Incentive Checks Arriving

The first incentive checks for implementing electronic health record (EHR) software are rolling into Alabama practices. "It's nice to see it come into play after all this waiting and talking about it," says Nancy Ellis, vice president of MediSYS.

In fact, just last week, Pediatrics Plus, P.C., an Anniston-based practice that had adopted the ONC-Certified MediSYS EHR last year, received $21,250 in Medicaid EHR incentives.

"The momentum to get EHR has dramatically changed with the stimulus incentives," says Mike Jones, CEO of Evolution Technology. "They understand they have to do it now. But they should be doing it for the return on investment alone."

Jones says one seven-physician group he works with implemented their EHR two years ago. Now they're reaping financial benefits beyond the stimulus check.

First, they slashed their staff costs by three full-time positions with the reduced clerical need, and then eliminated their transcription expense. The transcription alone saves them $1,200 to $1,300 per physician per month.

In addition, with paper charts gone, the practice now had two chart-storing rooms empty. They turned them into exam rooms. "They've now recruited another physician and put him into that space. So they added a physician without adding any new square footage, and that space now generates revenue," Jones says.

On the other end of the spectrum, Jones has witnessed the failing of an EHR transition in a 25-physician group with hundreds of employees. "They had a combination of lots of IT-related problems hindering their success, and on top of that they made their software decision based on price."

They snowballed the effect by short-cutting on the training. The final straw, and the most important, says Jones, was the lack of physician buy-in to the project. "So when the first trip-ups happened, they said, 'I knew this wasn't going to work'," Jones says. "The physicians in their sixties were thinking they wouldn't be here long enough to work this out, so let the young docs pay for it. They wound up throwing the whole thing out; wasted about $500,000."

The practice has gone back to the drawing board. They've formed a selection committee this time, including Jones with his IT knowledge of their hardware, to help decide on the next EHR purchase.

Upgrading their software this year would still qualify the practice for incentives. New purchases can still qualify as well. "Registration is still open for both Medicare and Medicaid programs, and eligible Medicaid providers can get $21,250 this year," Ellis says. "Medicaid's goal is to issue checks 30 days after registration and attestation."

The Medicaid EHR program, says Ellis, is easier to qualify for then Medicare and providers receive a greater total incentive. "You don't have to show meaningful use the first year. And if you purchase or upgrade your software and enter patient demographics or start training, you could receive the first check this year," Ellis says.

To qualify for the entire Medicaid incentive of $63,750 paid over five years, a provider must begin the program no later than 2016.

For the Medicare program, a provider can still start as late as 2012 and receive their full $44,000 incentive. Waiting until 2013, however, drops that maximum to $39,000 per provider.

Medicare also provides a stick even if providers do not choose the incentive carrot. "With Medicaid there are no payment penalties if you don't participate. But with Medicare, penalties begin in 2015, if eligible providers don't participate in meaningful use of certified electronic records technology," Ellis says.

Both programs require providers to attest online. The website asks a series of questions including some requesting certain numbers based on activity in their EHR.

In the Medicare program, providers must also report on 90 days of meaningful use of their EHR software in their first year of participating. That means for those who started the program this year, the last day to begin an attestation period starts Oct 1.

For meaningful use, the provider reports on fifteen well-defined core measures and ten menu set measures. "These are fifteen things they have to check off that their system will do and that they used that aspect of their software for a certain percent of their patient load," Ellis says. Providers also select five of the ten menu set measures on which to report.

ePrescribe forms a separate and mandatory program for Medicare providers. To avoid a payment penalty in 2012, Medicare providers must have already reported a G code on a certain number of claims by June 30, whether or not they chose to participate in the ePrescribe incentive. To reap any possible 2011 ePrescribe incentives, providers have until the year's end to submit G-code 8553 with at least 25 "visits".

For help with attesting properly on meaningful use in the Medicaid EHR program, Alabama's Medicaid office created One Health Record (onehealthrecord.alabama.gov). They also help providers determine if and how to qualify for Medicaid incentives.

"These ladies want providers to call. If you're at 28 percent when you need 30 percent for Medicaid eligibility, they may be able to identify additional patient volume to help you qualify," Ellis says. "They want to help Alabama providers get their share of the incentives. It's important that practices do not dismiss that they may qualify."