The federal government on July 13 released the much-anticipated requirements for how physicians and hospitals can qualify for tens of thousands of dollars in incentive payments to adopt and use electronic health records.
The final rule on the meaningful use of electronic health records (EHRs) eases many of the requirements that officials in the Health and Human Services department had outlined in a proposal published in January. Physician organizations had objected to the initial proposal, saying that it asked doctors, especially those in small practices, to do too much too quickly. Physicians were also critical of the all or nothing framework of the proposal, which required them to meet all 25 objectives for meaningful use or lose out on incentive payments.
Federal officials aimed to address those concerns in the final rule by requiring physicians to first meet a core set of 15 requirements and then meet any 5 of 10 additional requirements. The core set includes requirements such as recording patient demographics and vital signs in the EHR, maintaining an up-to-date problem list and an active list of medications and allergies, and transmitting permissible prescriptions electronically.
"We very much want well-intentioned providers to become meaningful users," Dr. David Blumenthal, National Coordinator for Health Information Technology at HHS, said during a press briefing to announce the final rule.
HHS officials also relaxed some of the thresholds related to the requirements. For example, under the proposed rule, physicians would have had to generate and transmit 75% of their permissible prescriptions electronically to meet the e-prescribing requirement. Under the final rule, the threshold has been lowered to more than 40% of permissible prescriptions. The revision was made so that the requirement would be achievable by average practices in the early years of the program, Dr. Blumenthal said.
The final rule also creates an easier path for physicians to meet meaningful use requirements on electronic reporting of quality data. Under the final rule, physicians will need to report data on blood pressure, tobacco status, and adult weight screening, and follow-up in 2011 and 2012, in order to qualify. Alternatives are available if those measures do not apply to their practices. Physicians will also have to choose three other quality measures to report on through their EHRs.
The final rule outlines the steps physicians must take in 2011 and 2012 to quality for the maximum incentive payments through the Medicare and Medicaid programs. The incentives were mandated by the Health Information Technology for Economic and Clinical Health Act (HITECH), a part of 2009’s American Recovery Act.
Starting in 2011, physicians who demonstrate meaningful use of certified EHRs can receive payments of up to $18,000 from Medicare. Those bonuses continue for 5 years, with physicians eligible to earn up to $44,000 in total incentives. Physicians can still receive bonuses if they begin their meaningful use of the technology later, but they must start before 2013 to get all the available incentives.
A similar program is in place under the Medicaid program, with physicians eligible to receive up to $64,000 over 6 years for the adoption and use of certified EHRs.
Also on July 13, HHS released a final rule with new standards for the certification of EHR technology. The simultaneous release of these certification rules should assure physicians that any certified EHR they purchase will be capable of meeting meaningful use standards, Dr. Blumenthal said.
The American Medical Association was still reviewing the final rules at press time. However, the organization stressed that a key part of making EHRs affordable for physicians is to address Medicare payments in general, so that physicians aren’t facing double-digit cuts in their reimbursement every few months.
"Congress needs to repeal the flawed Medicare physician payment formula to help eliminate one major obstacle to physician adoption of new technologies," Dr. Steven J. Stack, an AMA board member said in a statement.