Medicare Officials Announce Proposals for EMR Incentives

1/5/10 UPDATE:  

In recognition that the transition to EMRs might take a while, CMS is proposing a phase-in of three stages.  The first stage of meaningful use criteria focuses on electronically capturing health information in a coded format, using that information to track key clinical conditions and communicating that information for care coordination purposes. It also calls for implementing clinical decision support tools to facilitate disease and medication management and reporting clinical quality measures and public health information.  In order for professionals and hospitals to be eligible to receive payments under the incentive programs, provided through the Recovery Act, they must be able to demonstrate meaningful use of a certified EHR system.  The following list of Stage 1 Meaningful Use criteria for eligible providers was taken from the proposed rule: “Medicare and Medicaid Programs; Electronic Health Record Incentive Program.”

[1] Objective: Use CPOE
Measure: CPOE is used for at least 80 percent of all orders

[2] Objective: Implement drug-drug, drug-allergy, drug- formulary checks
Measure: The EP has enabled this functionality

[3] Objective: Maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM or SNOMED CT®
Measure: At least 80 percent of all unique patients seen by the EP have at least one entry or an indication of none recorded as structured data.

[4] Objective: Generate and transmit permissible prescriptions electronically (eRx).
Measure: At least 75 percent of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology.

[5] Objective: Maintain active medication list.
Measure: At least 80 percent of all unique patients seen by the EP have at least one entry (or an indication of “none” if the patient is not currently prescribed any medication) recorded as structured data.

For the complete list or 25 provider and 25 hospital requirements, continue at Healthcare IT News.

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Dec. 31 — Federal health officials said Wednesday they have cut billions of dollars from the projected cost of a program to push doctors and hospitals to use electronic medical records, suggesting their previous estimates overstated the number of health care providers likely to adopt the technology, according to The Huffington Post.

Under the proposal, doctors and hospitals that keep updated electronic medical records of their patients could still receive bonus payments for using the software.  Officials for the Centers for Medicare and Medicaid Services stressed to reporters on a conference call that the proposal is preliminary and won’t be finalized until next spring. The agency will take comments on Wednesday’s proposal for 60 days before beginning work on final guidelines.

Among the proposals to qualify for “meaningful use,” health care professionals who use electronic records for 80 percent of their medical instructions could receive bonus payments. They also would have to provide patients with printouts of their medical history and use computers to check for potential drug interactions. Hospitals would have to complete 10 percent of their orders electronically.

The Wall Street Journal laid out more details of how providers might receive those bonuses:  File prescriptions and submit insurance claims electronically; give patients electronic access to their health information; use computerized systems to enter at least some of doctors’ and nurses’ orders; track patients’ medications electronically; and record vital signs and lab test results electronically.

Sharing electronic information between different medical practices and hospitals isn’t something that happens very often; the meaningful use guidelines seem to recognize this. When the program kicks in, in fiscal year 2011, doctors and hospitals only need to say that they “performed at least one test” of their system’s ability to “electronically exchange key clinical information.”

If you’d like to read the document released by the feds that spells out all of the “meaningful use” proposals, it’s only 556 pages.

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6 comments

  1. The Medicare and Medicaid EHR Incentive Programs will provide incentive payments to eligible professionals, eligible hospitals and critical access hospitals (CAHs) as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology. Under this program Eligible Professionals will be paid incentives for upgrading to an Electronic Health Record program before 2015. Beginning in 2015, doctors will be penalized in the form of reduced Medicare payments. The incentive program differs Medicare is federally run by CMS and Medicaid incentive program is run by States and is voluntary.

  2. I believe it is practical, Alok. Many practices that have fully implemented EMR just in the past couple years are close to meeting these objectives. Every practice has a few years grace to get started.

  3. I believe that this list will get trimmed significantly as reality dawns upon the law makers that it is not practical and will take many more phases and years to implement.

  4. This set of rules is not “doable.”

    Essentially, the criteria as stated would only apply to either

    1) A large physician group setting already employing high end (ie expensive, at $40k/doc for initial outlay, then $6K costs per doc per year) systems.

    or

    2) Hospital IT installations.

    Personally, I’ll take the penalty.

    There is no way, esp the

    1) Computerized physician order entry or

    2) portal to patient data

    that is at all economical or would even come close to the costs expended.

    Instead of messing around with micromanaging MY medical practice, how about enforcing a national database of all test information, paid by a surcharge by the performing lab or facility, so all of the patient’s generated labs or X-rays, operative reports, etc, are accessable to all treating physicians?

    I’ll use technology, but only when it helps me take care of the patient!

    Comments welcome at matlev@comcast.net

  5. Electronic Records belong with the patient, So that it can be used whenever there is a need to access it. The Sharing infrastructure proposed is doable but would cost to much, that it would make the emr system very expensive.
    Please look at simple web based solutions that update patient data in realtime.

    http://www.youtube.com/watch?v=ToEftkVoIkM => emr solution
    http://www.youtube.com/watch?v=Q68vIBMs-70 => remote ekg exploits todays technology to extend doctor visits via internet.

    all comment’s welcome.

  6. http://www.emrexperts.com/articles/emr-adoption-infrastructure.php

    I am the President of EMR Experts, http://www.emrexperts.com, November 2009 I wrote the attached article describing that EMR Infrastructure, and Interoperability will come AFTER EMR Adoption by Medical Professionals.

    I would like to hear your comments.

    Chris Ferguson

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