Come and get IT: ready to reimburse

Part one of a two-part series.

The race is on—finally.

Physicians and hospitals are now able to chase freely after their share of some $27.3 billion in federal incentives to help them buy health information technology systems—all in the name of improved efficiency and higher-quality patient care.

Meanwhile, providers who don't participate, or who come up short, risk being declared meaningless and paying for it.

“This is their first investment in healthcare reform, and I think it will make a huge difference,” said Darlene Burgess, vice president of corporate government affairs for Detroit's Henry Ford Health System, in describing the federal spending spree. “We're quite happy.”

“A drop in the bucket” was how Burgess described the $3 million to $4 million subsidy large hospitals can earn through a $2 million “bonus,” plus more, depending on a formula involving Medicare patient share and the hospital's number of Medicare discharges. “But it's a drop in the bucket we welcome,” she said.

The starting gun was fired with CMS' release of the final rules on meaningful use of health IT. The rules explain not only how the largest reality game show of all time will be played, but also what contestants must do to claim their prizes.

In preliminary events, Donald Berwick was sworn in as the new CMS administrator in Boston on July 12, a day before the regulations were released. Berwick will referee the proceedings, enforcing newly released rules, including one that strengthens rarely enforced privacy laws and another that spells out how products that don't exist yet will be judged or “certified.”

“We are actually attempting, through these rules and our other programs, to comprehensively address the barriers that have been identified to the widespread adoption and use of electronic health systems for effective improvement in quality and efficiency,” David Blumenthal, national coordinator for health IT, said during a July 13 news conference.

To make matters more interesting, the meaningful-use obstacle course is still being assembled, even though several players already are running on the track unaware of where the first hurdle will be placed.

This is because, to qualify as a meaningful user, a physician must utilize a “certified” electronic health record, but—until last week—no one knew what the certification criteria would be. Those criteria were released July 13 in 228 pages of companion rules to the meaningful-use requirements and the final rules that were released June 18 on a temporary program that established a process for an organization to become an Office of the National Coordinator-authorized testing and certification body. At least one organization—the Certification Commission for Health Information Technology—had sought the ONC's blessing to become an authorized testing body.

Vendors can now start developing products to certification standards even if there is still no one to certify them.

The ONC has promised to move these applications through as quickly as possible, said Patricia Wise, vice president for healthcare information systems at the Healthcare Information and Management Systems Society. But she added that, even if an organization receives authorization on Aug. 1, it may not be ready to set up shop as an EHR-certification business on Aug. 2, as it will need to establish its testing process and then promote its services to the IT market.

Wise also noted that vendors may wait to see how many authorized testing and certification bodies emerge so they can gauge their options as far as setting their price and location.

“I think, consequently, it will be fall of 2010 before we start seeing certification of EHR technology,” Wise said.

Providers face a tight schedule in the next year. To meet deadlines included in the first phase of the meaningful-use program, they will need to make sure their EHRs are up and running by July 1, 2011. But first, there are a few hurdles to clear: They need to purchase and install a “certified” EHR, but they can't do that yet because none exists. And there is growing concern among providers about being in the back of a slow-moving line as vendors install the EHRs purchased by those providers who moved a little bit faster over those hurdles than they did.

"I understand those concerns," Wise said. "I think there's concern about a funnel being created, but the window is still wide enough that we shouldn't get in a panic yet."

The final rules released last week differed significantly than the proposed rules released Dec. 30, 2009, especially in the first stage of the program. In particular, thresholds for the use of computerized provider order entry, electronic prescribing, and the use of clinical quality measures were reduced, while measures for using IT to simplify administrative functions were deferred until later stages.

Also removed was an all-or-nothing approach that mandated that physicians meet 25 requirements and hospitals meet 23. These were changed to a list of 15 mandatory criteria for doctors and 14 for hospitals, with both being able to choose five items from a "menu" of 10 other requirements. Although the short time frame remains cause for concern, many on the provider side said they felt relief when they saw the final rules.

"When we looked at the 25 or so criteria, we practically had a heart attack," said Henry Ford Health System's Burgess.

The lowering of the requirements was good news, but what was even better was a change in definitions, Burgess said. She explained that the CMS, in an effort to avoid making duplicate payments to a hospital and its “hospital-based” physicians, had incorrectly defined a system's ambulatory doctors as "hospital-based."

After much lobbying, this definition was changed, and systems will be able to collect subsidies for the IT used by their outpatient physicians. Burgess said this change could result in $29 million more for Henry Ford Health System. She said the money is needed for maintenance of the system's CarePlus EHR and continued integration of that system at the former St. Joseph's Medical Center (now Henry Ford Macomb Hospital) it acquired in 2007 from Trinity Health.

—with Matthew DoBias