Healthcare Reform Resource Center
With the introduction of new legislation such as the HITECH Act and the Affordable Care Act, the healthcare industry has been bombarded with information about mandates and regulations. Keeping up with the changes and getting the facts straight can seem daunting. In response, we created this Healthcare Reform Resource Center which includes an FAQ section and links to help educate healthcare professionals on how they are affected by healthcare reform.
What is the HITECH Act? The HITECH (Health Information Technology for Economic and Clinical Health) Act is part of the American Recovery and Reinvestment Act of 2009 (ARRA). The Act outlines many new initiatives for the use of technology in the healthcare industry, including the mandatory implementation of an EMR/EHR system.
How does the HITECH Act affect doctors and hospitals? The HITECH Act mandates that by 2015 doctors and hospitals must be using a certified EMR/EHR system, otherwise known as EMR/EHR compliant. But they must also adhere to established criteria of “meaningful use”, which includes up to 30 measures and objectives. For example, one of these criteria is electronically record a patient’s weight, height and calculation of BMI within their EMR/EHR system.
What is the purpose behind the HITECH Act and meaningful use? The motive behind these new mandates is that it focuses on electronically capturing health information in a structured format; using that information to track key clinical conditions and communicating that information for care coordination purposes. The goal is to use EMR/EHR’s to engage patients and families and reporting clinical quality measures and public health information.
How will meaningful use criteria be enforced? Doctors and hospitals will submit their data to the Department of Health and Human Services. Submitting this data is part of proving meaningful use and then HHS will determine if they are meeting the objectives.
Is the government giving money to doctors and hospitals to cover technology expenses? To help kick-start the adoption of EMR/EHR and encourage providers to become compliant, the government started the EHR Incentive Program which provides eligible hospitals and physicians reimbursement payments for costs incurred while implementing new technology.
What is the EHR Incentive Program? The Medicare and Medicaid EHR incentive programs will provide incentive payments to eligible professionals and eligible hospitals as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology. These incentive programs are designed to support providers in this period of Health IT transition and instill the use of EHRs in meaningful ways to help our nation to improve the quality, safety and efficiency of patient health care. Source: www.cms.gov/EHRIncentivePrograms/
Who qualifies for these incentive payments?
- Doctor of medicine, osteopathy, podiatric medicine
- Doctor of dental surgery or medicine
- Doctor of optometry
- Hospitals (paid under inpatient prospective payment system, IPPS; Critical Access Hospitals, CAHs; Medicare Advantage hospitals)
- Certified nurse-midwives
- Nurse practitioners
- Physician assistants, in some settings
- Hospitals with at least 10% Medicaid
What types of medical practices do not qualify for HITECH incentives?
- Free clinics that don’t bill Medicare or Medicaid
- Physical therapists
- Hospital-based physicians such as pathologists, anesthesiologists or emergency physicians
- Acupuncturists and other holistic providers
- Any practice not eligible for Medicare or Medicaid payments
How do we receive our incentive payments? Eligible hospitals or physicians must successfully demonstrate "meaningful use" of an EHR system for a consecutive 90-day period in their first year of participation and for a full year in each subsequent year to participate in the program and receive incentive payments. The direct link to begin registration for the EHR Incentive Program is https://ehrincentives.cms.gov/hitech/login.action.
What if a physician or hospital does not comply by 2015? Those who are not compliant by 2015 will lose federal subsidies and be penalized with diminished Medicare and Medicaid payments.
What is the benefit of using EMR/EHR systems? There are many benefits to a paperless charting system and automatic transmission of information. EMR/EHR systems allow for consistent documentation, no handwritten legibility issues, and increased patient privacy. New technology can also help with a more efficient workflow and less transcription and prescription errors.
What is the first step to becoming EMR compliant? If you aren’t already using an EMR/EHR system, the first step is to research which certified system works best for your healthcare setting. There are numerous EMR/EHR system vendors so be sure to choose one that has a certified system and a vendor that can help educate you on how to use the system to meet the meaningful use criteria. To see a list of certified systems visit www.cchit.org/. Once the EMR/EHR system is implemented, educate yourself and your staff about the meaningful use criteria and begin making the necessary changes in your workflow to meet these standards. The Centers for Medicare and Medicaid services created training courses for both eligible professionals and eligible hospitals. Click on the links below for their comprehensive resource.
