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 EHR Resources > Financial Incentives Financial Incentives for U.S. Physicians - Updated October 18, 2010 In 2009, the Health Information Technology for Economic and Clinical Health Act (HITECH Act) — part of the American Recovery and Reinvestment Act — established criteria for Medicare and Medicaid participating physicians to receive financial incentives for using EHRs in a meaningful manner. Implementation of certified EHR technology will enable physician practices to take advantage of Federal Stimulus funding of up to $44,000 in additional Medicare payments and up to $63,750 in additional Medicaid payments between 2011 and 2015. Official CMS EHR Incentive Programs Website http://www.cms.gov/EHRIncentivePrograms (Provides information about the EHR incentive programs, including eligibility for the programs, how to register, meaningful use, and EHR training and events.)
Medicare Incentive Payments Tip Sheet (Sept 2010) - Click here to download
In order to apply for incentive payments, eligible providers must be enrolled in
PECOS, the Medicare (Provider Enrolment, Chain, and Ownership System) - Click here to register with PECOS
FAQs - ARRA Financial Incentives (Source ACP)
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Actually, there are several programs in the Act (also known as the HITECH Act). The Medicare-administered program will work best for most practices. There is a separate Medicaid program available for practices that qualify (see the details below). You can only receive payments from one program. So, it is worth taking some time to compare programs before choosing which program is best for your practice.
Special note for physicians working for certain Medicare Advantage organizations: Under specific conditions, physicians affiliated with Medicare Advantage organizations that are organized as Health Maintenance Organizations (“HMOs”) will not be paid directly. Instead, the payment incentives for meaningful EHR use go directly to the Medicare Advantage organizations – not to the practices.
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In order to receive the bonus payments, you must demonstrate “meaningful use” of a “certified system.” The government has issued two rules regarding these programs that define the specific tasks a practice needs to accomplish to demonstrate meaningful use. One of the best places to get information on the program is directly from CMS on their EHR website ( http://www.cms.gov/EHRIncentivePrograms). You can also find further information on the meaningful use program at this AmericanEHR Partners resource page.
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In order to qualify for this program, doctors must have a patient volume at least 30 percent attributable to Medicaid patients or, if they practice predominantly in a federally qualified health center or rural health clinic, they have patient volume at least 30 percent attributable to Medicaid patients and other needy individuals as defined by Medicaid rules. The Federal government will reimburse state spending up to the following limits: (1) 85 percent of $25,000, or $21,250, for the purchase and initial implementation of EHR technology, which must occur by 2016, and (2) 85 percent of $10,000, or $8,500, per year up to five years for operation and maintenance of the technology, with no payments made after 2021. Thus, the maximum aggregate Federal payments per provider ($21,250 + $8,500/year for five years) are $63,750. As noted, the Federal contribution is based on 85 percent of the costs; the statute requires that the covered providers be responsible for payment of the remaining 15 percent of the costs.
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Your best course is to run the calculations for the Medicaid option based on your estimates for system purchase and operation costs. Also, you will need to review your state’s specific regulations regarding this program.
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The requirements needed to demonstrate meaningful use can be found on the CMS website for the EHR program. However, the New England Journal of Medicine published an excellent summary by Dr David Blumenthal, National Coordinator for Health Information Technology. ACP also has an array of resources, which can be found on AmericanEHR Partners, to help practices become meaningful users of an EHR system. ACP hosted a Webinar, "Meaningful Use and Its Implications For Your Practice," featuring Dr. Blumenthal and Dr. Michael Zaroukian, FACP, Chief Medical Information Officer for Michigan State University, explains how to demonstrate meaningful use.
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You will have to demonstrate that you are a meaningful user for at least 3 months in the first year of your participation and then for the full year for each of the following years. However, if you do not already have an EHR, you should anticipate the time it will take you to install and integrate a system into your practice, which typically takes six to nine months.
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The new federal incentive program to encourage adoption of EHR systems a new certification process has been defined by the Office of the National Coordinator for Health Information Technology (ONC). The new certifications provide assurance to purchasers and other users that an EHR system, or other relevant technology, offers the necessary technological capability, functionality, and security to help them meet the meaningful use criteria established for the program.
Eligible professionals and eligible hospitals who seek to qualify for incentive payments under the Medicare and Medicaid EHR Incentive Programs are required by statute to use Certified EHR Technology. Once certified, Complete EHRs and EHR Modules can be used by eligible professionals and eligible hospitals (or be combined) to meet the statutory requirement for Certified EHR Technology.
As of August 2010, ONC has approved the following organizations as ONC-Authorized Testing and Certification Bodies (ATCBs):
Certification by an ATCB will signify to eligible professionals, hospitals, and critical access hospitals that an EHR technology has the capabilities necessary to support their efforts to meet the goals and objectives of meaningful use.
