WOW Global Corporation. LLC - Healthcare IT Consulting , Healthcare IT Product , Healthcare BPO

On February 17, 2009 President Obama signed the 2009 American Recovery and Reinvestment Act, to encourage providers to engage in EHR adoption and its meaningful use. The ACT allocates $19.2 Billion for HIT under ARRA for hospitals and Eligible Professionals (EP) that adopt a certified electronic health record system (EHR). While $2 billion would be directed towards achieving a health information exchange (HIE) mechanism across the county, the majority of dollars ($17.2 billion) under the HITECH act would be directed towards incentive payments to eligible professionals and hospitals.

Benefits of a timely adoption

More efficient patient care
Increased accuracy/patient safety
Reduced medical errors and unnecessary tests
Improved preventative care
Faster delivery of medications
Improved coding and better claims management
Increased patient satisfaction
Potential increase in the number of patient intake by a provider
Enhanced clinical efficacy
Improved workflow and significant time savings.
Reduced spending in man hours, stationary costs and other overheads.
Over 70% of the stimulus incentive dollars are accrued within the first two years of the program.

Incentives
The incentives are significant:

Provider Medicare Incentive = $44,000
Provider Medicaid Incentive = $63,750
Hospital Medicare Incentive = $2million to $10million

	Medicare Incentive Payment Schedule
Calendar Year	2011	2012	2013	2014	2015 - Subsequent years
2011	$18,000
2012	$12,000	$18,000
2013	$8,000	$12,000	$15,000
2014	$4,000	$8,000	$12,000	$12,000
2015	$2,000	$4,000	$8,000	$8,000	$0
2016	$0	$2,000	$4,000	$4,000	$0
Total	$44,000	$44,000	$39,000	$24,000	$0

	Medicaid Incentive Payments
Calendar Year	2011	2012	2013	2014	2015	2016
2011	$21,250
2012	$8,500	$21,250
2013	$8,500	$8,500	$21,250
2014	$8,500	$8,500	$8,500	$21,250
2015	$8,500	$8,500	$8,500	$8,500	$21,250
2016	$8,500	$8,500	$8,500	$8,500	$8,500	$21,250
2017		$8,500	$8,500	$8,500	$8,500	$8,500
2018			$8,500	$8,500	$8,500	$8,500
2019				$8,500	$8,500	$8,500
2020					$8,500	$8,500
2021						$8,500
Total	$63,750	$63,750	$63,750	$63,750	$63,750	$63,750

There are other provisions under Medicare PQRI, MCMP and e-Prescribing that can increase the HITECH incentive. The maximum incentives payouts are as described in the table below: The Medicare Care Management Performance (MCMP) program provides a one-time incentive for reporting quality measures and then additional yearly incentives for performance based measures. Additional incentive opportunities are also available from Medicaid for safety net providers as shown in the table below.

	Private Practice	Non-FQHC Net	FQHC
Medicare HITECH Incentive	$48,000 per provider	$48,000 per provider	$48,000 per provider
Medicaid HITECH Incentive	-	$65,000 per provider	$65,000 per provider
e-Prescribing Bonus	2% Bonus	2% Bonus	2% Bonus*
Medicare PQRI	2% Bonus	2% Bonus	-
Medicare MCMP	$12,500 per provider	$12,500 per provider	-

*Awaiting Confirmation from CMS

Medicare Incentives for Hospitals:
Medicare incentives to hospitals are set up in a similar model as physicians, with a more complex calculation and bigger dollars tied to their meaningful use of certified EHR's. Incentives are calculated based on an initial amount ranging from $2 - 4.6 million (based on number of discharges) multiplied by a Medicare share and a declining "transition factor" for each of four years (1, .75, .5, .25).

The table below shows how Medicare incentives would work for a hospital with 10,000 annual discharges, 30 percent Medicare volume, and 10 percent charity care, depending on the starting year of incentive eligibility. Medicaid payments would be added to this amount, based on a formula similar to that used for Medicare, but focused on Medicaid volume share. At state discretion, the Medicaid hospital payout schedule can be different than that for Medicare.

Stimulus Medicare Incentives, per Hospital (example only, per numerical assumptions above)
Pay-Out Year
Start Date	2011	2012	2013	2014	2015	2016	Totals
2011	$1,256,733	$942,550	$628,367	$314,183	$0	$0	$3,141,833
2012		$1,256,733	$942,550	$628,367	$314,183	$0	$3,141,833
2013			$1,256,733	$942,550	$628,367	$314,183	$3,141,833
2014				$942,550	$628,367	$314,183	$1,885,100
2015					$628,367	$314,183	$942,550

Hospitals can take advantage of the STARK Safe Harbor which will allow the hospital to offset the costs associated with HIT systems like EHR for the physicians. Under the guidelines provided by the OIG and CMS, there are regulations that provide additional protections under the federal Anti-Kickback Statute and the Stark Act for certain nonmonetary arrangements among health care entities involving the donation of items and services for use in electronic health record ("e-record") and electronic prescribing ("e-prescribing") systems.

Eligible professionals and hospitals already using EHR will also qualify for incentives under the HITECH Act.

Penalties
There are Medicare reimbursement penalties that will be imposed for those providers who do not demonstrate meaningful use of an EHR by 2015. For 2018 and beyond, if proportion of eligible professionals who are meaningful users is less than 75%, percentage shall increase by 1% from percent in previous year but not be greater than 5%

Year	Medicare Penalty
2015	-1.0%
2016	-2.0%
2017	-3.0%

A penalty has also been defined for a lack of e-Prescribing starting in 2012.

Year	Bonus	Penalty
2009	2.0%	-
2010	2.0%	-
2011	1.0%	-
2012	1.0%	-0.5%
2013	0.5%	-1.0%
2014	-	-2.0%

Eligible Providers

Medicare Incentive	Medicaid Incentive
Doctor of medicine or osteopathy	Physicians
Doctor of dental surgery or medicine	Dentists
Doctor of podiatric medicine	Certified nurse-midwives
Doctor of optometry	Nurse practitioners
Chiropractor	Physician assistants practicing in an FQHC or RHC that is so led by a physician assistant

Selection and Implementation Timeline
Provider must allow 12–17 months

1 month practice workflow analysis and review of HIT solutions
2 - 3 months selection of HIT solution
3 - 6 months Implementation
3 months accessing clinical components and identifying data reporting requirements
2 months collecting and reviewing data
1- 2 months internal adjustments to improve results/ reporting data

Application Process
Go to https://ehrincentives.cms.gov/hitech/login.action
Complete implementation of existing or new EHR system is not required in order to register.
What you need for registration:

National Provider Identifier Number - you may obtain it from following website.https://nppes.cms.hhs.gov/NPPES/CreateLogin.do
An enrollment record in the Provider Enrollment, Chain and Ownership System (PECOS) https://pecos.cms.hhs.gov/pecos/login.do
CMS Identity & Access Management (I&A) User ID and Password (same as PECOS ID & Password)
Payee Tax Identification Number

When you are ready to attest to the “meaningful use” of the EMR system go to https://ehrincentives.cms.gov/hitech/login.action
The information you will need in order to complete the Attestation information:

EHR Certification Number
EHR Reporting period start date
EHR reporting period end date
If the data is extracted from all patient records or only from patient records maintained using certified EHR technologyr
The numerator and denominator values of the 15 core measure objectives. These values can be obtained from the reporting function of your EMR system