Electronic health record 'meaningful use' reporting period begins

Experts recommend waiting before starting EHR 'ticking clock'

The federal government's "meaningful use" attestation period begins today, allowing hospitals and physician practices to submit data collected on electronic health record systems (EHR) in order to receive thousands to millions of dollars in reimbursement payments.

Over the next two years, 58% of small physician practices plan to roll out EHRs. And by 2014, the federal government wants more than half of all healthcare facilities to use EHRs. If they have not rolled out EHRs by 2015, physicians and facilities face penalties.

Meaningful use is a set of specifications and certification criteria for EHRs in three parts, created by the U.S. Office of the National Coordinator for Health Information Technology (ONC). (Only Phase 1 rules have been issued thus far.)

Under the American Recovery and Reinvestment Act of 2009, physicians who implement EHR systems and demonstrate that they are engaged in meaningful use of such systems can receive reimbursements as much as $44,000 under Medicare, or as much as $65,000 under Medicaid. Hospitals can receive funds from both Medicare and Medicaid.

On average, hospitals receive about $4 million in reimbursements, but the largest single facilities can expect to receive as much as $12 million, said Dr. Mitch Morris, national leader for health IT at Deloitte Consulting.

However, Morris noted that the total five-year spend by hospitals and physician practices on capital and operating costs could be two to three times what they will receive in government reimbursement payments.

"Even though the government is incentivizing this with significant money, it's not going to build the whole system," he said.

Clinicians and hospitals that have deployed EHRs must collect 90 days' worth of data from the systems and submit it to the Centers for Medicaid and Medicare Services. Morris said some facilities have already deployed EHRs and are preparing to submit their data today, but he advises that others wait.

"Once you use it, you really have to be sure, because it starts the clock ticking -- not only for the 90-day period, but also for the whole program," he said. "You have to be thinking ahead. While you may be qualified for Stage 1 [of meaningful use] now, you have to ask yourself it you'll be qualified for Stages 2 and 3."

Karen Bell, chairwoman of the Certification Commission for Health Information Technology, a nonprofit organization whose mission is to accelerate the adoption of healthcare IT systems, agreed. Bell said that if you haven't gone through the readiness process, gotten your staff prepared, made certain that everyone is on board with what an EHR will entail, and put a project plan in place, then you'd probably be better off waiting until 2012, when the new criteria come out.

As Morris pointed out, hospitals and practices won't lose out on any money by waiting; they just will not have the money as soon.

However, if you wait until 2013, reimbursement amounts begin to decrease, so timing is critical, Morris added.

Another benefit to waiting is learning from others' experiences. Over the next two years, there will be many articles published and commentary written about best practices and what pitfalls to avoid.

For Stage 1 of meaningful use, clinics must show that they have a certified EHR system, and document that they have met at least eight of 25 quality care measures.

Attestation requires eligible hospitals and physicians to report critical data from three main areas: Meaningful Use Core Set Measures, Meaningful Use Menu Set Measures, and Meaningful Use Clinical Quality Measures.

Stages 2 and 3 criteria for meaningful use have yet to be released, but the ONC did release draft proposals in January for public comment.

In short, the future rules will require hospitals and private practices to submit as much as one year's worth of EHR data, and they will require more clinical healthcare quality measures.

"Depending on how you've configured your EHR, when finding out the quality measures, you may be able to push a button and find out that you've been tracking all of them or, alternatively, you may find out you need to begin tracking all of them -- and everything in between," Morris said.

There are a number of methods for deploying EHR technology, from service provider models to in-house deployments and hybrids of both, to shared models where a large health system allows smaller affiliated and nonaffiliated facilities to share its data center infrastructure.

For clinicians and facilities that do not prove meaningful use by the end of 2015, the government will levy a penalty of up to 3% of Medicare payments each year, which for some hospitals could add up to 1% to 2% of their bottom-line income, Morris said.

The feds are planning an audit system just like for personal income taxes to ensure that health organizations are reporting accurate data, Morris added. "For now, it's on the honor system," he said.

Organizations must file by April 22 in order to receive a lump-sum payment for 2011 by mid-May, the CMS said.

Lucas Mearian covers storage, disaster recovery and business continuity, financial services infrastructure and health care IT for Computerworld. Follow Lucas on Twitter at @lucasmearian or subscribe to Lucas's RSS feed . His e-mail address is lmearian@computerworld.com.

Copyright © 2011 IDG Communications, Inc.

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