THE BASICS: What California Physicians Need to Know about the HIT funds in the Economic Stimulus Package (March 19, 2009)
Beginning in 2011, the federal economic stimulus package will provide approximately $19 billion over five years for health information technology (HIT), including direct bonus payments upwards of $44,000 for qualifying physicians who demonstrate “meaningful use” of Electronic Health Records (EHR) systems.
As eligibility is based on usage, even physicians who already use EHR systems will be eligible. Whether you already use an EHR system or just starting to survey the landscape, CMA is ready to help you begin to navigate this process.
The most important thing for physicians to know is: Now is not the time to rush out and purchase an EHR system.
The standards to determine which EHR systems will qualify for the physician subsidy will be worked out in the coming months. Physicians should, however, begin assessing their EHR needs, with an eye on what will work best for your practice.
To answer your initial questions, CMA has prepared the FAQs below. For more details, please visit our HIT Resource Center. There, you will always find the latest information and links to HIT-related resources for CMA members.
Frequently Asked Questions
1. Who is eligible for direct bonus payments?
Medicare providers who are not hospital-based will receive bonus payments directly from the federal government. Hospitals and ambulatory surgery centers also qualify for bonus payments, which will be paid separately.
It is important to note that, in order to qualify, a physician will be required to demonstrate “meaningful usage” (to be defined by a standards committee) of an EHR system and that he or she is participating in a Health Information Exchange (such as a Regional Health Information Organization).
2. Who is eligible for payments through Medi-Cal?
- Medi-Cal providers (who are not Medicare providers) will qualify if they fall into one of these categories:
- Non-hospital-based physicians for whom at least 30% of their practice (by patient volume) is Medicaid.
- Non-hospital-based pediatricians for whom at least 20% of their practice is Medicaid.
Physicians practicing in Federally-qualified Health Centers (FQHC’s) or Rural Health Centers (RHC’s), for whom at least 30% of their practice is “needy individuals” (Medicaid, SCHIP, sliding-scale, or uncompensated care patients). The methodology for how these payments will be made is left to the states to determine. CMA will distribute more information on that program as it becomes available.
3. How much are the bonus payments?
For Medicare providers, the bonus payments will be paid starting in 2011, or the first year that the physician demonstrates EHR usage. Generally, the bonus payments will be $44,000, paid out as follows:
- $18,000 for the first payment year;
- $12,000 for the second payment year;
- $8,000 for the third payment year;
- $4,000 for the fourth payment year; and
- $2,000 for the fifth payment year.
Physicians who adopt EHR systems after December 31, 2012, will receive lower payments. On the other hand, physicians who operate in a Federally-designated Health Professional Shortage Area (HPSA) will receive an additional 10% payment each year. Regardless of what year a physician first receives payments, the last year to receive payment is 2015.
For Medicaid providers who are not also Medicare providers, the bonus payments can be up to $65,000, paid as $25,000 the first year and up to $10,000 for each of the next four years. Medicaid-only providers can receive bonus payments starting with the first year that they purchase and implement the system. Again, these payments will be directed through the state, and will come from the state’s Medi-Cal program.
4. Do I still qualify if I have already purchased and/or am already using an EHR system?
Yes. The bonus payments are based on usage, not on purchasing the system, so practices and groups that already have purchased EHR systems can also qualify for funds. For physicians who already use EHR systems, CMA will provide more information on how to ensure your system qualifies once the standards are developed.
5. What is a “qualified” EHR system?
As defined in the bill, a qualified EHR system is one that: “includes patient demographic and clinical health information, such as medical history and problem lists; and has the capacity to (i) to provide clinical decision support; (ii) support physician order entry; (iii) capture and query information relevant to health care quality; and (iv) exchange electronic health information with, and integrate such information from other sources.”
In addition, the Office of the National Coordinator for Health IT (ONCHIT) will be convening a standards committee to develop more comprehensive standards for functionality and interoperability.
6. Can CMA help me select an EHR?
Now is not the time to rush out and buy an EHR. The standards to determine which EHR systems will qualify for the physician subsidy will be worked out in the coming months. Once the standards are developed, CMA will develop a marketplace of vendors with federally qualified EHR systems, complete with information about each that will assist you in choosing the right one for your practice. For now, CMA advises that you begin assessing your HIT needs, with an eye on what will work best for your specialty, the size of your practice, the stage in your career, and your comfort level with technology.
7. How will I report that I am using an EHR system?
A physician may report meaningful EHR use by an attestation, submitting claims with proper coding, a survey response, or other means to be specified by the Secretary of Health and Human Services. Reporting standards will also be fleshed out by ONCHIT.
8. Will this affect the Medicare e-prescribing bonus program?
Yes. Physicians who use an EHR system that is capable of e-prescribing will no longer be eligible for the e-prescribing bonus program once he or she begins receiving the EHR bonus to prevent “double-dipping.”
9. Is there a penalty for physicians who don’t adopt EHR?
Yes. Starting in 2015, physicians who are not using an EHR system will face a 1% cut in Medicare payments. That cut will grow to 2% in 2016 and 3% in each year thereafter.
