Per the American Recovery and Reinvestment Act (ARRA) of 2009, all eligible public and private healthcare providers across the US must have adopted an electronic medical record (EMR) and demonstrated meaningful use by January 1, 2014, to continue receiving Medicare and Medicaid reimbursements.
Incentives and Penalties
To facilitate this transition—which meets the United States’ goals of improving quality, safety, and efficiency; reducing medical disparities; engaging patients and family members; improving care coordination; and maintaining privacy and security—the government is offering financial incentives for compliance and assessing penalties for non-compliance. Specifically, according to this CMS webpage, eligible providers can receive up to $44,000 and/or up to $63,750 through the incentive programs for Medicare and Medicaid, respectively. On the other hand, eligible professionals who don’t implement an EMR and/or fail to demonstrate meaningful use by 2015 will face a 1% reduction in reimbursements—and experts speculate that this “rate of reduction will likely rise annually thereafter.” Some say penalties will reach 5% in coming years.
So what does meaningful use actually mean? Well, it means that providers must use an EMR that meets specific Centers for Medicare and Medicaid Services (CMS) requirements. These requirements are organized in stages: stage 1 requirements must be met for at least nine months in the first year and 12 months in the second; stage 2 requirements must be met for 12 months in both the third and fourth years. However, according to CMS’s website: “For 2014 only, all providers—regardless of their stage of meaningful use—are only required to demonstrate meaningful use for a three-month reporting period. For Medicare providers, this three-month reporting period is fixed to the quarter of either the fiscal (for eligible hospitals and CAHs) or calendar (for eligible professionals) year in order to align with existing CMS quality measurement programs, such as the Physician Quality Reporting System (PQRS) and Hospital Inpatient Quality Reporting (IQR).” To complete stage 1 requirements, eligible professionals must meet 19 (out of a possible 24) meaningful use objectives:
- Fourteen required core objectives (e.g., maintain active medication list, implement drug-drug and drug-allergy interaction checks, or record smoking status for patients aged 13 years or older.)
- Five objectives from ten menu set objectives (e.g., implement drug formulary checks, incorporate clinical lab-test results into record system as structured data, or send patient reminders per patient preference for preventive/follow-up care.)
Looking for more specifics? CMS provides downloadable specification sheets that include definitions, clarifications, and information about:
- Meeting the measure for each objective
- Calculating the numerator and denominator for each objective
- Qualifying for an exclusion to an objective
- Attesting to each measure
Although EMR adoption improves the nature of health care for patients and practitioners in every facet of the industry, not every medical professional is considered eligible. Thus, not every medical professional is mandated to make the switch or eligible to earn the incentive for doing so. For example, the Act does not consider physical therapists, occupational therapists, or speech-language pathologists eligible professionals. That’s why PTs, OTs, and SLPs should look for a rehab-therapy specific EMR and disregard the requirements for meaningful use. After all, there are all sorts of benefits associated with switching to an EMR, even without the promise of an incentive. And as the APTA points out: “While physicians and hospitals are the beneficiaries of many of the federal government’s initial efforts to encourage [EMR] system adoption, they will expect the other providers they work with, including physical therapists, to implement it as well. Patients also may begin to expect their providers to use [EMR]s to manage their care.”
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