Many confuse the American Recovery Act incentive program for Meaningful Use of a certified electronic health record system with the Affordable Health Care Act of America, which is being reviewed by the Supreme Court. Since 2003 there have been several Federal and some State laws and regulations that are already in effect and require the use of Electronic Healthcare Records and Prescriptions. These are required and many are confused that they are part of Obama Care.
Even though the requirements are focused on Medicare it is clear that all insurance programs will require a “paperless” electronic system. In addition, having these systems will enhance the quality, efficiency and reduce the costs of providing healthcare. The key is getting started now and enhance your abilities to lead and manage with these tools, as well as taking advantage of the incentives being provided and avoiding the penalties in several of the programs.
There are four key programs to understand and address. This illustrates the program and the underpinning Federal Legislation:
· Electronic Prescribing (eRX) Program
Law: Section 132 Medicare Improvements for Patients and Providers Act 2008 (MIPPA)
· Physician Quality Reporting System (PQRS)
Law: Medicare Medicaid & SCHIP extension Act of 2007 (MMSEA)
· Electronic Health Record (EHR) Incentive Program
Law: Recovery Act & HITECH Act of 2009
· Primary Care Incentive Program (PCIP)
Law: Patient Protection and Affordable Care Act of 2010 (PPACA) (ObamaCare)
Medicare Improvements for Patients and Providers Act 2008 (MIPPA)
This initiative provides a bonus in 2012 and 2013 for those who use electronic prescribing systems which
1. Generate a complete active medication list incorporating electronic data received from applicable pharmacies and pharmacy benefit managers
2. Select medications, print prescriptions, electronically transmit prescriptions and conduct all alerts
3. Provide information related to the availability of lower cost, therapeutically appropriate alternatives.
Effective October 6, 2011, physicians are allowed to use a certified EHR system to ePrescribe under the Medicare ePrescribing incentive and penalty program. The law that established ePrescripton incentive program requires a penalty phase for eligible physicians who do not ePrescribe during 2012 through 2014. The Medicare penalty ranges from 1% to 2% by 2014. The incentive ranges from 1% in 2012 to 0.5% in 2013.
Medicare Medicaid & SCHIP extension Act of 2007 (MMSEA) This is a “pay for performance program” that requires participating providers to choose quality measures. The Physician Quality Reporting program requirements and measure specifications differ from one year to another and it is the responsibility of each provider to use the current year requirements. Visit: www.cms.gov.
Providers that meet the required measures successfully will receive a bonus of half one percent (0.05%) for their professional, fee-for service Medicare allowed charges in 2012. An additional half percent is available to participants in government-designated maintenance of certification programs, which are available through several qualifying medical specialty societies.
Recovery Act & HITECH Act of 2009
This program provides incentives to those participating in Medicare and Medicaid. Medicare participants can get up to $44,500 and Medicaid $63,750 over multiple years if they fulfill the Government’s criteria for demonstrating “meaningful use of a certified EHR system”. In December, 2011, the government announced that the second stage of meaningful use is delayed until 2014. This gives those providers with EHRs another two years to operate their systems and adjust to compliance with current meaningful use rules, as well as giving new adopters a little more time to adopt the requirements.
Patient Protection and Affordable Care Act of 2010 (PPACA) - Commonly called “ObamaCare”
The Affordable Care Act provides a 10 percent bonus payment on top of the fee schedule payments for select primary care services furnished by primary care physicians in calendar year 2011-2015. To qualify for the bonus, a physician must be self-designated in a primary care specialist. This program which is part of the Patient Protection and Affordable Care Act of 2010 (PPACA) Obama Care encourages Accountable Care Organizations (ACO) to invest and use electronic healthcare records and practice management systems by giving double credits for these systems.
All of these programs can be found on the CMS website (www.cms.gov) and many are discussed and explained on our site www.enabledoc.com. Contact us to learn how our systems will allow you to capitalize on the incentives, avoid penalties and improve your practice of healthcare management.