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EHR Incentive Money Congressional Authorization versus Appropriation – Will EHR Incentive Money Disappear?

Posted on July 5, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve been having a number of discussions online and through email with people about the future of the EHR incentive money. A number of people are quite concerned with the government funding for the EHR incentive money. You may remember that I posted about this before on multiple occasions and had some really interesting discussion.

Here’s a summary of some of the points that I’ve heard people making when it comes to the EHR incentive money being taken away:

1-There is a crucial difference between the two steps required for Congressional funding, a-authorization and b-appropriations. Congress can authorize, but cannot appropriate for 5 yrs. This applies to the EHR stimulus money. Thus the 5 year EHR payment has been authorized, but no EHR funds have been, nor can they be, appropriated for 5 years, right?

2-There is $18k this year for doctor Medicare EHR. But not the remaining $26k over 5 years has not been apropriated (same applies to hospitals funds).

3-The budget deficit and debt ceiling suggest Congress will be looking now and in the future for cutting every dime they can,
and thus the $20B or so for EHR could be part of the cut. Thus there may be reduced EHR funds, or none, appropriated by Congress after this year.

I still believe in my gut that the EHR incentive money is going to be safe and still around going forward. There’s little benefit to cutting a mere $20 billion from a program that is generally bi-partisan. Plus, no one in congress really knows the potential good or bad impacts of the HITECH act on EHR and healthcare IT. However, it’s really easy for them to quickly assume that more technology in healthcare is good and worth funding (whether the way they’re doing it is good or not…a subject for a different post).

It’s certainly not beyond the realm of possibilities that the government could make some sweeping cuts and the EHR incentive money is a casualty of those sweeping no holds bars type cuts. Point being that I don’t think there are any people in congress that are passionately for it or passionately against it. So, I think that means that it will likely either get carried forward on a whim or cast aside on a whim.

How’s that for a concrete answer? Are there points that I’m missing? Are we misunderstanding the HITECH funding process? Feel free to chime in with any knowledge you might have of the government process.

Guest Post: The Meaningful Use Clock is Ticking

Posted on March 8, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

John’s Note: Much of this post will be child’s play for those of you reading the blog that are steeped in meaningful use, the HITECH act, EHR Certification, and the EHR stimulus money. However, I thought this guest post was a nice intro to the EHR stimulus money for a doctor or practice manager which was starting to learn. I’m all about helping doctors, so here it is.

90 days of data collection. This is what is required for year one meaningful use. This means by October 1 you better be collecting data…and hopefully you didn’t just start on October 1…that would be playing with fire.

What really is the purpose of Meaningful Use? In the grand scheme of things, the CMS wants to make sure that a practice hasn’t bundled together a spreadsheet and word processor, call it an EHR, and then try to claim a big reimbursement. So, sure, it makes sense that the CMS would have some requirements for your EHR.

As is the situation anytime you try and get money from the government, the list of requirements is lengthy, the red tape is plentiful and the maze continues to get more complex.

So is the case when “proving” meaningful use. Hopefully you aren’t of the idea that buying a Meaningful Use certified EHR makes you a Meaningful User.

Having an EHR with that “certification” stamped on the box is not like an Easy Button.

Selecting that EHR is the first big hurdle you have to conquer…now you have to show you are a Meaningful User.

The items of proof are shown here in this CMS summary [PDF]. What you’ll see is there are 15 Core Objectives you must be able to report on.

That shiny new EHR should have all of these reports built right in. You better try pulling some of those reports to make sure there is some data in them.

So, those 15 mandatory Core Objectives are already selected for you. Next, there are five more you must select from a gallery of ten.

Which objectives should you choose? Wait for it…IT DEPENDS.

Such the non-answer answer.

It does depend on a number of items, but really which five would you choose?

The easiest to gather? DING DING!

Why not?

Why make this craziness any more difficult than it needs to be.

We’ll go over the Menu Set Objectives, and which ones are the easiest for you to pull, in a future article.

John Brewer is the founder of HIPAAaudit.com. He and his team help physicians run HIPAA Compliant practices in the simplest, most pain free way.

