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The EHR Initiative,
Meaningful Use and
Federal Incentives

requires proper attribution.*

*Reproduction of any of this material
 The EHR Initiative ,
Meaningful Use and $27
Billion in Federal
The EHR Initiative,
Incentives
Meaningful Use and Federal
Incentives
and Participation
Updates, Requirements
 Health Information Technology for Economic and
Clinical Health Act

Signed into law on February 17,

2009 as a part of the American
Recovery and Reinvestment Act of 2009

“Our recovery plan will invest in

electronic health
records and new technology that will
reduce errors, bring down costs, ensure
privacy and save lives.”

-President Obama, Address to Joint Session of Congress,

February 2009
 Health Information Technology for Economic and
Clinical Health Act

ØEstablishes HIT Policy and Standards

Committees
Ø
ØReviews New Privacy and Security Provisions
Ø
ØDefines Meaningful Use of EHR Systems
Ø
ØAllocates $2 billion for the ONC

ØAllocates $27 billion in Medicare and

Medicaid Incentives
Ø
 Meaningful Use

ONC Final Rule

ØReleased on July 13, 2010

ØEstablishes the certification
criteria that will be used to certify
EHR technology
ØDefines the set of standards and
implementation specifications that
certified EHR technology must meet to
achieve stage 1 of meaningful use
 Meaningful Use

CMS Final Rule

ØReleased on July 13, 2010

ØSpecifies the initial criteria EPs
must meet to qualify for federal EHR
incentive payments
 Health Information Technology for Economic and
Clinical Health Act

What is Meaningful Use?

Using certified EMR Systems to meet the

following objectives:

ØImprove quality, safety, efficiency, and

reduce health disparities
ØEngage patients and families in their
health care
ØImprove care coordination
ØImprove population and public health
ØProtect patient privacy and ensure
electronic health information security

Ø
 Health Information Technology for Economic and
Clinical Health Act

$27 billion may be paid out to

eligible providers as incentive
payments through Medicare and
Medicaid to promote the adoption and
meaningful use of EHRs

ØA certified EMR system must be adopted

ØMust be deemed as an eligible provider
(“EP”) to receive incentive payments
ØAll meaningful use requirements must be met
ØEligible provider must submit required
attestations and/or clinical quality
reporting to CMS
 Federal Incentive Facts

ØEPs must choose to participate in either

the Medicare or Medicaid incentive program;
may not participate in both simultaneously
ØMay change incentive programs one time
during payment periods
ØMedicaid incentive program participants
must select one state, but may switch
states annually
ØMedicaid reimbursement through individual
states
ØMedicare reimbursement through CMS
ØEPs who provide 90% or more of their
services in inpatient or ED settings (based
on POS codes) are not eligible for
incentive payments
 Medicare Incentives

75% of Medicare Physician Fee

Schedule Allowed Charges - Up to
$44,000 Maximum

EPs:
ØDoctor of Medicine or Osteopathy
ØDoctor of Dental Surgery or Dental
Medicine
ØDoctor of Podiatric Medicine
ØDoctor of Optometry
ØChiropractor
 Medicare Incentives

ØIncentive program runs from 2011-2016

Ø2014 is the last year to begin participation
ØEPs may receive up to five years of incentive
payments
ØEPs must adopt and meaningfully use a certified EMR
System for 90 consecutive days to be eligible for
the first incentive payment, 365 consecutive days
for each incentive payment thereafter
ØIncentives are increased by 10% for EPs who
furnish services in a health professional shortage
area
ØBeginning in 2015, EPs are subject to a 1% penalty
of their Medicare reimbursement increasing up to
5% for each year the EP does not demonstrate
meaningful use
ØMedicare EPs are not eligible to receive eRx
incentive payments
Ø
 Medicare Incentives
Payment First First First First First
Amount Qualifies Qualifies Qualifies Qualifies Qualifies
in 2011 in 2012 in 2013 in 2014 in 2015

