Researchers at the George Washington University School of Public Health and Health Services estimate that as many as 45,000 physicians are eligible to receive up to $63,750 in Medicaid subsidy payments for the purchase and use of electronic health-record systems under the American Recovery and Reinvestment Act of 2009.
If all of the Medicaid-eligible physicians receive the maximum payments, the researchers conclude, taxpayers will invest more than $2.8 billion in the EHR subsidy program.
The 14-page study report focused on the impact of sections of the stimulus law applicable to different physician groups that provide medical care to a significant portion of their patient mix covered by publicly funded payment programs. Stimulus funds are different depending on which of the three groups the physicians practice.
EHR subsidies under the Medicaid section of the stimulus program are considerably higher than under a comparable section for Medicare, which is higher than subsidies afforded pediatricians.
“Physicians who are able to demonstrate “meaningful use” will be eligible for the Medicaid financial incentives up to $63,750 over six years if their patient mix includes at least 30% Medicaid volume,” the report's authors said.
Qualifying physicians under Medicaid can receive an initial $21,250 to cover the cost of purchasing or upgrading “certified” EHR technology. Funds can be used for training and other support services, the authors said. Subsequently, physicians can receive an additional $8,500 a year for five more years if they continue to comply with meaningful use guidelines set by HHS.
Under Medicare, the maximum stimulus payment is $44,000 per physician, with an initial payment of $18,000 in 2011 and lower payments over the next four years. But a physician “who predominately furnishes services in a federally designated health professional shortage area may receive a 10% incentive premium, bringing the maximum payment under Medicare to $48,400.
“For physicians who predominantly practice in federally qualified health centers or rural health clinics, the criterion for payment eligibility is broader: Physicians practicing in these settings can qualify for payments if at least 30% of their patients are determined to be ‘needy individuals,' defined as patients who either are covered by Medicaid or who receive uncompensated care and for whom charges are reduced by the provider on a sliding-scale basis,” the report authors said.
National Ambulatory Medical Care Survey data show, however, that 65% of physicians working in health centers meet the Medicaid 30% patient volume criterion, “but this is an underestimate since it focuses only on Medicaid volume and does not include the broader “needy individuals” category included in the ARRA criteria.
Separate analysis of federally qualified health center physicians, presented below, indicates that almost all physicians whose practice is predominantly in a health center can be expected to qualify, although the term “predominant” has not yet been defined.
Office-based pediatricians, if Medicaid patients comprise at least 20% of their patient volume, are eligible to receive a maximum of $42,500 in the form of five annual payments of $8,500 each.
Knowing where a physician, group or clinic fits under the new IT bonus payment scheme is important, the authors conclude.
Using the National Ambulatory Medical Care Survey data, the researchers report that care of Medicaid patients by office-based physicians “is highly concentrated,” with 10% of office-based physicians handling more than 70% of all Medicaid visits while 60% of office-based physicians saw few Medicaid patients or none at all.
“For physicians treating a high proportion of Medicaid patients, the availability of Medicaid financing to both support and reward adoption will be crucial,” they wrote. That's because pediatricians, obstetricians and gynecologists, and community health centers “either do not qualify for Medicare incentives at all (in the case of health centers because their payment system is a separate one and does not appear to be covered by the Medicare adoption provisions) or else serve such a low proportion of Medicare patients that Medicaid by definition becomes the central means of financing adoption.”
Research for the report was conducted by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative.Submit a letter to the Modern Physician Reader Blog. Please include your name, title, company and hometown. Modern Physician reserves the right to edit all submissions.