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Emr And Economic Stimulus


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Outlines the economic stimulus benefits for meaningful use of an EMR system in medical offices.

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Emr And Economic Stimulus

  1. 1. Economic Stimulus Overview Provided by gloStream and EMR Specialists, LLC
  2. 2. The Obama Stimulus <ul><li>The American Recovery & Reinvestment Act (ARRA) is a $787 billion stimulus package that became law in February 2009. </li></ul><ul><li>The stimulus is not related to healthcare reform legislation. </li></ul>
  3. 3. The Obama Stimulus <ul><li>$20 billion in incentives for meaningful use of certified EMR technology: </li></ul><ul><ul><li>Medicare: $44,000 per doctor </li></ul></ul><ul><ul><li>Medicaid: $63,750 per doctor </li></ul></ul><ul><li>Incentive money is per Doctor; not per Practice. </li></ul><ul><ul><li>Incentive money goes directly to the Doctor; there is no aggregator. </li></ul></ul><ul><li>There are penalties: </li></ul><ul><ul><li>Beginning in 2015, Medicare Physicians not demonstrating meaningful use of EMR technology will have their Medicare fee schedule reduced: </li></ul></ul><ul><ul><ul><li>2015: -1% </li></ul></ul></ul><ul><ul><ul><li>2016: -2% </li></ul></ul></ul><ul><ul><ul><li>2017 and beyond: -3% </li></ul></ul></ul>
  4. 4. Medicare/Medicaid Incentive Overview <ul><li>Providers must select either the Medicare or Medicaid program, they cannot select both. </li></ul><ul><li>Providers are allowed to change their program election…but only once. </li></ul><ul><ul><li>If changing programs, doctors start at the payment year level that you would have had in your original program. </li></ul></ul><ul><ul><li>Can’t change programs after 2014. </li></ul></ul>
  5. 5. Medicare/Medicaid Incentive Overview Meaningful Use 2011-2012 <ul><li>Functional measures have been replaced by Core Objectives and a Menu Set. </li></ul><ul><ul><li>Doctors must abide by all Core Objectives. </li></ul></ul><ul><ul><li>Doctors must abide by 5 of 10 Menu items. </li></ul></ul>
  6. 6. Medicare/Medicaid: “Meaningful Use” Core Objectives
  7. 7. Medicare/Medicaid: “Meaningful Use” Menu Set
  8. 8. Demonstrating “Meaningful Use” <ul><li>Medicare </li></ul><ul><ul><li>Year 1 – 90 days of continuous, meaningful use </li></ul></ul><ul><ul><li>Year 2 – Meaningful use for the entire calendar year </li></ul></ul><ul><li>Medicaid </li></ul><ul><ul><li>Year 1 – Doctor need only adopt, implement or upgrade </li></ul></ul><ul><ul><li>Year 2 – 90 days of continuous, meaningful use </li></ul></ul><ul><ul><li>Year 3 – Meaningful use for the entire calendar year </li></ul></ul><ul><li>Eligible Professionals must provide an attestation (witness statement) – mechanism TBD. </li></ul><ul><ul><li>Doctors must identify which certified EMR they are using. </li></ul></ul><ul><ul><li>Doctors must describe their performance on all Core Objectives and Menu Items. </li></ul></ul>
  9. 9. Payment <ul><li>Doctor’s will need to provide: </li></ul><ul><ul><li>National Provider Identifier (NPI), business address, phone etc. </li></ul></ul><ul><ul><li>Taxpayer identification </li></ul></ul><ul><li>The doctor’s participation in the incentive program will be made public. </li></ul><ul><li>Payment will come in a single, annual payment from CMS or the State Medicaid agency. </li></ul><ul><li>Payments can be re-assigned. </li></ul>
  10. 10. Clinical Quality Measures <ul><li>Part of meaningful use is submitting information on clinical quality measures (reports on care and care outcomes). </li></ul><ul><ul><li>Reports on clinical quality measures help the government identify trends and patterns of care, and provide guidance for improving care. </li></ul></ul><ul><li>There are now 44 measures </li></ul><ul><ul><li>Three measures required of everyone </li></ul></ul><ul><ul><li>Choice of 3 others , chosen from a subset </li></ul></ul><ul><li>Reporting </li></ul><ul><ul><li>2011: via attestation </li></ul></ul><ul><ul><li>2012: through an electronic means </li></ul></ul>
  11. 11. Medicare
