The United States government thrust healthcare into the national spotlight with the Health Information Technology for Economic and Clinical Health (HITECH) Act in its landmark legislation, The American Recovery and Reinvestment Act of 2009 (ARRA). The HITECH Act creates sweeping programs that aim to improve the health of Americans along five healthcare priorities:

• Improve the quality, safety and efficiency of care while reducing disparities
• Engage patients and families in their care
• Promote public and population health
• Improve care coordination
• Promote the privacy and security of electronic health records

The act uses the existing payment structures of Medicare and Medicaid to incent and penalize participating providers based upon their attainment of key objectives for the Meaningful Use of a certified EHR.

The legislation made permanent new arbitration bodies such as the Office of the National Coordinator for Health Information Technology (ONC) and grew the power of existing bodies like the Centers for Medicare & Medicaid Services (CMS) by placing accountability for defining and implementing its provisions with them. On July 13, 2010, these organizations announced the final rules to implement the EHRs incentive program under the HITECH Act.

There are two important considerations when trying to interpret Meaningful Use. The first is the requirements the health professional or care delivery organization must meet. The Final Rule specifies the objectives that providers must achieve in payment years 2011 and 2012 to qualify for incentive payments.

The second component to consider is the technology used by the provider. The ONC regulations specify the technical capabilities that EHR technology must have to be certified and to support providers in achieving the “Meaningful Use” objectives.

Eligible Hospitals: Must utilize a certified EHR to capture, calculate and report on existing Reporting Hospital Quality Data for Annual Payment Update (RHDQPAU) measures in addition to published measures in the Final Rule including stroke, emergency department throughput, and VTE measures in 2011.

Eligible Providers: Must utilize a certified EHR to capture, calculate and report on two groups of Physician Quality Reporting Initiative (PQRI) measures in 2011. The two groups are core measures applicable across all providers and one specialty group of measures.

Physician Practice: Learn more about achieving Meaningful Use for your practice.

Additional Resources:

The Centers for Medicare & Medicaid Services (CMS)

The Office of the National Coordinator for Health Information Technology (ONC)

Certification Commission for Health Information Technology (CCHIT)

The U.S. Government has laid out a methodology outlining three stages in which providers must successfully show a prescribed use of a certified EHR to meet both quality-of-care metrics and system-adoption metrics. Regulators considered the industry’s current level of technology adoption and expected returns from increased technology adoption to create the staging methodology for requirements and the timing of incentives and penalties. Their design encourages early adoption of certified technology and rapidly increasing the depth of usage over time.

Providers’ attainment of a stage’s requirements equate to Meaningful Use of an EHR thereby qualifying the provider for a bonus to their Medicare or Medicaid reimbursements. Failure to meet or continue to meet the required stage of Meaningful Use for a given year will result in the provider incurring a monetary penalty or possibly losing their full Medicare or Medicaid reimbursement.

Current legislation details the requirements an eligible hospital or EP must meet to attain Stage 1, as well as, the timeframe in which they have to begin participating in the program to obtain full incentives. While this may seem straight forward, the US Government has not yet indicated in what year eligible hospitals and EPs can expect to begin to incur penalties for failure to participate in the program or meet Meaningful Use criteria. Until requirements for Stages 2 and 3 have been finalized, the available reaction time for both vendors of certified EHR technology and eligible hospitals and EPs to create and update existing systems with the subsequent requirements beyond Stage 1, will be shortened.

Based on the currently released standards, providers can enter the Meaningful Use program at Stage 1 until fiscal year 2014, which runs from Oct. 1, 2013-Sept 30, 2014 for eligible hospitals and the 2014 calendar year for EPs. Organizations can attest to Stage 1 Meaningful Use criteria for two program years as long as they have entered the program by federal fiscal year 2013 (Oct.1, 2012-Sept. 30, 2013 for eligible hospitals or calendar year 2013 for EPs.) It is important to note that regardless of the year in which a provider enters the Meaningful Use program, the certified EHR technology must be the most current certified version available for the year of attestation. In effect, delaying attestation does not delay the project work necessary to remain on the most current certified version of any vendor’s software.

To begin receiving incentives for the investment your organization/practice has made to become meaningful users of certified electronic health record technology, you must enroll in an incentive program through Medicare or Medicaid. Some organizations will qualify for both programs, so please visit the CMS website for further detail.

If you're a Cerner client, a more indepth view of Payment Models is available.

As a service to our clients, Cerner has established an electronic medical record (EMR) financing program that will assist clients in aligning their EMR system costs with potential stimulus incentive reimbursements.

The financing program contains both payment deferrals and step-payment structures as options outlined below for both eligible professionals and hospitals.

Financing Options for Hospitals

Up to 12 months of payment deferral, followed by six months of interest-only payments.
Payments then remain fixed for the remaining term of the financing contract.

*Nothing stated above constitutes an offer or commitment for any sale, purchase or financing transaction. Such transactions are subject to credit and other approvals at Cerner and/or the financing bank in addition to the execution of mutually acceptable documentation.