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If a practice documents meaningful use of a certified EHR system at the start of 2011: - 2011 – $18,000
- 2012 – $12,000
- 2013 – $8,000
- 2014 – $4,000
- 2015 – $2,000
Total: $44,000 If a practice documents meaningful use of a certified EHR system at the start of 2012: - 2012 – $18,000
- 2013 – $12,000
- 2014 – $8,000
- 2015 – $4,000
- 2016 – $2,000
Total: $44,000 If a practice documents meaningful use of a certified EHR system at the start of 2013: - 2013 – $15,000
- 2014 – $12,000
- 2015 – $8,000
- 2016 – $4,000
Total: $39,000 If a practice documents meaningful use of a certified EHR system at the start of 2014: - 2014 – $12,000
- 2015 – $8,000
- 2016 – $4,000
Total: $24,000 If a practice documents meaningful use of a certified EHR system at the start of 2015:
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You must be able to demonstrate meaningful use of a certified system by the start of 2012.
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You should talk to your EHR vendor on their plans to become “Certified EHR Technology” and if they have received certification if you have upgraded your system to the certified version.
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Given the long selection and implementation process, you would be well advised to start the process of familiarizing yourself with the EHR systems that are currently in the marketplace. AmericanEHR Partners has been developed to provide guidance on EHR adoption as well as comparison and rating information on EHR systems.
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If the physician is not a meaningful EHR user, the amount the physician would otherwise receive under the Medicare fee schedule will be reduced to the following levels: - 99 percent for 2015 (or 98 percent for physicians who are subject to penalty under the e-prescribing provisions for 2014); 98 percent for 2016; and 97 percent for 2017 and each subsequent year. See http://www.acponline.org/running_practice/technology/eprescribing/ for information on e-prescribing.
- For 2019 and each subsequent year, if the Secretary finds that the proportion of eligible professionals who are meaningful EHR users is less than 75 percent, the applicable fee schedule amount is further adjusted downward by 1 percentage point each year, down to a maximum of 95 percent.
The Act also gives the Secretary the ability, on an annual and case-by-case basis, to exempt a physician from the penalty for up to five years, if HHS determines that being a meaningful EHR user would result in a significant hardship (e.g., if an eligible professional practices in a rural area without sufficient Internet access).
It is important to note that implementing an EHR system takes a substantial amount of time. If you choose to start implementing a system close to the penalty deadline, it is likely that you will not meet the requirements for meaningful use in time to avoid these penalties. It is also likely that there will be delays when installing and beginning to use your EHR system due to the volume of purchases expected by the vendors.
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While many practices are rightly concerned about the cost of purchasing an EHR system, we caution doctors that purchasing a less costly system may not always be the best solution. If you sacrifice usability for lower cost, you may end up losing money as a result of reduced productivity that would not be the case with a more expensive EHR. To help you with this assessment, AmericanEHR Partners allows you to view rating and comparison information on certified EHR systems.
If you are concerned about the upfront costs of an EHR system there are a number of options you should investigate ranging from innovative financing options offered by many EHR vendors, to different EHR delivery models. For instance, one alternative, which tends to have lower upfront costs, is a web-based service EHR frequently referred to as an ASP system (Application Service Provider). With this approach, you pay a monthly subscription fee to use the EHR system that is accessed through the Internet. With an ASP system you can also avoid having to purchase a server and many other hardware related expenses. A good explanation of the pros and cons of an ASP solution can be found in the Texas Medical Association's Implementation Guide Electronic Medical Record The Link to a Better Future 2nd Edition page 40.
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The legislation requires the Office of the National Coordinator for Health Information Technology, in consultation with the National Institutes of Standards and Technology (NIST) and other agencies with experience in IT services, to establish an HIT extension program to assist providers in adopting and using HIT. The Office of the National Coordinator for Health Information has created an HIT Extension program, which has contracted with 60 groups to provide services to the medical community with the adoption and meaningful use of EHR systems. The groups that are part of the HIT Extension program are generally referred to as Regional Extension Centers (RECs).
The RECs will support and serve health care providers to help them quickly become adept and meaningful users of electronic health records (EHRs). RECs are designed to make sure that primary care clinicians get the help they need to use EHRs.
RECs will: - Provide training and support services to assist doctors and other providers in adopting EHRs
- Offer information and guidance to help with EHR implementation
- Give technical assistance as needed
The goal of the program is to provide outreach and support services.
If you are interested in working with an REC you can find the regional extension center that serves your area by going to the ONC Web site or AmericanEHR Partners.
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