HHS Proposes Rules For Who’ll Get Federal Money for Using Health IT
The Department of Health and Human Services defined “meaningful use” of health IT in proposed rules released Wednesday and set out the standards for certification of electronic health records. Each regulation, scheduled to be published Jan. 13 in the Federal Register, has a 60-day comment period. The proposals culminate a nearly year-long process of comment and discussion in two federal advisory committees since Congress passed the Recovery Act in February.
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The certification criteria are meant to be “pragmatic, yet forward looking,” said National Coordinator David Blumenthal. “Meaningful use as defined for 2011 and the standards and certification criteria to support it are but the first major steps in a continuing process. These criteria will set a level of expectation for what can be achieved today and in the near future,” he said. As needs and technology evolve, expectations will also evolve, he said. The first incentive payments for adopting and using health IT are scheduled for 2011. A doctor who achieves meaningful use beginning in 2011 or 2012 can receive $44,000; doctors who don’t begin the program until 2014 will be eligible for $24,000.
The initial expectations include electronically capturing information in a specific, coded format, using the information to track conditions and reporting clinical quality and public health information. Actually exchanging information among entities isn’t, for the most part, required until stage two, when doctors will be expected to electronically transmit orders and diagnostic test results. Exact stage two criteria will be proposed in late 2011. Most of the proposals follow the recommendations of the Health IT Policy Committee, with a few exceptions: The Centers for Medicare & Medicaid Services (CMS) didn’t require documenting progress notes for each encounter, for example, because it’s a “basic functionality” of EHRs and doesn’t directly relate to quality or safety improvements, it said. The requirements are quite specific, said Jonathan Blum, director of the Center for Medicaid Management. For example, 80 percent of patients who ask for an electronic copy of their records should receive it within 48 hours, he said.
CMS also lowered estimates of how much the federal government is likely to spend on incentive payments. Earlier estimates had ballooned as high as $40 billion, but with the refining of the requirements and eligibility, new estimates are that incentives payments will be between $14.1 billion and $27.3 billion, said Tony Trenkle, director of the Office of E-Health Standards and Services at CMS.
The regulations tried to standardize requirements as much as possible across the Medicare fee for service, Medicare Advantage and Medicaid programs, Blum said. There are differences, though, because of differences in the programs. Chief among them is that states will be ensuring correct use and authorizing payments for those participating in the Medicaid program. Doctors participating in the Medicaid program also don’t have to demonstrate meaningful use in their first year, said Cindy Mann, director for Medicaid and State Operations. Because Medicaid serves 50 million people, including about 25 percent of children, it will play a key role in transforming health records, she said.
Some of the requirements will rely on attestation on the part of doctors or hospitals that they're meeting the criteria, Trenkle said. For example, the requirement that 80 percent of a doctor’s orders use computerized physician order entry will depend on doctors self-reporting their own percentages. CMS will do some auditing, he said.