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EHR Incentive Programs: Where We Go Next (Message from Andy Slavitt and Karen DeSalvo)

Where We’ve Been

As we mentioned in a speech last week, the Administration is working on an important transition for the Electronic Health Record (EHR) Incentive Program. We have been working side by side with physician organizations and have listened to the needs and concerns of many about how we can make improvements that will allow technology to best support clinicians and their patients. While we will be putting out additional details in the next few months, we wanted to provide an update today.

In 2009, the country embarked on an effort to bring technology that benefits us in the rest of our lives into the health care system. The great promise of technology is to bring information to our fingertips, connect us to one another, improve our productivity, and create a platform for a next generation of innovations that we can’t imagine today.

Not long ago, emergency rooms, doctor’s offices, and other facilities were sparsely wired. Even investing in technology seemed daunting. There was no common infrastructure. Physician offices often didn’t have the capital to get started and it was hard for many to see the benefit of automating silos when patient care was so dispersed. We’ve come a long way since then with more than 97 percent of hospitals and three quarters of physician offices now wired.

It’s taken a tremendous commitment by physicians, hospitals, technologists, patient groups and experts from all over the country to make the progress we’ve made together in a few short years. The EHR Incentive Programs were designed in the initial years to encourage the adoption of new technology and measure the benefits for patients. And while it helped us make progress, it has also created real concerns about placing too much of a burden on physicians and pulling their time away from caring for patients.

Transitioning From Measuring Clicks to Focusing on Care

Last year, the Administration and Congress took two extraordinary steps to put patients at the center of how we pay for care and support physicians. First, the Administration set a goal that 30 percent in 2016 and 50 percent in 2018 of Medicare payments will be linked to getting better results for patients, providing better care, spending healthcare dollars more wisely, and keeping people healthy.  And, second, Congress advanced this goal through the passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which considers quality, cost, and clinical practice improvement activities in calculating how Medicare physician payments are determined. While MACRA also continues to require that physicians be measured on their meaningful use of certified EHR technology for purposes of determining their Medicare payments, it provides a significant opportunity to transition the Medicare EHR Incentive Program for physicians towards the reality of where we want to go next.

What Comes Next

We have been working side by side with physician and consumer communities and have listened to their needs and concerns. As we move forward under MACRA, we will be sharing details and inviting comment as we roll out our proposed regulations this spring. All of this work will be guided by several critical principles:

  1. Rewarding providers for the outcomes technology helps them achieve with their patients.
  2. Allowing providers the flexibility to customize health IT to their individual practice needs. Technology must be user-centered and support physicians.
  3. Leveling the technology playing field to promote innovation, including for start-ups and new entrants, by unlocking electronic health information through open APIs – technology tools that underpin many consumer applications.  This way, new apps, analytic tools and plug-ins can be easily connected to so that data can be securely accessed and directed where and when it is needed in order to support patient care.
  4. Prioritizing interoperability by implementing federally recognized, national interoperability standards and focusing on real-world uses of technology, like ensuring continuity of care during referrals or finding ways for patients to engage in their own care. We will not tolerate business models that prevent or inhibit the data from flowing around the needs of the patient.

What This Means for Doctors and Hospitals 
As we work through a transition from the staged meaningful use phase to the new program as it will look under MACRA, it is important for physicians and other clinicians to keep in mind several important things:

  1. The current law requires that we continue to measure the meaningful use of ONC Certified Health Information Technology under the existing set of standards. While MACRA provides an opportunity to adjust payment incentives associated with EHR incentives in concert with the principles we outlined here, it does not eliminate it, nor will it instantly eliminate all the tensions of the current system. But we will continue to listen and learn and make improvements based on what happens on the front line.
  2. The MACRA legislation only addresses Medicare physician and clinician payment adjustments. The EHR incentive programs for Medicaid and Medicare hospitals have a different set of statutory requirements. We will continue to explore ways to align with principles we outlined above as much as possible for hospitals and the Medicaid program.
  3. The approach to meaningful use under MACRA won’t happen overnight. Our goal in communicating our principles now is to give everyone time to plan for what’s next and to continue to give us input.  We encourage you to look for the MACRA regulations this year; in the meantime, our existing regulations – including meaningful use Stage 3 – are still in effect.
  4. In December, Congress gave us new authority to streamline the process for granting hardship exception’s under meaningful use.  This will allow groups of health care providers to apply for a hardship exception instead of each doctor applying individually. This should make the process much simpler for physicians and their practice managers in the future. We will be releasing guidance on this new process soon.

