Health IT Law Blog : Health IT Law Blog : Post & Schell: Law Firm : HIT & Electronic Health Records

On October 20, 2011, CMS published the final rule on Accountable Care Organizations (ACOs) or, as it is formally known, the Medicare Shared Savings Program (the "Program"), enacted as part of the Patient Protection and Affordable Care Act (ACA) of 2010. According to CMS chief Don Berwick, MD, the Program represents an "opportunity to coordinate care among providers," which could "greatly improve the quality of care Medicare beneficiaries receive," and produce substantial savings for the federal government. The Program creates incentives for providers to collaborate in treating an individual patient across care settings, in order to receive a portion of the savings generated from providing such care. 

CMS has substantially relaxed the requirements for ACOs originally provided in the proposed rule. Some of the key changes include (among many others):

• Adding a "one-side" risk model, allowing providers to participate in the program without risking a loss in the event their ACO did not produce savings
• "Preliminary perspective assignment" of Medicare beneficiaries, giving ACOs more control over their Medicare beneficiary population
• Reducing the number of performance measures from 65 to 33
• Eliminating the two percent threshold for being eligible for shared savings

CMS will begin taking applications for the program on January 1, 2012, with start dates of April 1 and July 1, 2012.

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HHS released the first numbers regarding its Meaningful Use incentives program, established by the HITECH Act of 2009. Unsurprisingly, most eligible professionals and hospitals receiving funds this year qualified for incentive payments under Medicaid, rather than Medicare, because Medicare has a higher threshold for receiving such payments. Medicare requires the eligible professional or hospital to achieve and demonstrate meaningful use, while Medicaid mandates only adoption, implementation or upgrade of existing systems. 

Nevertheless, the extent of the disparity was somewhat surprising: only about 6% of eligible hospitals and 3% of eligible professionals qualified for meaningful use incentives under Medicare.  Via Modern Healthcare:

So far, Medicaid program payments for hospitals, physicians and other eligible professionals that have adopted, implemented or upgraded to a certified EHR system have totaled $389 million. Only $264 million has been paid under the Medicare program, which has a higher eligibility threshold, requiring providers to demonstrate that they are meaningfully using their certified EHR system.

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CMS announced that the online Attestation System for the Medicare EHR Incentive Program will launch on April 18, 2011. Eligible professionals and eligible hospitals will be able to use this online portal to self-attest to meeting the Meaningful Use criteria.

CMS also released a preview of the Attestation System. This preview includes attestation screenshots and is intended to give examples of what the attestation process will look like. CMS promised to release additional information about the attestation process soon, including "User Guides" that will give step-by-step instructions for completing attestation, along with educational webinars that describe the attestation process in depth.

Finally, CMS noted that providers will follow a similar process using their state's Attestation System. Such providers may find their state's scheduled launch dates of their Medicaid EHR Incentive Program by clicking here.

You can download the preview by clicking here.

For more information, please visit CMS's EHR Incentive Program web site.
 

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Center for Medicare and Medicaid Services (CMS) opened the registration process for eligible hospitals and professionals hoping to capitalize on the incentive payments provided under the HITECH Act.  Each such hospital or professional needs to register with CMS in order to receive such payments, and CMS encourages all eligible healthcare providers to register as soon as possible.

You can find the EHR Incentives Program registration page by clicking here.

According to Government Health IT, over 4,000 providers have already registered with CMS. Several states have also launched registrations for their Medicaid incentive programs.  Moreover, hospitals in Oklahoma and Kentucky have already begun receiving incentive payments:

Kentucky processed payment to the University of Kentucky Healthcare, the university’s teaching hospital, for $2.86 million. The first payment amounts to one- third of the hospital’s overall expected amount for participating in the program, according to CMS. Oklahoma issued payments to two physicians at the Gastorf Family Clinic of Durant, Okla., for $21,250 each for having adopted certified EHRs.

Besides Kentucky and Oklahoma, registration is available for the Medicaid EHR incentive program in Alaska, Iowa, Louisiana, Michigan, Mississippi, North Carolina, South Carolina, Tennessee and Texas.

In February, registration will open in California, Missouri, and North Dakota. Other states will likely launch their Medicaid EHR incentive programs during the spring and summer of 2011.

You can learn more about registration for Medicare incentives for eligible professionals by clicking here; and for Medicaid incentives for eligible professionals by clicking here. A similar CMS guide for both Medicare and Medicaid incentives for eligible hospitals can be found here.

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CMS launched a very useful Web site, http://www.cms.gov/EHRIncentiveprograms, providing an overview of the Medicaid and Medicare incentive payment programs established by the HITECH Act.  The site provides up-to-date, detailed information and many important links and "fact sheets" about the incentive programs, including overviews of CMS's final rule on meaningful use, the scope of the incentives program, and a Frequently Asked Questions section.  

It is definitely worth saving or bookmarking this site, so that you can check back in easily for regular updates.

