Will you get reimbursement for the purchase of an EMR or EHR?

Like all good government programs the reimbursement program for a physician buying an electronic medical record (EMR,) also called an electronic health record (EHR,) will depend on meeting the funding criteria demonstrated through some kind of application process. Seems simple enough but the following is a point form outline of how the “devil is in the details.”

• Meaningful use has yet to be defined. The preliminary definition was released in June, the first draft is expected the end of September and the final definition late in the first quarter or the second quarter of 2010. In the the initial draft it is proposed that to be considered a meaningful user, the user NOT the EMR qualifies in that “practices should be able to maintain electronic medication and allergy lists, record vital signs, and incorporate lab results.” The Health IT Standards Committee was recommending 31 standards for performance and data capture by a provider to demonstrate meaningful use.

• Electronic health record products need to be “certified.” It has been recommended by the policy committees that certification should be allowed by multiple organizations. The recommendation essentially validates criticism of the conflict of interest charges by the Certification Commission for Healthcare Information Technology (CCHIT.) CCHIT, EMR vendors, EMR consultants or any other body can not guarantee any EMR product as capable of meaningful use as no meaningful use definition is settled. The process to be recognize as a certification entity appears scheduled for release in October. It is scheduled to be finalized December 31. Again, for emphasis,while an EMR may permit “meaningful use” it is the provider who qualifies for “meaningful use.”

• States, for Medicaid, are the recipients of the stimulus funds which they are then responsible to reimburse doctors who are using EMRs in a “meaningful way.” The definition of a meaningful way for the states means EMR technology that is certified and interoperable with state or federal administrative management systems. The CMS emphasizes, ?States risk making unallowable incentive payments prior to receiving guidance on how to make these systems compatible.? This makes impossible deadlines to meet the “meaningful way”criteria and the reimbursement requirements criteria. Further refinement to either may correct this problem.

• “Meaningful use” seems now to include not just the ability to share patient data but the requirement to share patient data into large regional and / or state server farms. The HITECH Act amends Title XXX of the Public Health Service Act by establishing the Health Information Technology Extension Program. This program requires 70 regional or state entities to act as central databases to which EMRs must be able to connect. In other words the EMR must be an extension of a government controlled patient database. The timetable for these to be operational is December 2010. As there is no protocol for physical data exchange, privacy and security even being discussed, it is likely each of these entities will chose one EMR and then promote it as “the” solution. The 70 will likely cover nearly all Medicare / Medicaid patients nationwide.

• The reimbursements are only for providers with “significant” Medicare and Medicaid patient rosters. For Medicaid they must be non-hospital based providers with 30 percent Medicaid volume or pediatricians with 20-30 percent Medicaid patients, or in Federally Qualified Health Clinics (FQHCs) or rural clinics with 30 percent ?needy patient? volume. There does not seem to be a guidance with Medicare yet but it is likely to be the same.

• Reimbursement amounts have been calculated variously with some at a maximum of $48,400 for Medicare and $65,000 for Medicare for those who can report by 2012, which generally means installation by early in 2011. Those who install early in 2011 will not receive more but can collect some earlier. The least that can be collected is variously reported as $24,000 and $35,000 for Medicare for reporting in 2014, which means installation probably no later than early 2013. For Medicaid the full amount can be collected only but with the reporting date 2016, a early 2015 installation. Penalties of 1% of eligible billings start in the 2015 reporting year and up to 3% in the 2017 reporting year.

• The Secretary of Health is required to adjust any reimbursement downward at discretion to maintain that only an average of 85% of provider EMR purchase costs are covered. This also seems to indicate that receipts and invoices may be required as not the full cost will be covered. It could also mean that if a significant number of cheaper EMRs are installed those on the expensive side will not get the money expected. Expensive EMR systems may not be significantly reimbursed.

• Reimbursement will be tied to reporting. This will require reporting on all patients in a practice to meet the Medicare / Medicaid percentage of total patients. It is likely to include some granularity in the visit, diagnosis and treatment of those patient populations. Granularity will mean provider EMR input. This requirement is to ensure that an EMR must be used, installing and not using or using only certain features of an EMR will not qualify the provider for a reimbursement.

The bottom line is only primary care physician’s with a 30% Medicare or Medicaid patient load should consider the Stimulus fund’s EMR reimbursement in a purchase decision. Primary Care physicians applying under Medicaid should wait until their States determine a process. For these Medicaid providers there is no penalty in amounts finally collected up to a January 2015 installation date. Qualifying Medicare providers should install no later than January 2011 for full reimbursement but at least $24,000 can be claimed if an installation no later than January 2013.

Like non-qualifying providers value should be found in the EMR itself apart from any reimbursement. The reimbursement amount is small in comparison to years of lost income value. The bad taste of a purchase gone wrong will last a lot longer than savoring the reimbursement in the moment.