Will I have to buy other new equipment, besides EMR/EHR software to become compliant? It is very likely that you will also need to update other equipment that is EMR/EHR connected. For example, you may need a new vital signs monitor that uploads the patient’s temperature or blood pressure directly into their EMR/EHR. You may also need a scale that is capable of transmitting a patient’s weight either directly into your EMR/EHR system or into a spot monitor. You will also need equipment to measure a patient’s height and Body Mass Index (BMI).
What is Body Mass Index (BMI)? Body Mass Index (BMI) is a ratio between a person’s weight and height and interpreted as a BMI score. This BMI score is then used as a tool to categorize a patient as underweight, normal, overweight, obese or morbidly obese.
What does BMI have to do with the new Healthcare regulations? One of the mandates put forth in the 2009 Stimulus Act requires that practitioners track a patient’s Body Mass Index (BMI) in addition to weight and height.
Why is the government concerned with BMI and why does this measure have to be tracked as part of EMR/EHR compliance? According to the CDC, “BMI provides a reliable indicator of body fatness for most people and is used to screen for weight categories that may lead to health problems.” Providers will have to electronically share their patients’ BMI scores with the CDC and other health agencies, which will streamline data collection and lead to more accurate assessment of public health. These objectives correlate with one of the goals of healthcare reform which is to decrease healthcare costs related to preventable diseases. For example, those with a BMI score in the overweight and obese range are at increased risk for many diseases and health conditions, including the following:
- Dyslipidemia (for example, high LDL cholesterol, low HDL cholesterol, or high levels of triglycerides)
- Type 2 diabetes
- Coronary heart disease
- Gallbladder disease
- Sleep apnea and respiratory problems
- Some cancers (endometrial, breast, and colon)
In essence, by measuring BMI and guiding patients to a healthier lifestyle, providers may be able to help decrease healthcare costs related to these illnesses.
What is the Affordable Care Act? Signed into law on March 23, 2010, this Act has multiple sections all aimed at helping Americans obtain affordable health coverage, reduce healthcare spending and improve the overall quality and efficiency of healthcare.
How does the Affordable Care Act affect doctors and hospitals? Some programs developed as part of the Affordable Care Act have direct mandates that affect healthcare providers and some programs are incentive programs to improve the quality of care. See the questions below for more information.
What is the Medicare Shared Savings Program? The Centers for Medicare and Medicaid Services (CMS) established the Medicare Shared Savings Program, which began January 1, 2012. The goal of the program is to keep Medicare patients healthy and reduce hospital admissions and readmissions by providing high quality care and improving communication between the patient’s physicians. To participate in the program providers must create or participate in an Accountable Care Organization.
What is an Accountable Care Organization? ACO refers to a group of healthcare providers such as hospitals, physicians, or clinics, that have voluntarily joined together to coordinate the treatment and care of their Medicare patients.
How can ACO’s receive money as part of the Medicare Shared Savings Program? The Medicare Shared Savings Programs evaluates the ACO’s performance to meet quality standards in five key areas: patient/caregiver care experiences, care coordination, patient safety, preventive health and at-risk population/frail elderly health. The at-risk population includes those with the following diseases: Diabetes, Hypertension, Ischemic Vascular Disease, Heart Failure and Coronary Artery Disease. Based on the ACO’s performance score on the quality measures and if their costs have not exceeded a benchmark set by the CMS, they are given bonus payments as part of the shared savings.
How does the Affordable Care Act help physicians in rural areas? Community Health Centers, a main provider of primary care for many rural communities, will get more funding, enabling them to nearly double the number of patients they see. The Act also expanded the National Health Service Corps – a program that repays loans and gives scholarships to primary care providers who work in areas of the country with too few health professionals.
Are there any healthcare reform programs specific to hospitals only? Effective with discharges on or after October 1, 2012, the Hospital Value-Based Purchasing program will increase or decrease Medicare payments for inpatient acute care services based on care quality, not just the quantity of the services provided. Hospitals are evaluated on their performance on a variety of measures, including if they:
- Ensure that patients who may have had a heart attack receive care within 90 minutes
- Provide care within a 24-hour window to surgery patients to prevent blood clots
- Communicate discharge instructions to heart failure patients
- Ensure hospital facilities are clean and well maintained
- Provide a high quality patient experience of care
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