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February 2010
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The greatest EHR myths — and the truth behind them
The American Recovery and Reinvestment Act (ARRA) of 2009, casually known as the economic stimulus package, has generated a lot of buzz across the chiropractic profession.
A section of the ARRA, known as the HITECH Act, deals specifically with health information technology; however, there has been substantial misinformation and rampant rumors about the package and its relationship to you.
This article will help dispel some of the myths that are swirling around in the industry and simplify some of the complexities.
Separating myth and fact
MYTH: Chiropractors are not eligible for incentive payments related to the implementation of a qualified electronic health records (EHR) system.
FACT: The government is using the definition of “physician” from the Social Security code, which includes chiropractic physicians. Thus, you are eligible to receive reimbursement for implementing EHRs — as long as they also meet other established guidelines.
MYTH: Any electronic system will qualify me for government incentive payments.
FACT: Only qualified EHRs used meaningfully will be considered for incentive payments to you. To be a qualified EHR, the system must have the capacity to handle patient demographics and clinical health information, and have clinic management capabilities, as outlined by the entity that certifies qualified EHRs.
Only certified EHRs will be considered for the financial incentives, and while the certification entity has not yet been named, most predict it will be the Certification Commission for Healthcare Information Technology since it is currently the only recognized EHR certification entity in the federal system.
“Meaningful use” is defined by three key measures:
• Connectivity to health information exchanges (HIEs) and other EHRs;
• Regular reporting of quality measures, including outcome assessment scores and pain assessment; and
• E-prescribing capability. (Note: Because chiropractic physicians don’t have prescribing privileges, it is unknown whether this will remain a requirement.)
Digital note taking systems and other automated documentation programs that don’t meet these criteria will not be considered for incentive payments.
MYTH: I can’t receive incentive payments if I’ve already implemented EHR in my clinic.
FACT: Early adopters are included, even if implementation occurred as recently as last year.
Any doctor who has transitioned to an EHR system that meets the government requirements for incentive payments is eligible for full payment amounts, as long as the qualified system is implemented and “meaningful use” is demonstrated in 2010.
Incentive payments begin to decrease on a sliding scale if implementation occurs after 2011.
MYTH: If I choose not to implement EHR, nothing will happen to me.
FACT: Penalties will be assessed on doctors who opt not to transition to EHRs beginning in 2015 and will continue through 2018. Those penalties are expected to come through reductions in Medicare reimbursement payments.
MYTH: I will only get reimbursed for the amount I spend on my EHR system.
FACT:The incentive payment amounts have been set by the federal government and are generally higher than the amount of investment required to implement an EHR system.
The incentive schedule does not correlate with the amount spent on EHR. The government wants to motivate you to implement an EHR as soon as possible, and has created a strong financial incentive plan to move the process forward swiftly. The sooner you implement the more incentive payments you can receive.
The federal government also recognizes there are hardware and training costs, and possible lost revenue during the initial conversion and phase-in of the system when extra staff time is needed to support the transition. Thus, the government has accounted for those costs in the incentive payment schedule.
MYTH: Only the clinic receives incentive payments for implementing EHR, not the individual doctor.
FACT: The incentive payment program has been set up to benefit physicians specifically. This means several physicians who practice in the same clinic can each qualify for incentive payments, as long as all the individual doctors are using a qualified system meaningfully, according to the incentive payment requirements.
For clinics with multiple doctors, this can be a tremendous windfall. For example, three doctors could collectively receive $132,000.
MYTH: Now that the government is providing incentives to all physicians to adopt EHRs, the government will be able to dictate how we deliver care.
FACT: Nowhere in any of the legislation does it indicate that the government will impose on the methods to deliver patient care. Rather, an agency called the Office of the National Coordinator of Healthcare Information Technology (ONCHIT) was established in 2004 to facilitate the implementation of EHRs across healthcare entities.
The office is only given authority to organize the implementation process and is not charged with overseeing actual delivery of care and how doctors treat patients. ONCHIT is mainly concerned with how information is captured, how it gets reported, and ensuring the doctor is collecting the appropriate information for proper case management.
The Center for Medicare Services (CMS) and HHS will also be involved with the program, but CMS’ specific role is still being evaluated with regard to reporting and eligibility requirements for doctors participating in the incentive program.
For example: Minimum billing thresholds, such as an annual $25,000 in covered services to CMS, are being considered in order to be eligible for the incentive payments. However, there is some discussion on consideration for proportionate payments if the threshold is not met.
So, if you average 16 Medicare patient visits a week, you would likely qualify.
More truth to come
ONCHIT is working to establish the rules and standards that will govern the incentive payments for EHR implementation that have been funded by the HITECH portion of the ARRA of 2009.
The final decisions about a qualified EHR, meaningful use, and other applicable requirements will be determined by the end of December 2009 — but in the meantime, you may want to start planning your implementation now.
Steven J. Kraus, DC, DIBCN, CCSP, FASA, is CEO of Future Health Inc., a company that partners with chiropractors to deliver a comprehensive clinic management solution, including fully-integrated EHR. He can be reached at skraus@FutureHealthSoftware.com or through www.FutureHealthSoftware.com.
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