These principles we’ve outlined here reflect the constructive and clear articulation of issues and open sharing of views and data by stakeholders across the health care system, but they also promote our highest priority – better care for the beneficiaries of the Medicare and Medicaid program and patients everywhere.

The challenge with any change is moving from principles to reality. The process will be ongoing, not an instant fix and we must all commit to learning and improving and collaborating on the best solutions. Ultimately, we believe this is a process that will be most successful when physicians and innovators can work together directly to create the best tools to care for patients. We look forward to working collaboratively with stakeholders on advancing this change in the months ahead.

January 19, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 5 blogs containing over 11,000 articles with John having written over 5500 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 18 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Financial incentives and ability to exchange clinical information found to be top reasons for EHR adoption

The need to share patient information with other providers and the use of financial incentives are key drivers in why many providers adopt and use health information technology tools like electronic health records (EHRs), according a data brief released today from the Office of the National Coordinator for Health IT (ONC).

The new data brief details why physicians decided to adopt – or not adopt –EHRs, and it helps to explain how financial incentives drive EHR adoption. The data, from the 2013 National Ambulatory Medical Care Survey, also highlights the high level of importance providers put on health information exchange.

The data demonstrates the importance of incentive programs like the HITECH Act’s Medicare and Medicaid EHR Incentive Programs (meaningful use) and payments for services that include use of certified EHR technology, such as the separately billable Chronic Care Management services finalized under the 2015 Medicare Physician Fee Schedule. ONC today posted a new tool to help clinicians estimate the amount of money they might receive from treating Medicare patients living with chronic conditions, while using their certified health information technology, on the HealthIT.gov dashboard.

The results released today show that since the enactment of HITECH in 2009, 62 percent of physicians who adopted health IT tools identified financial incentives and penalties as a major influence on their decision to adopt, compared with only 23 percent of physicians who adopted before 2009.

“We have seen a significant increase in the adoption and use of health IT systems among providers and the new data shows the importance of incentives in building an interoperable health IT system,” said Karen DeSalvo, M.D., national coordinator for health IT and acting assistant secretary of health. “National delivery system reform initiatives linked to certified technology, such as the separately billable chronic care management services, will help make the electronic use and sharing of health information a reality.”

Today’s data brief found that the ability to easily share electronic information with other care givers, an important component of chronic care management, is also a major motivation for physicians to adopt EHRs. Among physicians who adopted health IT before incentive funds were available, the ability to electronically exchange clinical information with other health care providers was the greatest motivator for adoption. More than a third of physicians who adopted EHRs after HITECH was enacted cited this capability as a major influence in their decision to adopt, and almost 4 in 10 physicians who were not using an EHR reported that the ability to electronically exchange clinical information would be a major driver in their decision to adopt.

December 5, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 5 blogs containing over 11,000 articles with John having written over 5500 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 18 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Cerner Physicians Receive First Round of EHR Stimulus Payments that Require Meaningful Use Attestation

May 19, 2011 — Last evening, Juan Salazar, MD, an internal medicine physician from McAllen, Texas, and three physicians from multi-specialty West Broadway Clinic of Council Bluffs, Iowa, announced receipt of government incentive funding for successful use of electronic health records (EHR), with the support of Kansas City, Mo. based health company, Cerner Corporation (Nasdaq: CERN). West Broadway Clinic and Dr. Juan Salazar achieved the first stage of rigorous requirements certifying them ‘meaningful users’ of health information technology and are excited to announce that the meaningful use dollars have been received via electronic bank deposits.

