2010-07-14

The U.S. Department of Health and Human Services (HHS) has announced final rules aimed at increasing safety and reducing health-care costs through expanded use of electronic health records (EHR).

Under a provision included in the American Recovery and Reinvestment Act of 2009 (ARRA), eligible health-care professionals and hospitals can qualify for Medicare and Medicaid incentive payments when they adopt certified EHR technology and use it to achieve specified objectives. As much as $27 billion may be expended in incentive payments over 10 years. Eligible professionals may receive as much as $44,000 under Medicare and $63,750 under Medicaid, and hospitals may receive millions of dollars for implementation and meaningful use of certified EHRs under both Medicare and Medicaid.

One of the final rules, issued by the Centers for Medicare & Medicaid Services (CMS), defines the minimum requirements that providers must meet through their use of certified EHR technology in order to qualify for incentive payments. Specifically, the regulation defines the "meaningful use" objectives that providers must meet to qualify for the bonus payments, and the other regulation identifies the technical capabilities required for certified EHR technology. The final CMS rule specifies initial criteria that eligible professionals and eligible hospitals must meet and includes modifications to the rule originally proposed in January 2010 that address concerns raised by ASH and other stakeholders.

Originally, the proposal contained an "all-or-nothing" approach and would have required providers to meet all criteria on a list, with hospitals having to meet 23 objectives and clinicians facing 25 requirements. The final rule divides the objectives into a "core" group of required objectives (15 for eligible professionals and 14 for hospitals) and a "menu set" of 10 procedures from which providers may choose any five.

Some examples of the core mandates that must be met in order to receive funding include requirements for providers to record more than half of patients’ demographic data and vital signs; maintain diagnostic, and drug and medication allergy information for more than 80 percent of patients; record smoking status for more than half of patients; order medication electronically for more than 30 percent of patients; test the ability to exchange information with other providers; provide more than half of patients who request their records with copies within three days; and conduct information technology security checks.

Other optional goals that providers could get credit for include incorporating more than 40 percent of certain lab results into electronic records; providing summaries of care for more than half of patients who are going to another provider or setting; and providing immunization or disease surveillance data electronically to government agencies.

Additional key changes in the final CMS rule include:

• An objective of providing condition-specific patient education resources for both eligible professionals and eligible hospitals and the objective of recording advance directives for eligible hospitals, in line with recommendations from the Health Information Technology Policy Committee
• A definition of a hospital-based eligible professional as one who performs substantially all of his or her services in an inpatient hospital setting or emergency room only
• A lower percentage of patients required to qualify for many of the goals criteria and scaled back reporting requirements. For instance, the original rule had required physicians to electronically transmit 75 percent of the prescriptions that they prescribe, while the final version requires only 40 percent.

The rule also includes the formula for the calculation of the incentive payment amounts; a schedule for payment adjustments under Medicare for covered professional services and inpatient hospital services provided by eligible professionals and eligible hospitals that fail to demonstrate meaningful use of certified EHR technology by 2015; and other program participation requirements.

Requirements for meaningful use incentive payments will be implemented over a multi-year period and CMS anticipates that enrollment in the EHR incentives program will begin in January 2011, with the first payments to eligible professionals and hospitals expected around May 2011.

A second final rule, issued by the Office of the National Coordinator for Health Information Technology, identifies the standards and certification criteria for the certification of EHR technology so that eligible professionals and hospitals may be assured that the systems they adopt are capable of performing the required functions.

A fact sheet and additional information on the rules is available on the CMS website.

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