Payment for $18,000 $ $ $ $ 0

2011 0 0 0

Payment for $12,000 $18,000 $ $ $ 0

2012 0 0

Payment for $ 8,000 $12,000 $15,000 $ $ 0

2013 0

Payment for $ 4,000 $ 8,000 $12,000 $12,000 $ 0

2014

Payment for $ 2,000 $ 4,000 $ 8,000 $ 8,000 $ 0

2015

Payment for $ 0 $ 2,000 $ 4,000 $ 4,000 $ 0

2016

Total $44,000 $44,000 $39,000 $24,000 $ 0

Payments
 Medicaid Incentives

Up to 85% of Allowable EMR Costs – Not to

Exceed a Maximum of $63,750

30 % of EPs patient threshold must by a

Medicaid recipient
EPs:

ØPhysicians (Pediatricians have special rules)

ØNurse Practitioners
ØCertified Nurse-Midwives
ØDentists
ØPhysician Assistants who provide services in
a FQHC or rural health clinic led by a
Physician Assistant
•
 Medicaid Incentives

Ø Pediatricians must only by a 20%

Medicaid recipient threshold and
therefore their incentive payments
are reduced by 33%
Ø
Ø Pediatricians with a 30% Medicaid
threshold are eligible for the entire
incentive payment amount
 Medicaid Incentives

ØIncentive program runs from 2011-2021

Ø2016 is the last year to begin participation
ØEPs may receive up to six years of incentive
payments = $63,750 or = $42,500 for pediatricians
who only meet a 20% Medicaid patient threshold
ØEPs must adopt, implement upgrade or demonstrate
meaningful use of a certified EMR System to be
eligible for the first incentive payment year,
demonstrate meaningful use for 90 consecutive days
for the second incentive payment year, 365
consecutive days for each incentive payment
thereafter
ØBeginning in 2015, EPs will be subject to a 1%
penalty of their Medicare reimbursement increasing
up to 5% for each year the EP does not
demonstrate meaningful use - No Medicaid
reimbursement penalties applicable
ØEPs may participate in both eRx and PQRI incentive
programs
 Medicaid Incentives
Payment 1 st 1 st 1 st 1 st 1 st 1 st
Amount Qualifies in Qualifies Qualifies Qualifies Qualifies Qualifies
2011 in 2012 in 2013 in 2014 in 2015 in 2016
For 2011 $21,250/14,167 $ $ $ $ $
0 0 0 0 0
For 2012 $8,500/5,667 $21,250 / 14,167 $ $ $ $
0 0 0 0
For 2013 $8,500/5,667 $8,500/5,667 $21,250 / 14,167 $ $ $
0 0 0
For 2014 $8,500/5,667 $8,500/5,667 $8,500/5,667 $21,250 / 14,167 $ $
0 0
For 2015 $8,500/5,667 $8,500/5,667 $8,500/5,667 $8,500/5,667 $21,250 / 14,167 $
0
For 2016 $8,500/5,667 $8,500/5,667 $8,500/5,667 $8,500/5,667 $8,500/5,667 $21,250 / 14,167

For 2017 $ 0 $8,500/5,667 $8,500/5,667 $8,500/5,667 $8,500/5,667 $8,500/5,667

For 2018 $ 0$ $8,500/5,667 $8,500/5,667 $8,500/5,667 $8,500/5,667

0
For 2019 $ 0$ $ $8,500/5,667 $8,500/5,667 $8,500/5,667
0 0
For 2020 $ 0$ $ $ $8,500/5,667 $8,500/5,667
0 0 0
For 2021 $ 0$ $ $ $ $8,500/5,667
0 0 0 0
Total $63,750 / $42,500 $63,750 / $42,500 $63,750 / $42,500 $63,750 / $42,500 $63,750 / $42,500 $63,750 / $42,500
 Federal Penalty Facts

ØPenalties imposed for lack of eRx by

way of reductions in allowed Medicare
physician fee schedule payments

Ø2012 = -1%
Ø2013 = -1.5%
Ø2014 and beyond = -2.0%
Ø
Ø

Ø
 Federal Penalty Facts

ØPenalties imposed for lack of PQRI

reporting by way of reductions in
allowed Medicare physician fee
schedule payments