“All the pieces we’ve employed with Cerner through reaching Meaningful Attestation Use attestation have led to improved patient safety. The requirement from CMS [Centers for Medicare & Medicaid Services] is so beneficial to us—saying you have to do this and you have to do it now only leads to better safety,” said Jan Patterson, West Broadway Clinic’s practice administrator who drove the clinic’s meaningful use process and attestation.

To receive federal incentive funding, Medicare and Medicaid eligible professionals, eligible hospitals and critical access hospitals have to demonstrate ‘Meaningful Use’ through the CMS web-based Registration and Attestation System. According to the CMS definition of Meaningful Use, providers need to show they are using certified EHR technology in ways that can be measured significantly in quality and in quantity. The American Recovery and Reinvestment Act of 2009 specifies three main components of Meaningful Use:

  • The use of a certified EHR in a meaningful manner, such as e-prescribing
  • The use of certified EHR technology for electronic exchange of health information to improve quality of health care
  • The use of certified EHR technology to submit clinical quality and other measures
The physicians from West Broadway Clinic, including family medicine, internal medicine, endocrinology and women’s health specialists, successfully attested on April 20, 2011 and each received $18,000 in government incentive funding on May 18, 2011, with which they plan to continue to investing in patient safety for the communities they serve using certified EHR technology provided by Cerner. Dr. Juan Salazar’s office successfully attested on April 18 and also reports receipt of $18,000, the full amount offered through the CMS, as of May 18, 2011.

Cerner houses an expert team of professionals that specialize in navigating organizations and healthcare professionals through all healthcare reform topics. To learn more about how Cerner’s team can provide clarity, visit Cerner’s Stimulus and HITECH page or email cernerambulatory@cerner.com.

About Cerner
Cerner is transforming healthcare by eliminating error, variance and waste for healthcare providers and consumers around the world. Cerner® solutions optimize processes for healthcare organizations ranging in size from single-doctor practices, to health systems, to entire countries, for the pharmaceutical and medical device industries, employer health and wellness services industry and for the healthcare commerce system. These solutions are licensed by approximately 9,000 facilities around the world, including more than 2,600 hospitals; 3,500 physician practices covering more than 30,000 physicians; 500 ambulatory facilities, such as laboratories, ambulatory centers, cardiac facilities, radiology clinics and surgery centers; 800 home health facilities; and 1,600 retail pharmacies. The trademarks, service marks and logos (collectively, the “Marks”) set forth herein are owned by Cerner Corporation and/or its subsidiaries in the United States and certain other countries throughout the world. Nasdaq: CERN. For more information about Cerner, please visit www.cerner.com, Twitter, Facebook, and YouTube . For more information about Cerner Ambulatory, please visit www.Cerner.com/PhysicianPracticeTwitter and Facebook.

 

May 19, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 5 blogs containing over 11,000 articles with John having written over 5500 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 18 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

2011 Physician Quality Reporting System & Electronic Prescribing Incentive Program

2011 Physician Quality Reporting System & Electronic Prescribing Incentive Program

National Provider Call and Webinar with Question & Answer Session

The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host a national provider conference call on the 2011 Physician Quality Reporting System and Electronic Prescribing (eRx) Incentive Program.  This toll-free call will take place from 1:30 p.m. – 3:00 p.m., EST, on Tuesday, January 18, 2011.

The Physician Quality Reporting System is a voluntary quality reporting program that provides an incentive payment to identified individual eligible professionals (EPs), and beginning with the 2010 Physician Quality Reporting System, group practices who satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-For-Service (FFS) beneficiaries. The Physician Quality Reporting System was first implemented in 2007 as a result of section 101 of the Tax Relief and Health Care Act of 2006 (TRHCA), and further expanded as a result of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA), and the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).

The eRx Incentive Program is an incentive program for eligible professionals initially implemented in 2009 as a result of section 132(b) of the MIPPA.  The eRx Incentive Program promotes the adoption and use of eRx systems by individual eligible professionals and beginning with the 2010 eRx Incentive Program, group practices.
Following the formal presentation that will cover the following:

•       Electronic Prescribing (eRx) Incentive Program Payment Adjustment;
•       Centers for Medicare & Medicaid (CMS) Incentive Program Differences; and
•       Electronic Health Record (EHR) Submission.
The lines will be opened to allow participants to ask questions of CMS Physician Quality Reporting System and eRx subject matter experts.

