, who furnishes substantially all of his or her Medicare covered professional services during the relevant EHR reporting period in a hospital setting (whether inpatient or outpatient) through the use of the facilities and equipment of the hospital, including the hospital’s qualified EHR's (Fed Reg p. 1905). The determining factor is the site of service as to whether the service is hospital based or not. If the EP provides at least 90 % of their services in a hospital inpatient, hospital outpatient or hospital emergency room setting (Point of Service codes 21, 22, 23), then they are considered a hospital based EP and not eligible for EHR incentive payments (i.e. providing substantially all of his or her Medicare covered professional services).
Eligible Professional - there is a difference between Medicare and Medicaid when it comes to defining an eligible professional for EHR incentive payment purposes. Medicare defines an eligible professional as (Fed Reg p. 1996):
- doctor of medicine or doctor of osteopathy
- doctor of dental surgery or dental medicine
- doctor of podiatric medicine
- doctor of optometry
- chiropractor
Medicaid, on on the other hand, defines an eligible professional as (Fed Reg p. 2001):
- physician
- dentist
- certified nurse-midwife
- nurse practitioner
- physician assistant practicing in a Federally Qualified Health Center (FQHC) or a Rural Health Clinic, led by a physician assistant.
Meaningful Use - the specific requirements an eligible hospital or provider must meet to qualify for funding. These requirements have been developed through a series of working committees, and then reviewed by the HHS Secretary prior to issuing the Proposed Rules on December 30th, 2009. After a public comment period of 60 days, the final rules will be published, sometime in April in all likelihood. At that point eligible hospitals and providers will know what they must be compliant with to obtain HITECH funding. Table 2 of the Proposed Rules contains the requirements (except for the clinical quality measures) to meet the HITECH definition of "meaningful use". The specific requirements defining "meaningful use" are contained in the Proposed Rule, Table 2 (Fed Reg p.1867), for hospitals and eligible providers.
Certified -‘‘certified EHR technology’’ - a qualified EHR that has been properly certified as meeting standards adopted under section 3004 of the PHSA (Fed Reg p. 1846). CMS and ONC (Office of the National Coordinator for Health Information Technology) have been working closely to ensure that the definition of meaningful use of certified HR technology and the standards for certified EHR technology are coordinated. The EHR software must be certified under the certification process defined by HHS (specifically ONC). The specifics of the certification process have not been finalized as of early February, 2010. Remember, regardless of whether the eligible hospital or provider meets all of the other meaningful use requirements, useless a HHS certified EHR is being used, no EHR incentive payments will be available. The key for the eligible hospital or provider is to make sue their EHR vendor is positioned and seeking certification under the to be published certification process.
Program Timing - the timing of the HITECH EHR incentive program varies by both the payer (Medicare vs. Medicaid) and by hospital ve EP. For Medicare, the program for hospitals starts October 1, 2010, and runs through 2018 with an option to extend the program.
Payments - eligible providers are able to receive up to $44,000 of incentive payments under Medicare or up to $65,000 under Medicaid if they qualify. The amount per year is calculated by taking .75 times the total claims for covered services during the calendar year up to a maximum amount. They cannot participate in both programs; they must select in which program they wish to participate. Payments are made over five years for Medicare (Fed Reg p. 1908). For Medicaid, the total amount is capped at $65,000 which is paid out over a six year period. Remember, for eligible providers you must choose which program to get paid from, assuming you qualify for each.
Hospitals, if they can qualify, are able to receive EHR incentive payments for both Medicare and Medicaid. The payments consist of fixed and variable components based upon the number of discharges, the Medicare percent of inpatient day and charitable care charges. As an example, a hospital with a total of 7,000 discharges with 40% Medicare and 15% Medicaid would receive a total of $3.17 MM from Medicare and $1.19 from Medicaid over the four payment years. Remember a hospital can qualify for both EHR incentive payments if it reaches the minimum discharge and Medicaid targets (Fed reg p. 1912).
...and Penalties - yes, that's right, there are penalties if you failure to qualify as a meaningful user of an EHR in the time period allowed. This penalty is in the form of a reduction in the Medicare market basket adjustment ( i.e. your fee adjustment will be negatively impacted)(Fed Reg p. 1911). The penalties kick in if an eligible provider is not a meaningful user of EHR. The penalties start at .33 % reduction the first penalty year and escalates to a full percentage point penalty if not a meaningful user by the year 2017.