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On July 13, 2010, CMS issued the final rule defining "meaningful use" and establishing the parameters and requirements for eligible professionals, hospitals and other providers to receive incentive payments provided under the HITECH Act for widespread adoption of electronic health records.  According to CMS, the key changes included in the final rule (from the meaningful use NPRM published in the Federal Register on January 13, 2010) include:

• Greater flexibility with respect to eligible professionals and hospitals in meeting and reporting certain objectives for demonstrating meaningful use. The final rule divides the objectives into a “core” group of required objectives and a “menu set” of procedures from which providers may choose any five to defer in 2011-2012. This gives providers latitude to pick their own path toward full EHR implementation and meaningful use.
• An objective of providing condition-specific patient education resources for both EPs and eligible hospitals and the objective of recording advance directives for eligible hospitals, in line with recommendations from the Health Information Technology Policy Committee.
• A definition of a hospital-based EP as one who performs substantially all of his or her services in an inpatient hospital setting or emergency room only, which conforms to the Continuing Extension Act of 2010
• CAHs within the definition of acute care hospital for the purpose of incentive program eligibility under Medicaid.

You can view the PDF of the final rule on Meaningful Use by clicking here.

You can learn more about it from the HHS press release by clicking here.  Also, the New England Journal of Medicine published an excellent summary by Dr. Blumenthal of the changes included in the final rule; you can find this article by clicking here.

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As required in the Patient Protection and Affordable Care Act (PPACA), Center for Medicare and Medicaid Services (CMS) announced this week that it plans to integrate the quality reporting requirements for physicians' Medicare payments with reporting requirements for healthcare providers who achieve meaningful use under the HITECH Act.  Via Healthcare IT News:

Under the Physician Quality Reporting Initiative (PQRI), physicians who participate in Medicare can receive incentives for reporting various quality measures, a select number of which are aimed at those who want to report using EHRs.

Providers who become meaningful users of EHRs, as laid down by the American Recovery and Reinvestment Act (ARRA), will also be eligible for incentive payments. A final rule on that is expected soon.

CMS has requested public comment on how it should integrate the two programs, included within a proposed rule about changes in Medicare physician payments for 2011 CMS expects to publish the proposed rule July 13.

"In an effort to align PQRI with the EHR incentive program, we propose to include many ARRA core clinical quality measures in the PQRI program, to demonstrate meaningful use of EHR and quality of care furnished to individuals," the proposed rule says.

Meaningful use measures that physicians could use for PQRI reporting through electronic health records include such things as blood pressure measurement for hypertension, body mass index screening and prevention care follow up, and drugs to be avoided in the elderly, according to CMS.

You can find a copy of the proposed rule here.

"CMS to two align quality reporting programs," Healthcare IT News (June 29, 2010).

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Today the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) will announce two regulations that lay a foundation for improving quality, efficiency, and safety through meaningful use of electronic health record (EHR) technology.

The regulations will help implement the EHR incentive programs enacted under the Health Information Technology for Clinical and Economic Health (HITECH) Act, which was part of the American Recovery and Reinvestment Act of 2009. Public comments on both regulations are encouraged.

Join today’s call; details are listed below:

WHO:
--David Blumenthal, MD, MPP, national coordinator for health information technology
--Jonathan Blum, director, Center for Medicare Management
--Cindy Mann, director, Center for Medicaid and State Operations

WHAT:
Briefing for HITECH Partners and Stakeholders – Providers, HIT Industry Organizations

WHEN:
Today, Wednesday, Dec. 30, 2009, 5:15 p.m. – 6:00 p.m. Eastern Time

WHERE:
Toll-Free Dial: (800) 837-1935
Conference ID: 49047605
Pass Code: HITECH

Stay tuned for more updates and information on the HIMSS Meaningful Use Web site at http://bit.ly/5IdkDe . HIMSS will be posting a statement tomorrow.

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HHS Secretary Kathleen Sebelius has delegated the responsibility for administration and enforcement of the HIPAA Security Rule to the Office of Civil Rights, a division of HHS.  Previously, Centers for Medicare and Medicaid Services (CMS), another HHS division, was responsible for Security Rule administration, while OCR was tasked with administering and enforcing the HIPAA Privacy Rule.  Effective immediately, OCR is responsible for administering both Security  Rule and Privacy Rule, as well as all HIT privacy and security related provisions in the HITECH Act.

According to HHS, this move "will eliminate duplication and increase efficiencies in how the department ensures that Americans’ health information privacy is protected."  This transfer of authority is not meant to create any disruption of current procedures.  Consumers may continue to submit HIPAA security complaints using the on-line resource – the Administrative Simplification Enforcement Tool (ASET) -- which can be accessed here. New security complaints may also be sent to the Office for Civil Rights. 

You can find the Federal Register notice here.

"HHS Delegates Authority for the HIPAA Security Rule to Office for Civil Rights," HHS Press Release (August 3, 2009).

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