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EHR Stimulus Money (ARRA)

How much EHR Stimulus Money?

ARRA – HITECH Act – EHR StimulusEstimated $19.5 Billion Spent on Stimulus

$2 Billion for Office of National Coordinator (ONC) $36.3 Billion for Medicare and Medicaid Incentives Savings of $18.8 Billion

Improved Efficiencies Tax Revenue Reduce Fee Schedule Payments from Penalties

Medicare or Medicaid Bonuses

Medicare EHR Stimulus Incentives

$44,000 per Provider

Actual EHR Stimulus Amount - Medicare

75% of Medicare Allowable Charges $24k Medicare Charges = $18k in EHR Stimulus $13.3k Medicare Charges = $10k in EHR Stimulus

Medicare Penalties 2015 - 1% 2016 - 2% 2017 - 3% 2018 - 4% (HHS Secretary Option) 2019 - 5% (HHS Secretary Option)

Medicaid EHR Stimulus Incentives

$63,750 per Provider

Medicaid Details

More Complicated ProcessReimbursement is Percentage of EHR

expendituresExtended Time Horizon (through 2021)Must Demonstrate 20-30% of Patients are

Covered by MedicaidMust Show “Meaningful Use”GW Study

15% of Physicians Qualify 99% of Federally Qualified Health Centers (FQHC) 45,000 Office Based Physicians

Lies EHR Vendors Use

EHR Sales Lines

Move quickly…EHR deployment back-log!You won’t be ready to show “meaningful

use!”The government requires you buy an EMRSimply buy a CCHIT-certified product

2 Main Requirements

“Meaningful Use”“Certified EHR”Challenge

Still Only Partially Defined

Meaningful Use Matrix

Measures Improve quality, safety, efficiency and reduce health

disparities Engage patients and families Improve care coordination Improve population and public health Ensure adequate privacy and security protections for

personal health informationRequirements Increase Over Time

Provide Patients e-copy of Data (2011) Real Time PHR Access (2015)

EHR Certification

CCHIT Only Current EHR Certification

Other EHR Certifications?

“ Many certified EHRs are neither user-friendly nor designed to meet HITECH's ambitious goal of improving quality and efficiency in the health care system.“ - Dr. David Blumenthal, NEJM April 2009

Proposed CCHIT Certification Paths

EHR-C EMR Company Certification

EHR-M “Module” Certification

EHR-S Site Certification

Cost of Certified EHR

EHR Matrix of Prices Average for Certified EHR - $30,690.80 Average for Non-Certified EHR - $17,066.00

Cost of EHR Certification $20-30k

Cost of Extra Development One EMR Vendor Estimated $200,000 in Development

CostsMany Unnecessary Requirements

Problems with CCHIT Certification

More Successful Installs – Where’s the proof?De-install Rate is LargeStability of Certified EHR Vendors

Jabba the Hut EMR Companies

Timelines

6/16/09 – Meaningful Use Matrix7/16/09 – HIT Policy Committee Presents

Next Revision of Meaningful Use“Meaningful Use” Implementation Guide in

July7/21/09 – HIT Standards Committee Presents

Standards and Certification CriteriaInterim Final Rule by December 31st

Lessons Learned from Past Incentives

PQRI, P4P and ePrescribing Only 52% of participants got paid Only $600 per individual participating Only 2 of the 10 made a profit Not notified of problems for years

Scenarios

Guaranteed EHR Benefits

Legibility of NotesAccessibility of ChartsNo More Lost ChartsMultiple Users Accessing ChartDisaster RecoveryDrug to Drug and Allergy Interactions

EHR Pricing Models

One Time Cost Plus Annual MaintenanceMonthly Cost Per ProviderCost Per VisitFree EMR

Online Resources

EMR Forum http://www.emrupdate.com

Selecting an EMR http://www.emrconsultant.com

My Website http://www.emrandhipaa.com

Regional EHR Training Centers?

Counsel and Advice

Implement EHR That Fits Your Clinic

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Questions?