Early EMR adopters get a break; tougher criteria delayed to 2014

Physicians who didn't wait until 2012 to get their first meaningful use bonus will have an extra year to meet more rigorous reporting thresholds.

By Charles Fiegl — Posted Dec. 12, 2011

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Physicians meeting criteria in 2011 to earn federal electronic medical record incentives will have more time before the Dept. of Health and Human Services requires them to satisfy tougher standards for attaining additional bonuses.

The move is being viewed by physicians and health policy observers as a goodwill gesture by the Obama administration toward EMR early adopters. Doctors and hospitals who currently meet stage 1 meaningful use criteria would be able to vie for bonuses for an extra year under the same requirements, HHS Secretary Kathleen Sebelius announced on Nov. 30. These bonus recipients would not need to upgrade their EMR systems to comply with stage 2 standards until 2014, instead of 2013 under the initial plan.

The delay of stage 2 affects only physicians and hospitals who met stage 1 criteria in 2011. Doctors who will report meeting stage 1 requirements for the first time in 2012 will still be expected to meet stage 2 requirements starting in 2014. Before the new policy change, those who waited until 2012 to adopt would have had a later upgrade deadline but still would have been eligible to receive the same total bonus amounts as the early adopters.

Oct. 3 was the last day a physician could begin a 90-day reporting period for 2011, according to the Centers for Medicare & Medicaid Services. Physicians who met the requirements will have until Feb. 29, 2012, to register and attest to receive a bonus for 2011. Physicians can earn up to $44,000 over five years from the Medicare program or up to $63,750 over six years from Medicaid.

The American Medical Association applauded HHS for adding more flexibility to the incentive program by delaying stage 2. "We continue to urge HHS to fully evaluate stage 1 and develop solutions to increase physician participation rates prior to finalizing requirements for stage 2," said Steven J. Stack, MD, chair-elect of the AMA Board of Trustees.

Organized medicine groups have said that early proposals for requirements under the second phase of the EMR bonus program, if adopted, could dissuade physicians from using EMRs.

In a February letter, the AMA and 38 other organizations urged HHS to make the proposed requirements less rigorous and burdensome. For instance, physicians would need to use an electronic note system and ensure patient access to record portals under stage 2, a mandate many consider difficult to attain.

Public health studies have shown that more doctors want to participate in the EMR adoption program. A study from the Centers for Disease Control and Prevention found 52% of office-based physicians plan to register and attest to meeting program requirements for 2011, which is an increase from the 41% who planned in 2010 to do so. The total portion of physicians who have adopted EMRs also is at 34% in 2011, up from 17% in 2008.

"We are pleased that recent data show there is a high interest among physicians to take advantage of the available incentive payments through the government's [electronic health record] incentive program, but we remain concerned that this increase in EHR adoption will not occur unless the program maintains sufficient flexibility in later stages," Dr. Stack said.

Sebelius spoke about the EMR program and the CDC report during a forum held at Cuyahoga Community College in Cleveland on Nov. 30. The incentive program was created by the 2009 economic stimulus package. Since then, 50,000 new health information technology jobs have been created, she said.

Sebelius said the changes made by HHS would make it easier for physicians to earn incentives and hopefully create more jobs.

"When doctors and hospitals use health IT, patients get better care and we save money," she said. "We're making great progress, but we can't wait to do more. Too many doctors and hospitals are still using the same recordkeeping technology as Hippocrates."

Spurring EMR adoption

The announcement did not surprise those following the program, said Robert Tennant, senior policy adviser for the Medical Group Management Assn. The delay had the support of HHS National Coordinator for Health Information Technology Farzad Mostashari, MD, and was recommended by the office's Health IT Policy Committee in June.

EMR vendors, hospitals and physicians had opposed the 2013 stage 2 deadline for early adopters, the policy committee said in its recommendation. The stage 2 requirements are expected to be finalized in June 2012. That timeline would have given vendors only a few months to design, develop, test and release new products and upgrades before the beginning of the 2013 reporting period in October 2012. Doctors and hospitals also would have been expected to learn new system functionality and reporting requirements quickly.

"Overall, HHS is trying to be responsive, and they are going to continue to be responsive," Tennant said. "It's a huge hurdle, and the more they lower the roadblocks, the more eligible providers will register and attest -- and the program will be a success."

There are several takeaways for physicians from Sebelius' announcement, said Stephen Bernstein, an attorney who is the international head of the health industry practice group at McDermott Will & Emery in Boston. In general, more physicians are adopting EMRs and using the technology to improve their practices.

HHS also is sending a message to physicians who are undecided about whether they should make a significant investment in electronic recordkeeping, Bernstein said. The agency will work with physicians to help them adopt EMRs. He suggested that doctors get in touch with one of 62 federal regional extension centers that have been established to help physicians, in particular small primary care practices, adopt EMRs.

"The main message is that there are federal government programs out there to help physicians, and the federal government isn't going to stop offering help," he said.

Bernstein added that a robust EMR system is needed to participate in new Medicare payment models, such as accountable care organizations. If CMS wants physicians to participate in these initiatives as well, it must do everything it can to encourage doctors to use EMRs, he said.

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Primary care tops Medicare EMR bonuses

A total of 5,805 physicians and other eligible health professionals have earned a Medicare bonus for meaningful use of an electronic medical record system through October. Medicare will pay $18,000 to each professional, for a total of $104.5 million so far. Family physicians and internists led Medicare's list of physicians who have earned bonuses.

Specialty Bonuses
Family practice 1,216
Internal medicine 1,198
Cardiology 517
Podiatry 378
Gastroenterology 232
Orthopedic surgery 201
General surgery 197
Urology 197
Nephrology 174
Neurology 148
Other 1,347

Source: Electronic Health Record Incentive Program, Centers for Medicare & Medicaid Services, October

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What Medicaid paid for EMR use

So far, Medicaid has paid $711.6 million in bonuses to 9,306 physicians, nonphysician practitioners and hospitals for meaningful use of electronic medical records.

Professional type Bonuses Dollar amount
Physician 6,609 $138.5 million
Nurse practitioner 1,463 $31.1 million
Acute care hospital 607 $483.9 million
Dentist 333 $7.1 million
Certified nurse midwife 172 $3.7 million
Physician assistant 107 $2.3 million
Children's hospital 15 $45.1 million

Source: Electronic Health Record Incentive Program, Centers for Medicare & Medicaid Services, October

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External links

Centers for Medicare & Medicaid Services Electronic Health Record Incentive Program payment and registration data in report form (link)

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