President Obama signed the American Recovery and Reinvestment Act of 2009 into law on February 17, 2009. Along with numerous spending and tax reduction provisions in the Act, the President is maintaining his push to bring the healthcare industry into the electronic age with a key EHR (Electronic Health Record) incentive package. 

In an effort to increase the adoption of EHR systems in physician practices, the Act provides financial incentives modeled after the PQRI (physician quality reporting incentive). Eligible physicians including doctors, dentists, podiatrists, optometrists, and chiropractors can be reimbursed up to $44,000 for adopting a qualified EHR. 

There are several medical professionals who do not qualify for the incentive, including hospital-based physicians and physical therapists. There are separate hospital incentives. 

The incentive is provided through Medicare Part B payments to physicians who have demonstrated they are "meaningful" EHR users. This basically requires that the physician use certified EHR technology along with e-prescribing; the technology must be connected to provide electronic exchange of health information; and the eligible professional must provide information for the period on the clinical quality measures and other measures selected by the Health and Human Services (HHS) Secretary. 

The Medicare incentive payments will be based on an amount equal to 75% of the HHS Secretary's estimate of allowable charges and will be up to $15,000 for the first payment year. The payments decrease in subsequent years to up to $12,000 in the second year, $8,000 in the third year, $4,000 in the fourth year, and $2,000 in the fifth year. In all instances, the payments end in 2015 and will be replaced by a penalty for practices that are not meaningful users of EHR systems. In order to prevent double dipping, physicians who report using an EHR system capable of e-prescribing will no longer be eligible for the e-prescribing bonuses. For eligible professionals in a health professional shortage area, the incentive payments will be increased by 10%. 

The HHS Secretary is required to develop an initial set of standards, implementation specifications, and certification processes by December 31, 2009. 

As stated, beginning in 2015, the Centers for Medicare and Medicaid Services (CMS) will begin reducing Medicare payments for professional services furnished if that professional is not a meaningful EHR user. These penalties range from 1% in 2005 to 3% in 2017 and beyond.

The stimulus legislation also provides incentives for Medicaid providers to adopt EHR systems. This incentive provides up-front payments for the acquisition of the EHR technology for eligible providers. Eligibility includes a non-hospital based professional whose patient volume includes at least 30% Medicaid eligible recipients. Pediatricians who are not hospital based must have a patient base of at least 20% Medicaid eligible recipients. Professionals who practice predominately in a federally qualified health center or rural health clinic and have a patient volume of at least 30% Medicaid eligible recipients, and children's hospitals or acute care hospitals that have patient volume of at least 10% Medicaid eligible recipients also qualify for the incentive. 

This legislation applies to eligible physicians, dentists, certified nurse practitioners, certified nurse mid-wives, and physician assistants. 

The amount of the incentive is up to $63,750 in federal contributions towards the adoption, implementation, upgrade, maintenance, and operation of a certified EHR system. There are varying tiers of funds available for the various stages of implementation for up to five years. 

Other healthcare-related legislation included in the stimulus package include modifications to privacy provisions, patient control of records, patient access to information in electronic format, and other privacy related matters. 

The package also authorizes a 65% temporary COBRA premium subsidy for workers who have been involuntarily terminated between September 1, 2008 and December 31, 2009. The subsidy is available for up to nine months and is not considered income. The eligibility requirements are an individual must have modified adjusted gross income below $145,000 or $290,000 for joint filers. Individuals between $125,000 and $145,000 and joint filers between $250,000 and $290,000 will receive a reduced subsidy.

Finally, the stimulus package allows up to $500 million to address the shortage of primary health-care providers. This includes physicians, dentists, and nurses as well as helping pay medical school expenses for those who agree to serve in underserved communities through the National Health Service Corps.

EHTC has a thriving Healthcare Services Practice. For more information about the information contained in this article or if you have other questions, please contact Melinda DeMarse at 800-404-2065 or melindad@ehtc.com.