The American Recovery and Reinvestment
Act of 2009
Health Information Technology Incentives
American
College of Cardiology Summary
President Barack Obama on Feb. 17 signed into law the “American
Recovery and Reinvestment Act of 2009” (ARRA), authorizing $20 billion
to assist in the development of a robust health information technology
(IT) infrastructure. The law formally codifies the Office of the National
Coordinator (ONC), which is responsible for coordinating the health IT
programs created by the law; endorsing certification and standards; leading
the committees that fall under the ONC; and updating the Federal Health
IT Strategic Plan. Below is a summary of key information about the health
IT incentives.
The ACC has also created a list
of frequently-asked questions to assist members in understanding the
provisions.
Incentives for Adoption
ARRA authorizes $17.2 billion in incentives through Medicare and Medicaid
to assist providers in adopting health IT. From 2011-2015, physicians
that demonstrate “meaningful use” of electronic health record
(EHR) technology and performance during the reporting period of each payment
year will be eligible for positive payment incentives. Beginning in 2015,
physicians who are not meaningfully using EHRs will receive negative Medicare
payment updates.
The law defines a meaningful user as a physician who:
- Uses a certified EHR in a meaningful manner, which includes the use
of electronic prescribing (e-prescribing)
- Uses a certified EHR that can accommodate the electronic exchange
of health information to improve quality
- Submits information on clinical quality measures, as chosen by the
Health and Human Services (HHS) Secretary, for the reporting period
The law defines a certified EHR technology as that which
includes patient demographic and clinical health information, including
medical history and problem lists, with the ability to provide clinical
decision support. The decision support tools should support physician
order entry and be able to capture and query quality information. The
tools should also be able to exchange and integrate health information
from outside sources.
Physicians are able to receive incentives equal to 75
percent of their allowable Medicare Part B charges, subject to the following
caps:
First payment year: $18,000 in 2011 or 2012; $15,000 in 2013; $12,000
in 2014
Second payment year: $12,000
Third payment year: $8,000
Fourth payment year: $4,000
Fifth payment year: $2,000
Beginning in 2015, the penalties are as follows:
2015: -1 percent of Medicare allowed charges
2016: -2 percent
2017: -3 percent
* Exceptions: Eligible professionals in a health professional shortage
area will receive a 10 percent increase in incentive payment amounts.
Health professionals who work in a predominantly rural area will receive
a 25 percent increase in payment amounts.
Physicians who quality for the health IT incentive will not be eligible
for the incentives offered under the CMS
e-prescribing program. The e-prescribing incentives run from 2009
to 2013.
Hospitals are also eligible to receive incentive payments if they are
meaningful users of certified EHR technology, although the payment structure
is significantly different.
Other Provisions
- Standards: The law determines that an initial set
of standards will need to be adopted by Dec. 31, 2009, that will include
implementation specifications and certification criteria.
- Education: The law authorizes the development of
a program that will provide health care providers with health IT technical
assistance, and develop and publicize best practices that can ease the
adoption, implementation and utilization of health IT.
- Open Source Study: The law requires by no later
than Oct. 10, 2010, the completion of a study that examines the availability
of open source health IT systems; the total cost of ownership of these
types of systems, compared to proprietary commercial products; and capacity
of open source systems to facilitate interoperability.
ACC Recommendations
The ACC recommends that members who do not currently use an EHR begin
the process of adoption in 2009 and implement a system no later than 2010
in order to receive the maximum bonuses available under the program.
Practices interested in implementing EHR systems should be sure that
EHR vendors provide a guaranteed upgrade path that ensures their products
will meet certification criteria as established by HHS. Including this
requirement will also benefit practices interested in purchasing and implementing
systems in 2009. The ACC also recommends purchasing a CCHIT-certified
EHR.
Given the many benefits of using health IT, including reduced administrative
cost and medical errors, the ACC highly encourages members to take advantage
of the federal funding available from 2011-2015. The funding can significantly
offset the cost of adopting this technology.
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