The HITECH Act and Meaningful Use Incentives for Physicians - Essay Example

The HITECH Act and Meaningful Use Incentives for Physicians The Health Information Technology for Economic and Clinical Health Act (HITECH Act or theAct) is a component of the American Recovery and Reinvestment Act of 2009 (ARRA). The HITECH Act aims to improve health care quality and to reduce health care costs through persuading hospitals and physicians to adopt an electronic health record (EHR) system before 2015 ends. An EHR system promotes timely and accurate exchange of health care information across providers and the implementation of a nationwide health care information infrastructure (Neclerio et al., 2009). The Act establishes incentive payments, under the Medicare and Medicaid programs, for providers who “meaningfully use” electronic medical record systems. It will also reduce incentive payments for low compliance and non-compliance in 2015 (Neclerio et al., 2009, p. 45). The Act offers particular incentives that hasten the establishment of EHR systems. The government gives higher incentives to physicians who have acted quickly in meeting government standards. It also provides additional incentives for physicians who furnish services in “health professional shortage areas” and physicians who provide services to predominantly Medicaid recipients. EHR system adoption is voluntary for physicians, but the government aims for its widespread and quick implementation, and so incentives are available only to early adopters who become meaningful users within five years (i.e. 2011 to 2015), wherein it gives the largest payments to the earliest adopters. Physicians can begin their adoption of an EHR system through contacting hospitals where they have affiliations, or contacting professional associations to determine vendors used in their service areas. Physicians who are meaningful EHR system users are eligible for Medicare incentive payments, from 2011 to 2015, “in an amount that is equal to an additional 75% of the allowed charge for professional services” of physicians “with the payments capped at maximum amounts of $18,000 per year for 2011 and 2012” and decrease every year afterwards (Neclerio et al., 2009, p. 46). To qualify for these incentives, physicians have to prove that they have achieved a “meaningful use” of an EHR system. “Meaningful use” refers to attaining three EHR system components: (1) using an EHR system that possesses e-prescribing capability, which attains existing U.S. Department of Health and Human Services (HHS) standards (e.g. physicians are already e-prescribing using federally-accepted standards); (2) connectivity with other health care providers to enhance access to the comprehensive view of a patient’s health history (e.g. using computerized workstations to determine the whole medical history of the patient without having to ask past doctors for health care history and assessment); and (3) the ability to report their use of an EHR system to the HHS (e.g. being capable of showing physicians’ history of EHR system use to the HHS) (Neclerio et al., 2009, p. 46). However, to be eligible for reimbursements under “meaningful use,” physicians must be in the list of what the Act considers as an Eligible Professional (EP). States have different lists for EPs, where they usually include physicians (e.g. MDs and DOs), Advanced Registered Nurse Practitioners (ARNPs), Certified Nurse-Midwives, Dentists, and Physicians Assistants (PA) (KASA Practice Solutions, 2014). Counselors, Therapists, or other Mental Health Professionals are not considered as EPs and will not get incentives through the “meaningful use” condition of the Act (KASA Practice Solutions, 2014). Majority of mental health professionals will not have access to incentive dollars that can promote the adoption of EHR or EMR systems in the mental health practice (KASA Practice Solutions, 2014). Furthermore, the HITECH Act enables further reimbursement of 10% for physicians who offer services in areas that the HHS designates as “health professional shortage areas” (Neclerio et al., 2009, p. 46). “Eligible professionals” who are early meaningful users of an EHR system (i.e. uses an EHR system by 2011) can receive the maximum Medicaid incentive payment of $48,400, when providing services in “health professional shortage areas” (Neclerio et al., 2009, p. 46). Those who do not furnish services in said areas can receive up to $44,000 for early use (Neclerio et al., 2009, p. 46). Moreover, if more than 30% of the physicians’ patients pay with Medicaid (or 20% of patients for pediatricians), they are eligible for payments of up to $64,000 for more than five years (Neclerio et al., 2009, p. 46). These incentives are based on a formula that depends on the particular Medicaid mix of the physicians’ patients and amounts that range from $25,000 in the first year to $10,000 in succeeding years (Neclerio et al., 2009, p. 46). Furthermore, not implementing an EHR system and not being meaningful EHR system users can lead to reduced Medicaid payments. Physicians who are not meaningful EHR system users in 2015 will receive lower Medicare payments, unless they get an exemption from the Secretary of HHS. The Secretary can exempt physicians who are undergoing reasonable significant difficulties. The EMR Mandate site explained how waiting for EHR system adoption worked: “If you decide to wait until 2014 as your first year to participate, the last reporting period is July-September 2014. You must begin your first 90-day reporting period no later than July 3, 2014” (Ahuvia, 2014). These incentives are scheduled to be finished by 2021, with the last year to register as “meaningful use” adopters in 2015 (KASA Practice Solutions, 2014). Physicians who are not meaningful users will experience a deduction in Medicare reimbursements of 1% to 3% every year. Through HHS authorization, reductions in the reimbursement rate can last until 2018 and beyond, if eligible professionals who are expected to be meaningful EHR users are less than 75%. The Act encourages prompt EHR system adoption for physicians through providing them financial benefits in terms of incentives. Physicians who are meaningful EHR system users are eligible for Medicare incentive payments from 2011 to 2015, an amount that can reach 75% more than what they charge with a cap of $18,000 for 2011 and 2012. Having more Medicaid patients and servicing in “health professional shortage areas” will result to additional incentives too. National Quality Strategy’s Goal and Priorities: Effects on Patients The National Quality Strategy (NQS) was first established in March 2011 and initially called the National Strategy for Quality Improvement in Health Care. The Agency for Healthcare Research and Quality (AHRQ) led its development, in behalf of the U.S. Department