Ø2015 = -1.5%
Ø2016 and beyond = -2.0%

Ø
Ø

Ø
 Federal Penalty Facts
ØPenalties imposed to all providers who
fail to adopt EMR by way of reductions
in allowed Medicare physician fee
schedule payments:
Ø2015 = -1%
Ø2016 = -2%
Ø2017 = -3%
Ø2018 = -4%
Ø2019 = -5%
Ø
ØCMS will issue another proposed rule
to address penalties applicable to
2020 and beyond
ØNo penalties in Medicaid reimbursement
for lack of EMR adoption
 Meaningful Use

Stage One – Concentrates On:

ØCapturing electronic PHI in a structured
format
ØImplementing medication management tools
ØReporting clinical quality measures and
public health information
Eligible Providers Must Complete:
*See Handouts*
Ø15 Core Objectives
Ø5 of 10 Menu Objectives
Ø6 Total Clinical Quality Measures (3 core
or alternate core, and 3 out of 38 from
additional set)
 Stage I Meaningful Use – Objectives
and Measures
Terminology of Objectives and Measures

Numerator- The number of patients that satisfy

the objective or measure

Denominator- The total number of patients in a

provider’s patient population to whom
the objective or measure applies

Exclusion- Patient total with both a numerator

and a denominator equal to zero as
none of the objective or measure
criteria apply to the patient population

Attestation- EPs attest to the truth of the data

verses electronically submitting data
 Registration for CMS EHR Incentive
Programs
Registration Requirements

ØEP’s must have an active National Provider Identification

(“NPI”) number
ØEP’s must have a tax ID number or SSN
ØEP’s must have a web user account with the National Plan
and Provider Enumeration System (“NPPES”)
ØA NPPES user ID and password will be required
ØIf you need to create a NPPES account you may
access the website at:
https://nppes.cms.hhs.gov./NPPES/NPIRegistryHome.do
ØIf you need to reset your ID or password or have
additional questions you may contact NPPES help
desk at 800-465-3203 or email them at:
customerservice@npienumerator.com
 Registration for CMS EHR Incentive
Programs
Registration Process

ØEP’s should access the CMS Registration Portal at

https://ehrincentives.cms.gov
ØThe following websites provide complete instructions for
registering for EHR Incentive Programs:
ØFor the Medicare Incentive Program:

http://www.coms.gov/EHRIncentivePrograms/Downloads/EHRMedicaidEP_Regis
ØPlease note that in order to qualify for Medicare
incentives you must be enrolled in the Provider
Enrollment, Chain and Ownership System (“PECOS”)
ØYou will need your NPPES ID and password to
access the PECOS system
ØFor the Medicaid Incentive
http://www.cms.gov/EHRIncentivePrograms/Downloads/EHRMedicaidEP_Re
 Meaningful Use

CMS will continue to define meaningful

use through two more phases proposed
through future rulemaking

ØPhase two objectives expected to be

released by the end of 2011
ØPhase three objectives expected to be
release by the end of 2013

Ø
 ONC Final Rule for Meaningful
Use
Meaningful Use Stage Timeline
2011 2012 2013 2014 2015

2011 Stage I Stage 1 Stage II Stage II TBD

First Payment Year

2012 Stage I Stage I Stage II TBD

2013 Stage I Stage I TBD

2014 Stage I TBD

2015 TBD

CMS will continue to define meaningful use through two more

phases proposed through future rulemaking
 Meaningful Use

Phase Two of Meaningful Use is Expected

to Expand the Focus on:

ØExchange of electronic PHI in

structured format between affiliate
and unaffiliated providers, facilities
and EHR Systems
ØIncrease usage of computerized
provider order entry
ØExpanded requirements for eRx
Ø
 Meaningful Use

Phase Three of Meaningful Use is

Expected to Expand the Focus on:

ØDecision support for national high

priority conditions
ØPatient access to self management
tools
ØAccess to comprehensive patient data
through electronic exchange of PHI
ØImproving population health outcomes
Ø
 EMR Network Solutions

Types of Network Solutions

ØSaas or ASP or Hosted

Ø
ØClient Server
Ø
ØHybrid
Ø

Ø
Ø
Ø
 Questions ….

F or more information please contact

Julie Thomas at 910-470-3971