In December 2009, CMS released a proposed rule that aims to change the practice of medicine. This rule, if finalized, will codify a $17.2 billion dollar program that provides large financial incentives to practices that adopt EHRs. The finalization of this program represents an unprecedented commitment to health IT and to transitioning physician practices from paper to EHRs.
Numerous studies have examined the value of health IT in improving patient safety, increasing coordination of care and improving quality. However, despite the documented improvements available from health IT, adoption rates remain low. The Robert Wood Johnson Foundation in 2006 estimated that only 17 to 24 percent of office-based physicians use some type of EHR. A survey, conducted in 2008 by Ashish Jha et al, found that 1.5 percent of U.S. hospitals had implemented a comprehensive EHR and an additional 7.6 percent had a basic EHR in place.
These low adoption rates may change with the initiation of an EHR incentive program. Not only are there upwards of $44,000 per physician available, as an additional “incentive” for practices to implement health IT, the program includes Medicare Part B payment reductions for eligible physicians who do not implement health IT beginning in 2015. However, it remains to be seen if this payment structure will affect the rate of EHR implementation in practices across the U.S.
Specifically, the proposed “meaningful use” rule released in December 2009, which is scheduled to be finalized in mid-2010, outlines the government’s vision for EHR adoption, including the structure for both the Medicare and Medicaid programs, the initial eligibility criteria, as well as the timing and calculations of the payments.
Under the new Medicare program, physicians are able to receive incentives equal to 75 percent of their allowable Medicare Part B charges, subject to an annual limit that varies based on when the individual begins participating in the program. Maximum incentives are available for those who participate in the program beginning in 2011. CMS has proposed that payments be made annually on a rolling basis after the individual practice has qualified and reached the threshold for maximum payment.
To qualify for these incentives, physicians must meet requirements for meaningful use of EHRs. CMS has proposed a three-staged definition of meaningful use to address concerns that technology is likely to evolve over the next few years. Stage 1 would begin in 2011 and would require basic use of an EHR. Stages 2 and 3 will include increased requirements.
From the perspective of cardiology, there are still many issues that need to be worked out before the proposed rule becomes final. For example, there will be a significant administrative burden if the rule goes through as proposed, with participants required to report on a variety of measures and attest to a number of different criteria. The ACC’s Health IT Committee remains hopeful that CMS is able to make participation less administratively burdensome while still ensuring that use of EHRs through the program will improve quality.
Clearly, this is an issue that affects cardiovascular practitioners across the U.S., both those without an EHR—who should strongly consider implementing one—and those with an EHR—who will need to ensure that their EHR can meet the requirements to qualify for an the incentive payments. ACC’s Health IT Committee has resources available to practices. Please visit www.acc.org/healthIT for more
Dr. Tcheng is the co-chair of the ACC Health IT Committee and an interventional cardiologist at the Duke Heart Center in Durham, N.C.