Stimulus

The United States Government, through the enactment of The American Recovery and Reinvestment Act of 2009 (ARRA), has authorized the Centers for Medicare & Medicaid Services (CMS) to provide reimbursement incentives for eligible professionals who are successful in becoming "meaningful users" of certified electronic health record (EHR) technology. The law includes the Health Information Technology for Economic and Clinical Health Act, or the "HITECH Act," which established incentive programs under CMS. CMS established the criteria and reporting requirements, which eligible professionals follow to prove meaningful use of their adopted Electronic Health Record technology.


Eligible providers (EP) must be able to demonstrate and report "Meaningful Use" by adopting a certified EHR/EMR (electronic health record/electronic medical record) technology.


The software system adopted must meet a set of specific requirements to be considered "certified" electronic health record (EHR/EMR) technology.


The eligible provider (EP) must adhere to and complete a series of criteria in order to qualify as a meaningful user of health information technology (HIT) to receive incentive payments.


The EP must properly report the established series of clinical quality measures (CQM) in order to receive the incentive payments.


The ONC (Office of the National Coordinator) for Health Information Technology was created in 2004, through an Executive Order, and legislatively mandated in the Health Information Technology for Economic and Clinical Health Act (HITECH Act) of 2009.


The HITECH legislation directs the ONC to support and promote meaningful use of certified electronic health record (EHR) technology nationwide through the adoption of standards, implementation specifications, and certification criteria as well as the establishment of certification programs for HIT, such as EHR technology.


Authorized Testing Certification Bodies(ATCB) have been identified by the ONC, to test and certify that certain types of EHR technology (complete EHRs and EHR modules) are compliant with the standards, implementation specifications, and certification criteria adopted by the Health and Human Services (HHS) Secretary and meet the definition of "certified EHR technology."


Any adopted EHR/EMR must be certified by the ONC-ATCBs in order to qualify for the Medicare/Medicaid incentive payments.


Stage of Meaningful Use Criteria by Payment Year The following table outlines the CMS proposal to apply the respective criteria of meaningful use, in stages, for each payment year (first, second, third, etc.) for eligible providers and eligible hospitals that become meaningful EHR users before 2015. Nothing in the proposed rule limits CMS from making proposed changes to meaningful use beyond Stage 3.


subsequent payment Year


Meaningful use will happen in three stages. Stage 1 will begin in 2011. In 2013, stage 2 will begin. Stage 2 will add more requirements and new reports. Stage 3 will begin in 2015 and is expected to add more requirements.


Meaningful use Stage 1:Have a certified electronic health record(EHR) and to be able to demonstrate that it is being used to meet the requirements of : 1. Health IT Functionality measures and 2. Clinical Quality measures.


Meaningful use Stage 2:Stage 2 would expand upon the Stage 1 criteria in the areas of disease management, clinical decision support, medication management support for patient access to their health information, transitions in care, quality measurement and research, and bi-directional communication with public health agencies.


Meaningful use Stage 3: Outcome based measures would focus on achieving improvements in quality, safety and efficiency, focusing on decision support for national high priority conditions, patient access to self management tools, access to comprehensive patient data, and improving population health outcomes.


CMS Medicare and Medicaid Milestone Timeline


CMS Medicare & Medical Milestone Timeline

Medicare and Medicaid Incentive Payouts At-A-Glance:


Table 1: Maximum EHR Incentive Payments Based on the First Calendar Year of Participation in the Program>


Payment for the Year   Max Eligibility if the First Year of Participation is:
2011 2012 2013 2014
2011 $18,000
2012 $12,000 $18,000
2013 $8,000 $12,000 $15,000
2014 $4,000 $8,000 $12,000 $12,000
2015 $2,000 $4,000 $8,000 $8,000
2016 $ - $2,000 $4,000 $4,000
Total $44,000 $44,000 $39,000 $24,000


Adjustment Beginning in 2015: If an EP does not successfully demonstrate meaningful use of certified EHR technology, the EP's Medicare fee amount for covered professional services will be reduced as follows:


2015 - 1% of Medicare physician fee schedule covered amount
2016 - 2% of Medicare physician fee schedule covered amount
2017 and each subsequent year - 3% of Medicare physician fee schedule covered amount


For 2018 and subsequent years, if less than 75% of EPs are meaningful users, then the payment adjustment penalty shall be increased by 1% for each year until the cumulative adjustment (penalty) reaches a maximum of 5%.


Table 2: Medicaid EHR Incentive Payments Based on the First Calendar Year of Participation in the Program


Payment for the Year     2011 2012 2013 2014 2015 2016
2011 $21,250
2012 $8,500 $21,500
2013 $8,500 $8,500 $21,500
2014 $8,500 $8,500 $8,500 $21,500
2015 $8,500 $8,500 $8,500 $8,500 $21,500
2016 $8,500 $8,500 $8,500 $8,500 $8,500 $21,500
2017 $8,500 $8,500 $8,500 $8,500 $8,500
2018 $8,500 $8,500 $8,500 $8,500
2019 $8,500 $8,500 $8,500
2020 $8,500 $8,500
2021 $8,500
Total   $63,750     $63,750     $63,750     $63,750     $63,750     $63,750  


Please visit the official Centers for Medicare & Medicaid Services website at www.cms.gov to get the most up-to-date information.