Offerings

In addition to conferences and educational opportunities available to all clients, Cerner offers a variety of services in the area of regulatory compliance:

Workshop

The workshop is a one-day event held at your organization. The workshop provides an executive overview of Meaningful Use and healthcare reform at a federal level. Our team will deliver thorough discussion related to Stage 1 Meaningful Use objectives, their measurements, and key takeaways. As Stage 2 Meaningful Use objectives are further developed, the workshop will expand to include a deeper analysis as preparation for Stage 2 -intensifies over Stage 1.

Readiness Assessment

The assessment includes functional report configuration and gap analysis. The analysis will measure your organization’s current state against all Meaningful Use objectives and isolate risks using detailed data analysis.

Monitoring and Reporting

This offering evaluates your reporting needs, identifies gaps for the Practice Manager driving mitigation plans and drives reporting and attestation strategy.

Task Force Participation

A Cerner Regulatory Compliance consultant is placed on your Meaningful Use Task Force as a subject matter expert and as a participant but not as the driver or chair. The Cerner team sits on the Task Force to help develop its Meaningful Use compliance program, and the steps needed to help meet Meaningful Use Stage 1.

1. What are the ARRA and HITECH Acts?
2. In relation to certified EHRs, who has been recognized by Health and Human Services (HHS) to be a certifying body?
3. Has Cerner received EHR certification?
4. What does Cerner’s certification mean?
5. What is Meaningful Use?
6. What are the criteria for Meaningful Use?
7. Who is an Eligible Provider (EP) under the Medicare EHR Incentive Program?*
8. Who is an EP under the Medicaid EHR Incentive Program?*
9. What is an Eligible Hospital under the Medicare EHR Incentive Program?
10. What is an Eligible Hospital under the Medicaid EHR Incentive Program?

*For more detailed information and answers to your questions, please visit the Centers for Medicare & Medicaid Services (CMS) website or contact your Cerner representative anytime.

What are the ARRA and HITECH Acts?

ARRA stands for the American Recovery and Reinvestment Act of 2009 (ARRA), which is a stimulus bill created to help the United States economy recover during a recession. A portion of ARRA was dedicated to investing in health information technology (HIT), which, according to current estimates, reports that as much as $27 billion over the next decade will be expended to support adoption of electronic health records (EHRs).

HITECH stands for the Health Information Technology for Economic and Clinical Health Act (HITECH Act). Under the HITECH Act, federal incentive payments will be available to doctors and hospitals when they adopt certified EHRs and demonstrate Meaningful Use with their HIT.

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In relation to certified EHRs, who has been recognized by Health and Human Services (HHS) to be a certifying body?

The Certification Commission for Healthcare Information Technology (CCHIT), Drummond Group Inc., InfoGard Laboratories, SLI Global Solutions, and ICSA Labs have been named as certifying bodies for EHRs.

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Has Cerner received EHR certification?

Cerner received complete EHR certification for both the eligible hospital and eligible provider (EP) incentive programs for Millennium® 2007.09.12 from the Certification Commission for Health Information Technology (CCHIT®), an Office of the National Coordinator for Health Information Technology - Authorized Testing Certification Bodies (ONC-ATCB).

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What does Cerner’s certification mean?

The ONC-ATCB 2011/2012 certification program tests and certifies that EHR technology is capable of meeting the 2011/2012 criteria approved by the Secretary of Health and Human Services (HHS). The certifications include Complete EHRs, which meet all of the 2011/2012 criteria for either EP or eligible hospital technology and EHR modules, which meet one or more – but not all – of the criteria.

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What is Meaningful Use?

At high level, an eligible provider (EP) or eligible hospital must achieve a series of set stages* through your certified EHR, with the ability to:

• Use a certified EHR in a ‘meaningful’ way, such as e-prescribing;
• Improve the quality of care through the exchange of health information to improve quality of healthcare;
• Use a certified EHR to submit clinical quality and other measures

*These stages are subject to changes determined by future rule making.

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What are the criteria for Meaningful Use?

The criteria for Meaningful Use will be staged in three steps over the course of the next five years. Stage 1 (2011 and 2012) sets the baseline for electronic data capture and information sharing. Stage 2 (expected to be implemented in 2013) and Stage 3 (expected to be implemented in 2015) will continue to expand on this baseline and be developed through future rule making.

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Who is an Eligible Provider under the Medicare EHR Incentive Program?*

• Doctor of medicine or osteopathy
• Doctor of dental surgery or dental medicine
• Doctor of podiatry
• Doctor of optometry
• Chiropractor

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Who is an Eligible Provider under the Medicaid EHR Incentive Program?*

• Physicians (primarily doctors of medicine and doctors of osteopathy)
• Nurse practitioner
• Certified nurse-midwife
• Dentist
• Physician assistant who furnishes services in a Federally Qualified Health Center or Rural Health Clinic that is led by a physician assistant

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What is an Eligible Hospital under the Medicare EHR Incentive Program?

• "Subsection (d) hospitals" in the 50 states or DC that are paid under the Inpatient Prospective Payment System (IPPS)
• Critical Access Hospitals (CAHs)
• Medicare Advantage (MA-Affiliated) Hospitals

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What is an Eligible Hospital under the Medicaid EHR Incentive Program?

• Acute care hospitals (including critical access hospitals and cancer hospitals) with at least 10 percent Medicaid patient volume
• Children's hospitals (no Medicaid patient volume requirements)

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