Health insurers and organizations are backing the U.S. Department of Health and Human Services and its newly issued regulations for implementing the Medicare and Medicaid electronic health records (EHR) incentive programs.
The Medicare and Medicaid EHR incentive programs are part of the Health Information Technology for Economic and Clinical Health Act (HITECH) of 2009, which, in turn is part of the American Recovery and Reinvestment Act signed into law in 2009.
The EHR provision authorizes Medicare and Medicaid to distribute $18 billion in incentive payments to physicians and hospitals that are meaningful users of EHR systems.
Last week, the Centers for Medicare and Medicaid Service (CMS), an arm of HHS, sent an 864-page draft of the final rule for the "Medicare and Medicaid Programs; Electronic Health Record Incentive Program" to the Office of the Federal Register for publication.
HHS also sent the Federal Register office a 228-page final rule relating to "Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology."
Both rules will help create a set of standards for implementing the first of a three-stage plan to shift to EHR systems. Regulators are expected to use the criteria to determine whether providers are making enough "meaningful use" of EHR systems to qualify for incentive payments.
Meaningful Use Standards
CMS says that the requirements for meaningful use incentive payments will be implemented over a multi-year period, in which additional requirements will be phased in at the end of 2011 and end of 2013 in order to raise the bar for performance on IT.
According to CMS, stage one will focus primarily on "establishing the functionalities in certified EHR technology that will allow for continuous quality improvement and ease of information exchange."
The majority of physicians don't have electronic tools, so stage one primarily focuses on creating electronic versions for traditional health records such as physicians' charts, says Charles Kennedy, vice president of health IT at WellPoint and a member of the federal IT committee that created the "meaningful use" guidelines.
As part of the regulation, providers must meet 15 core requirements and five of 10 additional objectives to qualify as meaningful EHR users during Stage 1.
But due to consideration of comments received, CMS says, claim submission and eligibility verification check objectives have been eliminated from the Stage 1 meaningful use standards.
CMS says that over 75 percent of people who commented on these two objectives included in the proposed rule wanted them eliminated from the final rule, noting that they believe the objectives are not part of traditional EHR technology.
Since the HITECH Act is "largely a clinical goal," eligibility verification checks and claim submission are not an area to focus on in order to improve the quality of care people are receiving, Kennedy says.
CMS says that Stage 2 will "encourage the use of health IT for continuous quality improvement at the point of care and the exchange of information in the most structured format possible," and that Stage 3 criteria will "focus on promoting improvements in quality, safety and efficiency leading to improved health outcomes."
Reactions
"In general, we support the HITECH Act," Kennedy says. "Adoption that is correctly designed and used appropriately will improve the quality of care."
Reed Tuckson, executive vice president and chief of medical affairs at UnitedHealth Group also supports the HHS "meaningful use" standards for EHRs.
