Roadmap to the $44K EHR Incentive

You've probably heard about electronic health records (EHRs) and the $44,000 incentive. What you might not know, is what you must do to qualify for the incentive and when you need to meet those requirements.

What Is Driving EHR Adoption?

The first wave of certified EHRs are already hitting the chiropractic marketplace. EHR adoption will help to decrease medical errors and improve care by creating a transparent patient record that can be accessed by all of the health care providers delivering care to an individual patient. In the near future, reimbursement will be based upon the efficiency and the effectiveness of care you deliver as measured against the entire spectrum of possible interventions.

Eligible Providers

According to the Centers for Medicare and Medicaid Services (CMS), chiropractors are among the providers eligible to receive up to $44,000 as an incentive for achieving the meaningful use of EHR. The $44,000 incentive is per provider, not per clinic. This means that multiple provider practices have an even greater incentive to adopt EHR.

CMS will pay incentives based upon 75 percent of the allowed charges submitted to Medicare during the time frames outlined in the program. The only Medicare allowable charges for chiropractors are the chiropractic manipulative treatment codes (98940, 98941 and 98942). For example, if you have $24,000 in submitted allowed charges to CMS over the year, then 75 percent of this is $18,000. You would be eligible to receive this amount, in one payment, at the end of the year. Whether you are a participating or a non-participating provider has no impact on your eligibility for the incentive. All providers must submit an application for the incentive payment and must repeat the process electronically the following year.

Steps to Incentive Payment

The HITECH Act that established the rules for EHR adoption is a separate law from national health care. On July 13, 2010 the "Electronic Health Record (EHR) Incentive Program Final Rules" were published in the federal register. The first date that any eligible provider can start EHR is Jan. 1, 2011. You have until Oct. 1, 2011 as the last date to start "meaningful use" (described below) to qualify for the 2011 payment. You'll have until Jan. 1, 2012 to be eligible for the full $44K. Then the amount begins to decrease.

What Is Meaningful Use?

The first step to qualify for the incentive payment is to adopt a certified EHR system and then to achieve "meaningful use" (MU) of your system as ruled by CMS. The purpose of meaningful use is the capture and sharing of healthcare data. MU is defined by the federal government and is required for ARRA incentive payments.

There are 15 "core objectives" that define meaningful use. Most chiropractors will have to meet only 13 of them to demonstrate MU of their EHR. For example, chiropractors are excluded from the prescribing criteria if they do not prescribe more than 100 prescriptions annually. All of the information that is required to achieve MU must be recorded in the EHR as "structured data". Structured data is data that can be shared electronically.

The 13 Core Objectives Required to Achieve MU

1. Implement drug-drug and drug-allergy interaction checks. You must enable this functionality for the entire EHR reporting period.
2. Maintain an up-to-date problem list of current and active diagnoses. You must maintain this list on more than 80 percent of your patients (not only your Medicare patients). This means there must be at least one diagnosis entered, or an indication that no problems are known for these patients.
3. Maintain an active medication list on more than 80 percent of all of your patients. These patient records must have at least one medication listed or an indication that the patient is not currently prescribed any medication.
4. Maintain an active medication allergy list. You must maintain this list on more than 80 percent of your patients. This means there must be at least one entry, or an indication that there are no known allergies for these patients.
5. Record these demographics on 50 percent of all of your patients: preferred language, gender, race, ethnicity, and DOB.
6. Record and chart changes in the following vital signs on 50 percent of all of your patients over the age of 2: height, weight, blood pressure, calculate and display BMI, and plot and display growth charts for children 2 - 20 years old, including BMI.
7. Record smoking status for more than 50 percent of all patients 13 years old or older. You are excluded from this core objective if you see no patients who are 13 years or older.
8. Report ambulatory clinical quality measures to CMS or, in the case of Medicaid, to the appropriate state. Ambulatory clinical quality measures include: tobacco use assessment and tobacco cessation intervention; adult weight screening and follow-up. If the denominator for either of these two measures is zero, you will be required to report results for up to three alternate core measures: influenza immunization for patients 50 years old or older; weight assessment and counseling for children and adolescents; childhood immunization status.
9. Implement one clinical decision support (CDS) rule relevant to specialty or high clinical priority along with the ability to track compliance with that rule. This should appear in the EHR as a "care alert". The practitioner's agreement or disagreement with the alert should be recorded in that particular case. An example for chiropractors would be the National Committee for Quality Assurance's Low Back Pain Guideline or the cervical acceleration/deceleration (CAD) guidelines for neck trauma.
10. Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, and medication allergies) upon request. More than 50 percent of all patients who request an electronic copy of their health information must be provided it within three business days. This core objective has an exclusion: if you have no requests from patients or their agents for an electronic copy of their patient health information during the EHR reporting period.
11. Provide clinical summaries to patients for more than 50 percent of all office visits within three days. You are exempt if you have no office visits within the reporting period.
12. Perform at least one test of your EHR's capability to exchange key clinical information (e.g. problem list, medication list, allergies, and diagnostic test results) among providers of care and patient-authorized entities.
13. Protect health information created or maintained by certified EHR technology through the implementation of appropriate technical capabilities. You must conduct or review a security risk analysis per 45 CFR 164.308 (a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process.

