Information Arena

Understand the HITECH Act and Meaningful Use so that your practice can benefit.

Penalties for non-compliance with HITECH begin in 2015.

On February 17, 2009, the American Recovery &Reinvestment Act was signed into law. The health IT component of the Bill is the HITECH Act, which appropriates a net $19.5 billion dollars to encourage healthcare organizations to adopt and effectively utilize Electronic Health Records (EHR) and establish health information exchange networks at a regional level, all while ensuring that the systems deployed protect and safeguard the critical patient data at the core of the system.
Navigating the language of the Bill and the regulations stemming from it is time consuming and onerous, so the following is a plain language summary of the health IT provisions within the HITECH and the Meaningful Use Rules.
Incentive Payments to Physicians and Hospitals: There is a program designed for those that see large volumes of Medicaid patients, and another for those that accept Medicare. The physician chooses which program to participate in. In order to qualify for the incentives, both physicians and hospitals have to demonstrate, at a high level, three things:

  • Use of a certified EHR product with electronic prescribing (eRx) capability that meets current HHS standards
  • Connectivity to other providers to improve access to the full view of a patient’s health history
  • Ability to report on their use of the technology to HHS
The incentives include payments for up to six years, but provide the largest payments early in the program, and those that don’t demonstrate Meaningful Use of an EHR under the Medicare component of the program will eventually be penalized through lower payments. The incentive payments began in 2011 to ensure the providers have time to adopt and learn to use the EHR;penalties begin in 2015.
Medicaid: Eligible providers (EPs) who see more than 30% of patients paying with Medicaid (20% for pediatricians) are eligible for payments of up to $64,000 over six years.
Those meeting the 30% threshold can begin earning the incentive payments even as they adopt, implement and upgrade their EHR software; they can begin proving Meaningful Use of the EHR in the second year of their program participation.
Medicare: Eligible providers (EPs) who do not have a large Medicaid volume but do accept Medicare can earn up to $44,000 over the five years based on a calculation of submitted allowable charges multiplied by 75%, up to the cap for the year.

Medicaid and Medicare providers need to show Meaningful Use in order to get full reimbursement.

Reimbursement reductions:
Providers who do not demonstrate meaningful use in 2014 will see, in their 2015 fee schedules from Medicare, a decrease of 1%
. An additional decrease will be affected in 2016 and 2017 down to a total of 97% of the regular fee schedule; it can further be reduced to 95% if the Secretary determines that total adoption is below 75% in 2018.
Additional Incentives for Physicians Currently Available:
By maximizing the eRx incentives currently available through the Medicare Improvements for Patients and Providers Acts of 2008 and PQRS incentives, a qualified provider can earn an additional incentive from all Medicare payments in one year.
What Constitutes Meaningful Use:
Eligible Providers or EPs will need to do the following to qualify for the EHR incentive payments:

  • EPs will need to prove Meaningful Use of their EHR for at least 90 continuous days in their first year in order to earn an incentive, and then for the entire calendar year for their next attestation
  • Physicians need to prove that they have met several different functional objectives with their use of the EHR product to demonstrate meaningful use. These objectives include (but aren’t limited to) computerized physician order entry, the use of clinical decision alerts, incorporation of lab results into their EHR as discrete data, eRx, and electronic information distribution to patients.
  • Six clinical quality measures will need to be submitted by an EP – three from a Core set of measures and three from 38 other measures (these have no benchmark).
  • Physicians will be paid on a rolling basis as soon as they have proven to CMS that they have met all the functional objectives of the Meaningful Use requirement and have hit the maximum amount for the year.
Standards and Certification:
The Department of Health and Human Services (HHS) developed specific testing criteria to certify software as being “EHR Certified.” A system may be certified as a “Complete EHR” or an “EHR Module.” A Complete EHR is a system that fulfills all the requirements for demonstrating Meaningful Use (and the other certification requirements) as a single unit. An EHR Module performs some subset of those functions. Vendors may certify components as “EHR Modules” and then offer them as a “bundle” which, if it covers all the requirements, will have the same status as a “Complete EHR.”

Privacy Expansion:
As part of the HITECH Act, Federal privacy and security laws (HIPAA) were expanded to protect patient health information, including:
  • Defining which actions constitute a breach (including some inadvertent disclosures)
  • Imposing restrictions on certain disclosures, sales, and marketing of protected health information
  • Requiring an accounting of disclosures to a patient upon request
  • Authorizing increased civil monetary penalties for HIPAA violations
  • Granting authority to state attorneys general to enforce HIPAA
Additionally, a mandatory HIPAA Security Risk assessment was included amongst the requirements to demonstrate Meaningful Use.