Screwed Up Meaningful Use (at least for specialists)

Posted on January 24, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I regularly get passionate emails from readers of EMR and EHR (and of course my other site EMR and HIPAA. I don’t always agree with the emails, but I almost always find them interesting. The following is one such email. It wasn’t intended to be published, so excuse the format. However, I find much of the comments about ONC’s approach to specialists spot on. The hard part is that I think ONC realizes this as well. The question is whether ONC in meaningful use stage 2 is going to do anything to address the specialist problem. I think this is a topic we need to voice to ONC.

The EMR’s basically started with certification requirements from CCHIT…ONC took that starting point…and moved to MU from it…without regard to specialty. Properly done, they should have started with MU by specialty…then figured out what the product certification requirements should be from there—for that specialty: Orthopedic guys see lots of patients (50-70 per day, and lose two days/week to surgery), mostly NEW patients with specific problems (broken bones or joint replacements)…no big longitudinal charts…and need to dictate complex notes; Dermatologists have lots of lab/biopsy tests, need to draw pictures and annotate them, not dictate; Pediatricians need growth charts and long medical histories and trends; Oncologists need detailed treatment histories, dosages, outcomes; Ophthalmologists need lots of technical data, measurements and interfaces to optic devices. Yet ONC made a set of rules that really only apply to Primary Care…which is where much of the CHRONIC conditions (and a large portion of the medical cost issues) are quarterbacked…and have the best chance of prevention.

Besides…all the data from specialists should flow back to the PriCare docs anyway…why try to keep it coordinated in both places? I think we have a long way to go to get all healthcare “communitized”…and powers that be need to recognize how different things are for various specialties…and define MU from each specialty’s point of view…and find out that the current certification standards are WAY overkill for most of them…unnecessary complexity and, thereby, cost….to do the irrelevant things to qualify for incentives. After five years, they will stop doing those things anyway, when incentives run out. Having a data pathway between in-patient and out-patient (ambulatory) is a great goal…that should come first..the ability to share data…even if via documents. That could be done today. Trying to devise interoperability standards for 400 EHR’s, a dozen or so major Hospital-based vendors…and registries, labs and other participants….that is a LONG way from being reality

Will be interesting to see how the “success stories” pan out this year starting in May for EP’s. Thank goodness ONC has made it almost impossibly easy for specialists in Stage I….they can opt out of almost everything required and get incentives the first 2 years($30k)…is that a good use of taxpayer money?

Great Chart Comparing Meaningful Use Stage 1 with Stage 2 and 3

Posted on January 21, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today I came across this really great chart that compares the meaningful use stage 1 requirements with the proposed requirements for meaningful use stage 2 and 3. The comment period is still open for meaningful use stage 2 and 3 so make your voice heard.

Here’s the roadmap as described by John Halamka:
Jan, 12, 2011: release draft Meaningful Use criteria and request for comment
Feb-March, 2011: analyze comment submissions and revise Meaningful Use draft criteria
March, 2011: present revised draft Meaningful Use criteria to the HIT Policy Committee
2Q11: CMS report on initial Stage 1 Meaningful Use submissions
3Q11: Final HIT Policy Committee recommendations on Stage 2 Meaningful Use
4Q11: CMS Meaningful Use NPRM

See the comparison chart embedded below.


Nephrologists (Dialysis Centers) and EMR Stimulus Money

Posted on January 17, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I often get questions from readers of my sites and I often don’t know the answer. So, instead of acting like I know the answer, I like to put it out to my readers to see what they have to say about the topic. This is one of those cases. Here’s the question I got about Nephrologists and Dialysis Centers and EMR stimulus money.

I am interested in finding out how dialysis centers qualify for the EHR incentive money and best practices for Nephrologists, NPs, and/or PAs running dialysis centers for attestation.

This is an area I’m not that familiar with. So, if you know more than I (which many of you do), let us know your thoughts in the comments. I’ll update the post if needed too.

My only general thought is that it wouldn’t seem like I’ve seen an exception that would exclude nephrologists so I assume they could be considered an “eligible provider.” I also imagine that they probably have a large number of Medicare patients so that they can easily meet the Medicare reimbursement requirements and they might even meet the Medicaid requirements.

I guess the real question might be whether nephrologists and dialysis centers use a “certified EHR” or not. If not, then they’re likely up a creek. If they do, then my next question is whether or not it’s worth their time to ask their patients if their smokers (amongst other meaningful use requirements) every time they come for a visit.

Talk amongst yourselves in the comments.