  12. 12. Medicare: Eligible Professionals <ul><li>Doctors of medicine </li></ul><ul><li>Doctors of osteopathy </li></ul><ul><li>Doctors of dental surgery </li></ul><ul><li>Doctors of dental medicine </li></ul><ul><li>Doctors of podiatric medicine </li></ul><ul><li>Doctors of optometry </li></ul><ul><li>Chiropractors </li></ul>
  13. 13. Medicare Payment Schedule -Medicare providers who practice in health professional shortage areas (HPSA’s) will have their incentive payments increased 10%. Incen 2011 Incen 2012 Incen 2013 Incen 2014 Incent 2015 Incen 2016 Incen 2017 Total 2011 $18,000 $12,000 $8,000 $4,000 $2,000 - - $44,000 2012 $18,000 $12,000 $8,000 $4,000 $2,000 - $44,000 2013 $15,000 $12,000 $8,000 $4,000 - $39,000 2014 $12,000 $8,000 $4,000 - $24,000 2015 -1% -1% MFS 2016 -1% -2% -3% MFS 2017 -1% -2% -3% -6% MFS
  14. 14. Medicare Payment Schedule <ul><li>Medicare incentive payments are based on 75% of submitted allowable charges (look to the physicians Medicare fee schedule). </li></ul><ul><ul><li>Clinic that charges $24,000 or more is eligible for $18,000 incentive (75% of 24k = $18k). </li></ul></ul><ul><ul><li>Clinic that charges $13,300 is eligible for $9,975 (75% of $13,3000 = $9,975). </li></ul></ul><ul><ul><li>Only for services furnished by the EP. </li></ul></ul>
  15. 15. Medicaid
  16. 16. Medicaid: Eligible Professionals <ul><li>Physicians </li></ul><ul><li>Nurse Practitioners </li></ul><ul><li>Dentists </li></ul><ul><li>Certified Nurse Midwifes </li></ul><ul><li>Physician Assistants practicing in federally qualified health centers led by a PA </li></ul>
  17. 17. Medicaid: Payment Structure 85% of “Net Average Allowable Costs” Maximum Incentive Payment is $63,750 Year Incentive Year 1 $21,250 (25k) Year 2 $8,500 (10k) Year 3 $8,500 (10k) Year 4 $8,500 (10k) Year 5 $8,500 (10k) Year 6 $8,500 (10k)
  18. 18. Medicaid Incentives <ul><li>Year 1 incentive payments are provided to eligible providers who are adopters / meaningful users of certified EMR technology: </li></ul><ul><ul><li>Eligible providers receive up to 85% of net average allowable costs for their EMR (software, implementation, training, etc.). </li></ul></ul><ul><ul><li>Last “first” year is 2015 and no payments after 2021. </li></ul></ul>
  19. 19. Medicaid: Eligible Professionals <ul><li>A non-hospital-based professional with at least 30% of their patient volume coming from Medicaid patients. </li></ul><ul><li>A non-hospital-based pediatrician with at least 20% of his/her patient volume coming from Medicaid patients. </li></ul><ul><li>A professional who practices predominately in a Federally-qualified health center or rural health clinic with at least 30% of the professional’s patient volume coming from Medicaid patients. </li></ul>
  20. 20. Pediatrician Incentive <ul><li>The pediatrician incentive is lower, because the threshold is lower. </li></ul><ul><li>Maximum cumulative incentive = $42,500. </li></ul><ul><ul><li>$14,167 in Year 1 </li></ul></ul><ul><ul><ul><li>($16,667 x 85% = $14,167). </li></ul></ul></ul><ul><ul><li>$5,667 in Years 2-6 </li></ul></ul><ul><ul><ul><li>($6,667 x 85% = $5,667). </li></ul></ul></ul>
  21. 21. How is Patient Volume Defined? <ul><li>“ at least 30% of patient volume” means that the physician must be able to attribute 30% of his/her patient encounters over a 90-day period to Medicaid patients. </li></ul><ul><ul><li>Numerator: amount of Medicaid patients </li></ul></ul><ul><ul><li>Denominator: total amount of all patients </li></ul></ul><ul><li>“ practice predominantly in a federally qualified health centers” means more than 50% of the time. </li></ul>
  22. 22. What Should I Do Today? <ul><li>Start researching your options. </li></ul><ul><li>Consider your technology, maintenance and support options. </li></ul><ul><li>Don’t wait! </li></ul><ul><ul><li>With nearly 1 million providers going electronic there will be a line. </li></ul></ul><ul><ul><li>The plans are front loaded, most of the money is available in the first few years. </li></ul></ul><ul><li>The requirements ramp up over time. </li></ul>
  23. 23. Contact <ul><li>Michael Kanet </li></ul><ul><ul><li>Cell: 702-279-8603 </li></ul></ul><ul><ul><li>Email: </li></ul></ul>