[pb]Menu-Set Objectives

Beyond the 13 core objectives, you must also choose from a list of 10 "Menu Set" objectives to demonstrate MU. Because most chiropractors have exclusions from three of the 10, you will only need to choose four of the remaining seven items.

1. Generate at least one list of patients organized by their specific conditions. This list must be used for quality improvement, reduction of disparities, research, or outreach.
2. Send reminders to patients, for preventive or follow-up care. You must send these reminders to 20 percent of all of your patients 65 years old or older, or to the parents/guardians of patients 5 years old or younger, during the reporting period. You are excluded from this if you have no patients in these age groups.
3. Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate. More than 10 percent of all patients seen must be provided patient-specific education resources.
4. If you transition a patient to another care setting or refer a patient to another care provider, you must have a summary care record for each care transition or referral. You must provide a summary of care record for more than 50 percent of all transitions of care and referrals. You are exempt from this objective if you neither transfer a patient nor refer a patient to another provider during the EHR reporting period.

2011 Early Adopters Catch a Break

Eligible providers are required to achieve meaningful use of their certified EHR system for only 90 continuous days in 2011, rather than for a full year thereafter.

Once you have achieved 90 days of MU, you may submit an application for incentive funding. The 2011 payment will be by paper application and then via electronic means from 2012 to 2015.

From 2012 to 2015, a full year of MU will be required. You will submit an application for the incentive payment at the end of the year. Reporting will be part of the EHR rather than a manual application. The deadline for submission is no later than February 28 of the following year to receive payment for the prior year.

You must register to be in the EHR incentive program. Registration is expected to begin in January 2011. You will be able to find registration and other program information at www.cms.gov/EHRIncentivePrograms when it becomes available.

You must also be registered in the Medicare Internet-Based Provider Enrollment, Chain and Ownership System (PECOS) to participate in the EHR incentive program. For information on PECOS, visit www.acatoday.org/medicare under "Medicare Enrollment FAQS."

Take Action

Now that you know what EHR is, be sure that the vendor's product you choose is certified.

Create a plan to implement EHR adoption with your practice team and to train all providers on eligible use. If you have an associate doctor who will be using an EHR system that you are purchasing, you should determine how the incentive payments will be disbursed prior to implementing the program. It's time to decide where your practice will be next year. In regards to EHR, it is choice, not chance, that will determine your destiny.

Important EHR Dates to Remember

• Fall 2011: Certified EHR technology listed online at: http://dhhs.gov/healthit.
• January 2011: Registration for the EHR Incentive Programs begins at www.cms.gov/EHRIncentivePrograms.
• May 2011: Medicare incentive payments begin.
• Feb. 29, 2012: Last day for providers to register and attest to receive an incentive payment for calendar year 2011.