of Health and Human Services (HHS). The NQS has three goals and priorities, which will be explained further and with respect to their impacts on patients. The NQS aims to attain three broad goals that guide and evaluate local, state, and national efforts in enhancing health and quality of health care systems and services. The first aim is to attain better care through enhancing the “overall quality, by making health care more patient-centered, reliable, accessible, and safe” (AHRQ, 2014). An example is when doctors can access a patient’s medical history through the hospital’s electronic health record (EHR) system. The EHR system can help a patient’s new doctors understand his illness without having to go through past medical records manually, wherein manual records can also have documentation errors. Accessible and reliable EHR systems can increase patient safety and patient-centered care. The second aim of the NQS is to develop healthy people and healthy communities through boosting “the health of the U.S. population by supporting proven interventions to address behavioral, social and, environmental determinants of health in addition to delivering higher-quality care” (AHRQ, 2014). By proven interventions, they refer to evidence-based treatments that have a holistic approach to health care. For illustration, the physician will not only prescribe medicine, but recommend more exercise, such as walking 20 minutes or more every day, to reduce cardiovascular disease risks. Patients can benefit from receiving care that is not only reactive, but preventive, through receiving specific recommendations for diet and lifestyle changes, as part of their health care plan. The third aim of the NQS is “affordable care” through “[decreasing] the cost of quality health care for individuals, families, employers, and government” (AHRQ, 2014). One of the means of attaining affordable care is through the Health Information Technology for Economic and Clinical Health Act (HITECH Act or the Act) that reduces medical errors because physicians can make more accurate diagnoses through EHR systems, which results to precise treatments too. Instead of timely laboratory tests, access to a reliable EHR system can reduce costs through providing timely and valid diagnosis and treatments. Under the three aims of the NQS are its six priorities, the first of which is “[m]aking care safer by reducing harm caused in the delivery of care” (AHRQ, 2014). This priority reduces mortality and morbidity risks and rates through the existence of harm-reduction programs. An example is the Hospital Value-Based Purchasing program that allocates funds through performance metrics (Goodrich & Williams, 2014). These metrics gauge quality of care and provide lower payments for poor care standards (Goodrich & Williams, 2014). The second priority is “[e]nsuring that each person and family is engaged as partners in their care” (AHRQ, 2014). An example is the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) measure (Goodrich & Williams, 2014). It surveys patients after they have been hospitalized. The survey gives an opportunity for patients and health care providers to share experiences and feedback (e.g. on communication with doctors and nurses, hospital policies and environment, and others) (Goodrich & Williams, 2014). The second priority promotes patient engagement. The third priority is “[p]romoting effective communication and coordination of care” (AHRQ, 2014). An illustration is the Hospital Readmission Reduction program. It provides incentives for physicians and providers who reduce hospital readmission rates (Goodrich & Williams, 2014). The third priority encourages health care collaboration and the provision of the right and complete care and health education the first time to reduce readmission rates. The fourth priority is “[p]romoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease” (AHRQ, 2014). An example is the Physician Quality Reporting System, “a pay-for-reporting program for physicians,” and the Physician Value-Based Payment Modifier, “pay-for-performance program for physicians” (Goodrich & Williams, 2014). These measures focus on the leading causes of mortality through focusing on safety, patient engagement, and care coordination standards (Goodrich & Williams, 2014). The fifth priority is “[w]orking with communities to promote wide use of best practices to enable healthy living” (AHRQ, 2014). An example is when physicians, other providers, and hospitals collaborate with communities to encourage healthy living. The fifth priority reduces hospital readmissions and admissions altogether through devising community-based health education and health practices. The sixth priority is “[m]aking quality care more affordable for individuals, families, employers, and governments by developing and spreading new health care delivery models” (AHRQ, 2014). An example is the Physician Quality Reporting System (PQRS) program that provides incentives for health care delivery innovations (Goodrich & Williams, 2014). Patients benefit from constant medical innovations that continuously evaluate and develop care with respect to patients’ needs and in consideration of useful technological advances. The National Quality Strategy (NQS) has aims and priorities that emphasize the need for lifelong improvements on the human and technological systems that provide health care. These priorities emphasize reduction costs and community-based collaborations too. Moreover, they encourage collaboration among health care providers, so that they can meaningfully shape a new health care system that maximizes technological advancements for a more patient-centered health care industry. References Agency for Healthcare Research and Quality (AHRQ). (2015). About the National Quality Strategy (NQS). Retrieved from http://www.ahrq.gov/workingforquality/about.htm Ahuvia, M. (2014, February 20). HITECH Act ushers in tighter security for digital health records. Safenet. Retrieved from http://data-protection.safenet-inc.com/2014/02/hitech-act-ushers-in-tighter-security-for-digital-health-records/#sthash.5sbSbiKd.dpuf Goodrich, K., & Williams, J.M. (2014). Implementing the National Quality Strategy: 6 priorities for better healthcare. Medscape. Retrieved from http://www.medscape.org/viewarticle/820525_2 KASA Practice Solutions. (2014, March 4). Understanding EMR/EHR (Part II): Understanding the development of EMR/EHR and your practice. Retrieved from http://www.kasa-solutions.com/blog/development-of-emr-and-emr-systems/ Neclerio, J.M., Cheney, K., Goldman, C.M., & Clark, L.W. (2009). Adopting electronic medical records: What do the new federal incentives mean to your individual practice? Medical Practice Management, 44-48. Retrieved from http://www.duanemorris.com/articles/static/jmpm_0809.pdf Read More