There’s no shortage of incentive programs coming out of the Centers for Medicare and Medicaid Services (CMS) these days. One example that we discussed recently on the pmFAQtory blog is the Physician Quality Reporting System (PQRS), which financially prods health care providers to report on certain quality measures.
CMS carrots also include the Medicare and Medicaid Electronic Health Records (EHR) Incentive Programs, which were set up via the Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the 2009 federal stimulus bill.
Collectively known in the health care and health IT industries as HITECH, these programs offer financial incentives to “eligible professionals, eligible hospitals and critical access hospitals (CAHs) as they adopt, implement, upgrade and demonstrate the meaningful use of certified EHR technology,” says CMS. “Certified” is a key word here, as providers must use a certified health IT product to be eligible for incentive payments.
What is “meaningful use” and how can providers achieve it?
To be a meaningful EHR user, an eligible entity must demonstrate:
- The use of a certified EHR in a meaningful manner (e.g., e-prescribing)
- The use of certified EHR technology for electronic exchange of health information to improve quality of health care
- The use of certified EHR technology to submit clinical quality and other measures
To demonstrate the above three points (for 2011-2012, known as “stage one” of meaningful use), eligible professionals, hospitals and CAHs must fulfill certain objectives:
- Eligible professionals must meet 15 required “core” objectives, and five of 10 “menu set” objectives (see PDF list from CMS).
- Eligible hospitals and CAHs must meet 14 required “core” objectives, and five of 10 “menu set” objectives (see PDF list from CMS).
On top of this, there are also extensive clinical quality measure reporting requirements.
Finally, the eligible professional, hospital or CAH must attest (legally declare) to have demonstrated meaningful use with certified EHR technology.
What financial incentives are available?
There are two programs available, one for Medicare and one for Medicaid. For both programs, eligible professionals and hospitals may begin to participate this year. Hospitals can potentially receive payments under both programs, but professionals must choose to receive payments from one or the other. A complete outline of payments is on the CMS website, but here’s a summary:
- For the Medicare incentive program, eligible professionals (individual providers) can receive up to $44,000 over five years (through 2016). Eligible hospitals and CAHs begin with a $2 million base payment and can receive incentives over a total of four years (through 2015). Professionals, hospitals and CAHs who do not demonstrate meaningful use are subject to “payment adjustments” (reductions in Medicare reimbursements) beginning in 2015.
- For the Medicaid incentive program, eligible professionals can receive up to $63,750 over the six years they choose to participate (between 2011 and 2021). Eligible hospitals and CAHs begin with a $2 million payment and must enter the program no later than 2016. Unlike the Medicare incentive program, there are no payment adjustments for those not demonstrating meaningful use.
Why meaningful use?
The ultimate goal of meaningful use, of course, is to improve health by improving health care and health care delivery.
To that end, CMS sees meaningful use of EHRs as maintaining privacy and security while improving quality, safety, efficiency, care coordination, and population and public health; reducing health disparities; and engaging patients and families in their health care.
Check out the CMS meaningful use website for more information. When you’re still confused, get in touch with pmFAQtory so we can help you navigate the process of achieving meaningful use.