What’s in it for Me?
What the Health Care Stimulus Package Can Do For Your Practice
Of the $787 billion in the American Recovery and Reinvestment Act of 2009, approximately $150 billion is directed toward health care. This article reviews the impact of the stimulus package specifically for physician practices.
On February 17, 2009, President Obama signed into law H.R. 1, the American Recovery and Reinvestment Act (ARRA) of 2009, also known as the Economic Stimulus Package. Of the $787 billion in the ARRA, approximately $150 billion is directed toward health care. These funds benefit the health care industry in general, and physician practices in particular. In this article, we will review the stimulus package impact in four areas: electronic health records, privacy provisions, e-prescribing and Physician Quality Reporting Initiative (PQRI).
Electronic Health Records, iEHR Incentives
If you have been contemplating implementing an electronic health record system, now may be the time. The Health IT component of the Bill, known as the HITECH Act, appropriates $19.2 billion dollars to encourage the adoption of electronic health records. It is believed electronic health records will enhance quality of care and care coordination, decrease duplication of services, decrease medical errors and, ultimately, provide practice cost savings.
Eligible physicians are defined as medical doctors, dentists, podiatrists, optometrists and chiropractors, and can be reimbursed up to $44,000 over five years for adopting a certified iEHR and using it in a “meaningful” way. Physicians providing care in a designated health professional shortage area may receive an additional 10 percent. The legislation outlines three requirements:
• The electronic health record must be certified and meet the requirements of electronic prescribing. This provides an additional 2 percent incentive.
• The eligible provider must submit clinical quality measures; this can provide an additional 2 percent incentive bonus.
• The electronic health record must be able to exchange health information; the specifics have yet to be defined.
Providers who choose not to implement an electronic health record may see a reduction in payment from Medicare, starting with a 1 percent reduction in 2015, a 2 percent reduction in 2016 and a 3 percent reduction in 2017 and beyond.
Electronic prescribing, also known as e-prescribing, is the electronic submission—using a computer or hand held device—of a prescription to the patient’s pharmacy of choice. It also gives the pharmacist or physician the ability to see the patient’s drug benefits and medication history prior to prescribing a medication. E-prescribing has the following benefits: creates a safer, more secure process when prescribing for patients, decreases medication errors, improves patient compliance in filling the prescriptions, increases efficiency between the physician’s office and pharmacy and improves cost utilization due to the accessibility of drug formulary and benefit information.
Eligible providers will receive 2 percent incentive payments in 2009-2010. This is 2 percent of the total estimated allowed Medicare charges submitted for all covered professional services provided from January 1, 2009, to December 31, 2009. To qualify for the incentive payments, a provider must report the e-prescribing quality measure PQRI #125 at least 50 percent of time. To review this measure, visit:
Providers who choose not to e-prescribe will see a reduction in payment from Medicare. Payments will decrease by 1 percent in 2012 and 2013, and 2 percent in 2014 and beyond. Providers can continue to report PQRI measure #125 for e-prescribing even after it is no longer identified as “eligible” in 2008. Providers are eligible to receive a maximum benefit of 4 percent for e-prescribing and PQRI participation.
Physician Quality Reporting Initiative (PQRI)
We have all heard of Physician Quality Reporting Initiative, also known as PQRI. The time period for PQRI reporting has been extended through December 31, 2010. Providers can report for the full 12 months or a six month period, July 1, 2009, through December 21, 2009. Bonus incentives have increased from 1.5 percent to 2 percent.
Providers can participate by reporting via claims or through a medical registry on at least three PQRI measures on 80 percent of the applicable Medicare patients. The PQRI measures, along with tools for implementation can be found at:
Accounting for Disclosure of Patient
Information—The legislation has recently made numerous changes to the privacy and security rules for the Health Insurance Portability and Accountability Act (HIPAA). Practices using iEHR, such as those using paper charts, must track all disclosures of patient information, whether it is for continuum of care, payment or health care operations. This disclosure list must be readily available to patients upon request. Patients have the right to ask for their disclosure list for three previous years. For practices that have an iEHR as of January 2009, compliance date for accounting for disclosures is January 1, 2014. For those practices that implement an iEHR after January 1, 2009, the date of compliance is the date that the iEHR was implemented or January 1, 2011, whichever is later.
The privacy and security rules are now applicable to all business associates. Business associates are now subject to the same criminal and civil penalties as are the covered entities for the disclosure of personal health information (PHI).
Notification of Breach Mandate—This mandate requires the practice to notify each patient, or their next of kin, by letter within 60 days of the breach of their personal health information. If more than 10 patients’ PHI was breached, the practice must post information related to the breach on their website. If the breach affected more than 500 patients, the practice should disclose the breach to local media and inform HHS of the breach immediately.
Privacy Penalties—There are four proposed tiers of penalties for breach of confidentiality of personal health information. These penalties range from $100 for each violation to $50,000 for each violation, depending on the severity of “willful” neglect. It is anticipated that the final regulation will be published in July 2010 with penalties being imposed on or after January 1, 2011.
Although there are opportunities for incentive bonuses, the mechanism to file for the various bonuses has yet to be defined by CMS. We will continue to monitor provisions made by legislation to identify the mechanism to file for incentive bonuses and share developments in future newsletters.