A PowerPoint slide presentation will be posted to the Physician Quality Reporting System webpage at, http://www.cms.gov/PQRI/04_CMSSponsoredCalls.asp on the CMS website for you to download prior to the call so that you can follow along with the presenter.

Educational products are available on the Physician Quality Reporting System dedicated web page located at, http://www.cms.hhs.gov/PQRI , on the CMS website, in the Educational Resources section, as well as educational products are available on the eRx Incentive Program dedicated web page located athttp://www.cms.hhs.gov/ERxIncentive on the CMS website. Feel free to download the resources prior to the call so that you may ask questions of the CMS presenters.

Conference call details:

Date:  January 18, 2011

Conference Title:  Physician Quality Reporting System & Electronic Prescribing Incentive Program National Provider Call

Time:   1:30 p.m. EST

In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data.  This registration is solely to reserve a phone line, NOT to allow participation.  Registration will close at 1:30 p.m. EST on January 17, 2011, or when available space has been filled.  No exceptions will be made, so please be sure to register prior to this time.

1.      To register for the call participants need to go to:
http://www.eventsvc.com/palmettogba/011811

2.      Fill in all required data.

3.      Verify that your time zone is displayed correctly in the drop down box.

4.      Click “Register”.

5.      You will be taken to the “Thank you for registering” page and will receive a confirmation email shortly thereafter.   Note: Please print and save this page, in the event that your server blocks the confirmation emails.  If you do not receive the confirmation email, please check your spam/junk mail filter as it may have been directed there.

6.    CMS will be adding a webinar as part of this national conference call. This feature will allow participants who are on the Internet the ability to follow the presentation online as it is given. This will not have any effect on those participants who are only dialing in to the audio portion of the call.

Please note participants who are not signed into the webinar should download the presentation from the CMS website. CMS would like to thank those of you who will participate in this feature.

To access Adobe Connect Pro Webinar: please use the following URL:  https://webinar.cms.hhs.gov/PQRS – Instructions: Sign in as a “Guest” when prompted – please enter your first and last name.
Please dial in for the call first and then go to Adobe Connect Pro. Thank you.
If assistance for hearing impaired services is needed the request must be sent to medicare.ttt@palmettogba.com no later than 3 business day before the event.

For those of who will be unable to attend, a transcript and MP3 file of the call will be available at least one week after the call at http://www.cms.hhs.gov/pqri on the CMS website.
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First EHR Incentive Payments Issued
Registration opened on January 3rd for the Medicare and Medicaid EHR Incentive Programs and Medicaid payments have already been issued by two states!

On Wednesday, January 5, 2011 the first payments under the Medicaid EHR Incentive Program were issued by Oklahoma and Kentucky.  Kentucky processed payment to the University of Kentucky ‘s teaching hospital, University of Kentucky Healthcare.  The first payment, $2.86 million, was one- third of the hospital’s overall expected amount for participating in the program.  Oklahoma issued payments to two physicians at the Gastorf Family Clinic of Durant, OK for $21,250 each, for having adopted certified EHRs. These incentive payments for the adoption of certified EHR technology are federally-funded under the Health Information Technology for Economic and Clinical Health (HITECH) Act provisions of the American Recovery and Reinvestment Act of 2009.

For additional information on the this action by Oklahoma and Kentucky please visit their websites:   http://www.okhca.org/EHR-incentive and  http://chfs.ky.gov/dms/EHR.htm

For more information on the Medicare and Medicaid Electronic Health Records Incentive Programs, please visit CMS‘ EHR website at http://www.cms.gov/EHRIncentivePrograms/

Jon Langmead
Centers for Medicare and Medicaid Services
San Francisco Regional Office

January 13, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 5 blogs containing over 11,000 articles with John having written over 5500 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 18 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.