Who Is Eligible?
Eligible Providers (EPs) can choose to get money from CMS based on either their Medicare collections or their Medicaid patient volume, but not both.
For those applying for Medicare incentives, which are based on your annual Medicare collections, eligible providers are any doctor (MD, DO, DPM, OD, DC) or dentist (DDS, DMD, DDM) who performs at least 90% of their clinical services in an office-based setting (e.g., not an inpatient hospital or emergency room).
The potential Medicaid incentives are higher, but so are the requirements. The Medicaid incentive is based on the percentage of your patients who are on Medicaid. Eligible Providers for this incentive program must be an MD, DO, CNM, NP, and certain PAs (and dentists) who performs at least 90% of their clinical services in an office-based setting AND whose patient mix include at least 30% Medicaid beneficiaries. Pediatricians can qualify if their patient mix contains at least 20% Medicaid beneficiaries, and EPs at Federally Qualified Health Center (FQHC) or Rural Health Center (RHC) can qualify if 30% of their patient mix are people in need – defined as patients who have Medicaid, receive uncompensated care, or for whom charges are adjusted on a sliding scale.
How Much Money Are We Talking About?
Let’s be frank, this incentive money being used to encourage providers to adopt EHR technology and use it “meaningfully,” is long overdue given the chronically poor reimbursements from Medicare and Medicaid. So while the dollar amount seems significant, don’t get too excited. There is always a chance the funding will be removed as our economy and political landscape ebbs and flows.
Medicare incentive program: If you are an EP who uses an ONC-ATCB Certified EHR in a meaningful way (defined later), you can receive up to 75% of your annual Medicare collections, or $44,000 – whichever is less. For example, if you collect $24,000/year (or more) in Medicare payments then you may receive the maximum of $44,000 over 5 years:
$18,000 in 2011 or 2012 (or 75% of your Medicare collections, whichever is less)
$12,000 the next year (or 75% of your Medicare collections, whichever is less)
$ 8,000 the year after that (or 75% of your Medicare collections, whichever is less)
$ 4,000 the year after that (or 75% of your Medicare collections, whichever is less)
$ 2,000 the year after that (or 75% of your Medicare collections, whichever is less)
= $44,000 total from Medicare.
As long as you get going sometime in 2011 or 2012, you can get the full available amount as shown below providing you collect at least $24,000/year from Medicare:
|Max Payment in 2011||$18,000||$0||$0||$0||$0|
|Max Payment in 2012||$12,000||$18,000||$0||$0||$0|
|Max Payment in 2013||$8,000||$12,000||$15,000||$0||$0|
|Max Payment in 2014||$4,000||$8,000||$12,000||$12,000||$0|
|Max Payment in 2015||$2,000||$4,000||$8,000||$8,000||$0|
|Max Payment in 2016||$0||$2,000||$4,000||$4,000||$0|
|Maximum 5 year Payment||$44,000||$44,000||$39,000||$24,000||$|
Keep in mind, however, if you collect less than $24K/year from Medicare, you get less. For instance, if you collect $10,000/year from Medicare, this is how your compensation might look:
$ 7,500 in 2011
$ 7,500 in 2012
$ 7,500 in 2013
$ 4,000 in 2014
$ 2,000 in 2015
= $28,500 total
Although significantly less, $28,500 is still nice. What is even nicer, is that since this money is not related to the price of your EHR, Amazing Charts users get to keep this government stimulus money, rather than pass it on to one of our overpriced competitors.
This EHR incentive money is the carrot being fed to eligible providers. The stick that will slap those of us who fail to use this technology appropriately is a 1% reduction of the Medicare fee schedule starting in 2015. This penalty increases to 2% in 2016 and 3-5% in 2017.
Medicaid incentive program: To receive the Medicaid EHR incentive money, an EP must have a practice composed of a minimum percentage of Medicaid patients as detailed above. The payments for Medicaid are:
$21,250 in year 1
$ 8,500 in year 2
$ 8,500 in year 3
$ 8,000 in year 4
$ 8,500 in year 5
$ 8,500 in year 6
= $63,750 total from Medicaid
(There are no penalties for failing to adopt an EHR in the Medicaid program.)
So What is Meaningful Use?
Unfortunately, it isn’t as easy as just owning or using an EHR. One must show they are using this technology “meaningfully.” So the government has spent tons of time and money defining what this means, and have come up with 25 meaningful use objectives. To qualify for money, 20 of the 25 must be met. Here are some examples of these requirements:
- More than 30% of unique patients with at least one medication seen by the eligible provider (EP) must have been prescribed electronically, and more than 40% of all permissible prescriptions must be transmitted electronically using certified EHR technology.
- The ability to implement electronic drug-drug and drug-allergy interaction checking must be enabled for the entire reporting period.
- More than 50% of the unique patients seen by the EP must have a preferred language, gender, race, ethnicity, and DOB documented as structured data.
- And a whole bunch more discussed here.
There are also Clinical Quality Measures that must be met such as BP measurements, assessment of tobacco use, etc. All of the objectives and how they are measured and reported are detailed here, and full details on all these CMS incentive programs can be found at the CMS EHR Incentive Program website.