Medical Practice Management

EMB and the Economic Stimulus Package
HHS Certification
Economic Stimulus FAQ

EMB and the Economic Stimulus Package

With the introduction of the American Recovery and Reinvestment Act of 2009, Section 4101 of Title IV, America’s leadership has taken a significant step towards reforming the healthcare industry. ARRA initiates the steps needed to deploy standards and practices to ensure the interoperability of different Electronic Health Record systems.

As an industry leader, EMB has always believed that interoperability is a key component to enhancing the quality and safety of patient care, while also helping to lower associated costs. At the same time, ARRA has introduced incentive payments that create a vehicle for reasonable adoption. Given the historic proportion of the ARRA, providers who want to understand the potential benefits and wish to participate often seek counsel on what to do.

This site contains an outline of the current understanding of ARRA, including how it maps an incentive payment schedule; what terms are used in the act (including their definitions); and how CareRevolution is positioned to fulfill the requirements for participation.

Participants can leverage potential grants and reimbursements to choose and ultimately implement a Qualified Electronic Health Record. Understanding the sine qua non of a Qualified Electronic Health Record will ensure monetary compensation for participating, and will also place the participants where they are able to provide quality and safe care for their patient populations.

HHS Certification:

On July 16, 2009, the HIT Policy Committee proposed the following definition of HHS Certification1:

HHS Certification means that a system is able to achieve government requirements for security, privacy and interoperability, and that the system would enable the Meaningful Use results the government expects. HHS Certification is not intended to be viewed as a ‘seal of approval’ or an indication of the benefits of one system over another.

Under the proposal, EMR vendors would only need to get certification from one accredited certifying organization. Updates should occur no more frequently than every other year and be done in time to enable vendors and providers “sufficient time for effective implementation.”

Who is Eligible?

Physicians who demonstrate “meaningful use” of a certified EMR, implemented by December 2010, are eligible for funding. “Meaningful use” requires that users demonstrate the ability to perform E-prescribing, exchange of information (interoperability), and certain reporting capabilities.

How are the Medicare incentives paid?

Incentives will be paid out over a 5-year period. Thereafter, healthcare professionals will receive maximized incentive payments for HIT adoption by embracing a qualified electronic health records technology by 2011 or 2012. After 2014, there will be no incentive payment, and potential penalties may be assessed from then on.

If Adopted by:	2011*	2012*	2013*	2014	2015
Year 1	$18,000
Year 2	$12,000	$18,000
Year 3	$8,000	$12,000	$15,000
Year 4	$4,000	$8,000	$12,000	$12,000
Year 5	$2,000	$4,000	$8,000	$8,000
Year 6	$0	$2,000	$4,000	$4,000	$0
Total	$44,000	$44,000	$39,000	$24,000	$0
*Eligible Professionals in a designated health professional shortage area can receive a 10% increase.

How are the Medicaid incentives paid?

The same eligible professional requirements of “meaningful use” of a “certified EHR Technology” must be met. The difference between Medicare incentives and Medicaid incentives is that “meaningful use” for Medicaid is State-approved, and acceptable to the Secretary of HHS. Payments may begin in 2011 and will not exceed 85% of the net average allowable costs for the certified EHR technology, including support, maintenance, and training. Also, unlike Medicare, there will be no reduction in Medicaid reimbursement for non-adoption.

Eligible Provider Type	Percent of Patient Volume	Incentive
Non-hospital Based (e.g. Family Medicine)	At least 30% Medicaid	85% of net average allowable costs for EHR
Non-hospital Based Pediatrician	At least 20% Medicaid	85% of net average allowable costs for EHR
FQHC or Rural Health Clinic Provider	At least 30% Medicaid	85% of net average allowable costs for EHR
Children’s Hospitals or Non-Children’s Acute Hospitals	At least 10% Medicaid	Max. Amount permitted for the provider involved.

