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AAOS Now

Published 4/1/2009
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Howard Mevis

Government stimulus package includes EHR funding

Investigate before you buy to ensure a workable system

The Economic Stimulus Act of 2009, recently approved by Congress and signed into law by President Obama, includes $19 billion in grants and loans for infrastructure and incentive payments under Medicare and Medicaid for physicians who adopt certified Electronic

Health Record (EHR) technology. The grants and loans include $17 billion slated for incentives, with $2 billion allotted to jump-start health information technology (IT) adoption.

Although the funding has been appropriated, however, the implementation provisions have not yet been announced. The Department of Health and Human Services (HHS) must prepare regulations delineating who gets the funding and how it can be used and accessed. This process may take several months. Once the regulations are published in the Federal Register, orthopaedic surgeons will have a roadmap to applying for financial support to purchase new EHR technology.

What we currently know
The Act provides funding for physician practices to receive incentive payments totaling $44,000 per physician over 5 years. This amount represents a partial offset of the total cost of implementing EHR technology. Physicians who meet certain criteria, such as those who have a practice in an underserved rural region, may get additional funding support.

Other factors may affect the total incentive payment to a physician. For example, if a physician receives additional EHR funding support from a hospital—an allowable exception under the Stark regulations—the government funding may be reduced by an equal amount. The same is true if the state government provides any support.

In addition, the amount of money available depends on when the application for government support is received. The incentives start in 2011 and end in 2016. Waiting too long to apply for support reduces the likelihood of getting all the available incentives. In addition to Medicare-based incentives, the Act also includes Medicaid-based incentives.

Physicians who do not implement EHRs during this period will be subject to penalties. Physicians who do not adopt a certified EHR by 2015 would receive a 1 percent reduction in Medicare payments; the penalties increase to 3 percent over the next three years.

The Act requires HHS to define meaningful use; this definition will be part of the final published regulations. The regulations will likely include EHR certification standards and implementation specifications, too. As a result, many advisors are saying to wait for the regulations if you want to seek government funding support. Today’s EHR technology may not meet the standards and specifications prescribed by HHS. Additional certification standards are expected from the Certification Commission for Healthcare Information Technology (CCHIT), but whether HHS will use the CCHIT standards is not yet known.

Do your homework now
While you are waiting for the government to sort out and publish the rules, you can take several steps to prepare for the transition to EHR technology. Many orthopaedic surgeons have no idea of how long it takes to select, implement, train staff, and start using an EHR.

You can start by reviewing the Academy’s Electronic Medical Record Primer, released in 2007, and by listening to the complementary audio program. Both are available free to members at the Academy’s online Practice Management Center (www.aaos.org/pracman).

Using this information, you can begin to evaluate the technology. The centerpiece of the Primer is a set of 56 questions that your potential vendor should answer before you make a purchase.

An EHR should include the following capabilities:

  • electronic record of health-related information on an individual that includes patient demographic and clinical health information
  • clinical decision support
  • physician order entry
  • capture and query information relevant to healthcare quality
  • patient health information exchange with other sources (such as hospitals or other medical practices)

Avoiding mistakes
Companies that sell EHR technology may try to exploit the Economic Stimulus Act as part of the selling process. Consultants with expertise in EHR technology may seek to leverage the provisions to gain engagements. A great deal has already been written about this portion of the economic stimulus package, and more is sure to come in healthcare-related newsletters and magazines.

Using this time to learn about EHR technology and how it can affect your practice will help you avoid costly mistakes in the future. It is time to do your homework.

Howard Mevis is director of the AAOS department of electronic media, evaluation programs, course operations, and practice management. He can be reached at mevis@aaos.org