Beware EMR bullies quoting federal stimulus rules

I’ve been hearing a lot of stories these days about EMR companies telling potential physician customers that they need to buy a sophisticated or “full blown” EMR right now in order to get any stimulus funds. Some of my readers have asked whether this is true or not so let me set the record straight.

Yes, it’s true that the ARRA HITECH Act clearly states (in section 4101, page 353) that the government shall provide “incentives for adoption and meaningful use of certified EHR technology.” Specifically, the language in the bill (page 353) says:

Subject to the succeeding subparagraphs of this paragraph, with respect to covered professional services furnished by an eligible professional during a payment year (as defined in subparagraph (E)), if the eligible professional is a meaningful EHR user (as determined under paragraph (2)) for the EHR reporting period with respect to such year, in addition to the amount otherwise paid under this part, there also shall be paid to the eligible professional (or to an employer or facility in the cases described in clause (A) of section 1842(b)(6)), from the Federal Supplementary Medical Insurance Trust Fund established under section 1841 an amount equal to 75 percent of the Secretary’s estimate (based on claims submitted not later than 2 months after the end of the payment year) of the allowed charges under this part for all such covered professional services furnished by the eligible professional during such year.

Later, “certified EHR technology” is further define on page 356 as:

MEANINGFUL USE OF CERTIFIED EHR TECHNOLOGY.—The eligible professional demonstrates to the satisfaction of the Secretary, in accordance with subparagraph ©(i), that during such period the professional is using certified EHR technology in a meaningful manner, which shall include the use of electronic prescribing as determined to be appropriate by the Secretary.

If this sounds like legalese and mumbo jumbo, I agree. And, if it sounds like it’s murky and unclear, well, it is and it’s meant to be.

When a vendor comes to you and tells you that you need to purchase something because the stimulus bill is telling you to, ask them to show you the language in the bill that indicates that. If they can’t point to a page in the bill or a Medicare regulation, it’s probably a fear tactic and you should be very wary.

The only thing that we know for sure right now is what is in the bill — that certified EHR technology is required for incentive payments. However, nobody knows how much actual money will be incentivized to a particular physician, nobody knows what the final certification requirements will be, nobody knows exactly which certifications will guarantee payments, etc. The reason none of this is known is that the Secretary of HHS and the head of CMS (Medicare) havent written the rules that they are required to write. It will be many more months before the hundreds of pages of regulations necessary to enact many provisions of the bill will be written and approved.

Anyone who says they know what will be in the federal rules is either misleading you or is delusional :-).

The unknowns are greater than the knowns, even today, almost a year after ARRA was passed. If the only reason you’re buying an EMR is to get incentive money then you should wait until at least this Summer when things are clearer (but you should prepare yourself using some guidance I provided earlier).

If, however, you’re buying electronic health records management technology to improve your business or improve clinical care with a clear payback period and ROI then it shouldn’t matter whether you get the incentives or not — the savings to your business should be enough to convince you; if the savings aren’t there, then even the incentives shouldn’t change your mind because it’s not likely that the government can provide enough money to compensate you for the inevtiable operations hit you’ll take with a full-fledged EMR.

My simple advice is this: treat the incentive payments as a bonus — if you get it, great. If not, it shouldn’t kill you. Don’t jump into any technology promises that can only be realized if the government does it’s job. You’ve been there before, I’m sure.


Shahid N. Shah

Shahid Shah is an internationally recognized enterprise software guru that specializes in digital health with an emphasis on e-health, EHR/EMR, big data, iOT, data interoperability, med device connectivity, and bioinformatics.