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 (C)(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.

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13 thoughts on “Beware EMR bullies quoting federal stimulus rules

  1. The reason these EMR and Health IT companies are 'bullying' is because of the little word “incentive” (as we all knew this – I guess I'm just stating the obvious). It happens for almost every product that offers a sale incentive. “Don’t jump into any technology promises that can only be realized if the government does it’s job” – Some of the best advice!

  2. Great advice, and yes, treat the incentives as a bonus, not the reason to buy an EMR. For the record I am a EMR reseller, but I don't bully clients into the purchase. In fact, the incentives is one of my least important “selling points”. I'm sure other vendors may be more pushy.

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  4. EDEN PRAIRIE, Minn. – Jan. 11, 2010 – Ingenix today introduced a package that includes interest-free financing, health information technology (HIT) services and performance guarantees to help physicians integrate HIT into their practices. The program enables physicians to implement Ingenix CareTracker EHR, a low-cost, full-functioning electronic health record (EHR), with no out-of-pocket costs and no payments until 2011 when American Recovery and Reinvestment Act (ARRA) reimbursements for EHRs begin.

    Qualifying U.S. physicians can receive an interest-free loan from Ingenix (underwritten by OptumHealth Bank, Member FDIC) to license and implement CareTracker EHR. The financing covers implementation and monthly subscription costs until November 30, 2015. Qualifying physicians can repay the loans with annual reimbursement dollars from the incentives authorized in the stimulus bill. Under the terms of the ARRA, physicians can receive up to $44,000 in Medicare reimbursements over five years for implementing an EHR and demonstrating meaningful use of the technology.

  5. Interesting article. It does seem like any incentives offered won't be enough to tip the scales. I, for one, am a bit skeptical of anybody claiming that EHR will result in immediate cost savings for any organization. I have seen the implementation process firsthand and it is not always a pretty thing.

  6. Healthcare IT Guy warns against EMR bullies mis-quoting stimulus. FUD – or Fear Uncertainty and Doubt is unfortunately a sales tactic as old as the hills. I LOVE THE good counsel not to depend on the gov't to do their job in order for a practice to be paid!

  7. Pingback: Healthcare IT guy says beware… |

  8. Many a time, I've been mistaken and sometimes I've been confused. Have you ever felt like that? Following the current wave of changes and understanding the rhetoric concerning the American Recovery and Reinvestment Act of 2009 and the associated incentives and penalties is not as easy as it might seem.

    In recent weeks we have heard comments that have incorrectly emphasized the importance of clinic owners being timely on their selection of an EMR . Some have referred to the “law” that “requires” the implementation of an EMR. This is rhetorically incorrect.

    Basically, there is no law specifically requiring the use of an EHR. There is however, HIPAA, which is a law that clearly requires security, privacy, portability, protection and management of patient records.

    The “obvious” often gets lost in the translation. The basic cause for the incredible push for electronic medical records is that nearly all of the requirements of the HIPAA law can be met most effectively by the use of electronic means, yet that simple point was never clearly defined. Thus the confusion.

    So, to be clear, there is no law requiring an electronic medical record, but then, there is also no law that requires a doctor to wash his or her hands before seeing a patient. It's just common sense. Implementing an EMR is common sense.

    The stimulus discussions add to the confusion, as it is an incentive to do the right thing and a penalty for failing to do what is sensibly right. The stimulus package provides a reward for doing something that will vastly improve health care and practice management in today's busy work environment, in an effort to motivate physicians and other practitioners to evolve along with the rest of the planet. Can you believe it is 2010? We have definitely arrived in the future.

    There is a 1% Medicare penalty per year (2015-2017) if EHRs are not adopted. The government calls that a penalty.

    But what about the doctor who does not see Medicare patients? He has no penalties and no stimulus. We are sure the feds will get around to that issue soon enough. Many clinicians find that the $44,000 stimulus for adoption and 3% total penalty for non-adoption to be compelling. however they are weighing their decisions based on dollars and common cents.

    The first 25 definitions of Meaningful Use were published in February '09. Most are truly meaningful and others seem so impractical that they will probably be stricken from the list during the first wave of “editing” planned for spring '10.

    Let's get back to reality and face the issue head on.

    We are in the middle of a Renaissance. Not at the cutting edge, mind you. The renaissance started a couple of decades ago. Health care is just slow in catching up. Forget the Stimulus Package for a moment. Forget the penalties and all the rhetoric. The entire health care industry is about to make a critical change in the way practices are run, a change that will improve patient care, speed and streamline the work-flow, reduce errors and document management problems, eliminate clutter, protect the patient and improve overall care and treatment.

    And yet, there are physicians, (intelligent men and women, mind you) who are stalling, delaying and balking over percentage points on a claim and a monetary carrot designed to motivate them to do the right thing. This, of course, conjures up visions of early physicians standing in conference and debating whether it makes sense to actually inject a liquid remedy into a patient's vein, rather than use the standard, fully accepted and easily procured leech.

    Can we all imagine when the first physician suggested that we actually keep a record of what we administered to a patient, just in case the patient lives and we need to treat him or her again? “Ridiculous”, some would say. “My calculations show that it is cheaper for me to just treat them and not know their name. I don't need a record?”

    Another might say, “keeping records will never catch on. Most of my patients die before I get to treat them again anyway. In the near future, you will have to burn all that paper just to make room for more patients.” Medicine has come a long way, hasn't it!

    Are we missing the point? Some of us can actually remember the first fax machine. It was mesmerizing to watch as a single sheet of paper took seven minutes to be sent across the street. The future is coming at us at full speed. That first fax seems like just yesterday. At least for this reporter it does.

    And today?
    Today, Remedy can provide a practice management suite of tools for any size clinic that virtually eliminates the need for paper, substantially reduces the over-all cost of running a practice, increases employee morale and productivity, increases the number of patient visits, increases revenue, maintains a real-time document retrieval system, allowing the doctor and the staff to do their jobs faster and more efficiently than ever before. And we do it in “real-time”. Yes, we are in the future.

    OK, forget the Stimulus Package. Forget the penalties. Stop disguising resistance as a financial issue. The cost of a complete practice management system, with EMR and dozens of applications and functionality, should cost less that a part time employee. Just ask, we'll be happy to show you how! And it should generate three to four times what it costs in added revenue.

    Physicians are professionals. They can do something that most men and women cannot do. These abilities and their diplomas make them physicians. But, let's face it, it doesn't make them the best business managers.

    However, the management of a medical practice is a team effort. There are many different talents that make a practice successful. Some are administrators. Others are medical records managers, nurses, receptionists, assistants, billing clerks and more. MPS Remedy has worked with hundreds of talented people in all positions within a clinic to develop an incredible practice management tool. From designers to programmers, we are all focused on optimizing the work flow, accessibility, portability and completeness of your practice.

    Remember the patient?

    It was once said that the physician holds the patient's life in his hands. That was true once, but not any more. The patient's life is held by the receptionist, admissions clerk, records management office, scheduler, coder, nurse, the physician's assistant and billing department before the doctor even gets to see the patient. One mistake from that pile of paper, currently called a patient record, can often mean the difference between life and death. In fact, it is more often than you might think.

    Ok, forget the patient! Forget the penalties, forget the Stimulus Package.

    The implementation of an electronic medical record and a transition from a paper work-flow to a streamlined, real-time computer accessible medical record will make you more money! Remember money?

    No! It should not cost an arm and a leg. It should not require financing. It will not disrupt the office environment. It will not replace employees. It will increase cash flow and reduce expenses.

    That said, we are standing ready to demonstrate the effectiveness and profitability of Remedy!

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