EMB Is Prepared to Support HHS Standards

While detailed requirements of the plan are still being defined, EMB expects that the requirements will include electronic prescribing, clinical decision support, and interoperability. This expectation is based on previously published requirements related to the EHR Demonstration Project. EMB will be launching a directory on our website, http://www.embllc.com to keep customers and prospective customers informed.

* The information provided on this documentation and the EMB website is for informational use only. Customers and prospective customers should seek advice from attorneys, accountants or other professionals retained to advise them.

Economic Stimulus FAQ

Is “Meaningful Use” defined in ARRA?

“Meaningful Use” is not defined in ARRA. However, ARRA created two new federal advisory committees: HIT Policy Committee and HIT Standards Committee. These committees were staffed in December 2009 and met for the first time before the end of the year. Working to advise the Office of National Coordinator (ONC), they will be looking to formally define “meaningful use.”

Under ARRA, do MDs will have a choice of incentive programs?

Under ARRA, MDs will have to choose either Medicare or Medicaid incentive programs

• Choosing Medicaid means you “waive” your right to a Medicare incentive

Physicians under Medicaid incentives can receive up to $25,000/provider year 1 and up to $10,000/provider for 4 additional years to support “meaningful use” of an EMR.

What is the role of the Secretary of Health and Human Services (HHS)?

The Secretary is the head of the U.S. Department of Health and Human Services, and a member of the President’s Cabinet. This position advises the President on matters of health, welfare, and income security programs. The Secretary must be confirmed by the Senate Health, Education and Pensions Committee and the Senate Finance Committee, which has jurisdiction over CMS (Medicare and Medicaid).

Under ARRA, the Secretary is charged with detailing the requirements for HIT loans and incentive programs, as well as standards. The current Secretary of HHS, Kathleen Sebelius, is responsible for developing the initial set of relevant standards and certifications.

What is the role of the Office of National Coordinator (ONC)?

The ONC provides counsel to the Secretary of HHS and departmental leadership for HIT implementation and interoperability. This office will be responsible for endorsing standards and certification criteria and the coordination of HIT policy and programs.

Under ARRA, the ONC can recognize and direct entities to regularly update these standards, and, with the Director the National Institute of Standards and Technology (NIST), will recognize programs for voluntary certification of HIT.

What is the role of the HIT Policy Committee?

The HIT Policy Committee is a federal advisory committee that will make recommendations and suggest priorities to the ONC for areas in which standards, implementation specifications, and certification criteria are needed for the electronic exchange and use of health information for purposes of adoption. This includes named standards, architectures, and software schemes for the authentication and security of individually identifiable health information and other information as needed to ensure the reproducible development of common solutions across disparate entities.

What is the role of the HIT Standards Committee?

ARRA creates the HIT Standards Committee to recommend to the ONC standards, implementation specifications, and certification criteria for the electronic exchange and use of health information for purposes of adoption in accordance with policies developed by the HIT Policy Committee. Other duties include: pilot testing of standards and implementation specifications; and ensuring consistency with standards for information transactions and data elements adopted by the Social Security Act.

This committee was charged with developing a schedule for the assessment of policy recommendations from the HIT Policy Committee not later than 90 days after the date of enactment of this title (90 days from February 17, 2009). The HIT Standards Committee also conducts open public meetings for comment and recommendations.

What is the definition of a “certified EHR technology”?

According to the PRO(TECH)T Act of 2008 the term “certified EHR technology” is defined as a qualified electronic health record that is certified pursuant to section 3001(c)(5) as meeting standards adopted under section 3004 that are applicable to the type of record involved (as determined by the Secretary, such as an ambulatory electronic health record for office-based physicians or an inpatient hospital electronic health record for hospitals). Source – Library of Congress

What is a “Qualified Electronic Health Record”?

According to the PRO(TECH)T Act of 2008 the term “Qualified Electronic Health Record” is an electronic record of health-related information on an individual that:

1. includes patient demographic and clinical health information, such as medical history and problem lists; and
2. has the capacity to:
   1. provide clinical decision support;
   2. support physician order entry;
   3. capture and query information relevant to health care quality;
   4. exchange electronic health information with, and integrate such information from other sources.

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