Information Technology Reference
In-Depth Information
that an equal percentage send secure electronic messages to their provider. As we'll
see later on, these new core measures promote wider use of Personal Health Records
and the new DIRECT approach to health information exchange. At least one useful
comparison of the three stages in chart form is posted on the Internet. [
6
]
The specifics are the subject of debate, discussion, and negotiation. However,
even a casual inspection of these examples should reveal how closely they align
with the data logistic problems of chronic disease management. They are clearly
designed to move electronic health record system vendors and their customers from
“basic” to “fully functional” use of the technology. Finally, in many cases, they
align well with the original arguments made by Dr. Larry Weed for electronic
records back in the 1960's and quoted in part at the beginning of the topic.
The Medicare and Medicaid EHR Incentive Programs
These are complex programs we won't cover broadly here. There is an official site
[
7
] and a good article that summarizes the programs for health providers.
[
8
] Providers are termed “eligible professionals”. The definition of this is different
under the Medicare and Medicaid incentive programs but extends beyond licensed
physicians in both. Eligible professionals can be reimbursed for their investment in
a certified electronic health record system up to $44,000 over five years under the
Medicare EHR Incentive Program and up to $63,750 over six years under the
Medicaid program.
There are criteria for whether or not a provider practice is eligible based on their
volume of Medicare or Medicaid patients. Providers cannot participate in both pro-
grams. Medicare is run by the federal government so it is uniform across the coun-
try. Medicaid is run by each state with some funding from the federal government
so, as with all Medicaid policies, the details can vary by state. Those providers who
do not achieve Meaningful Use by 2015 will see a downward adjustment in their
Medicare payments. The amount of this adjustment will grow through 2020 when it
will reach 5%. There are currently no payment adjustments under the Medicaid
program.
These incentive programs were clearly designed to resolve the incentive discon-
nect with respect to who invests in electronic records and who benefits from them.
In other words, the federal government acknowledges that the main beneficiaries
will be the organizations that pay for healthcare - primarily the government itself
and employers providing health insurance. As a result, the government will cover
the investment for eligible professionals who install electronic records and use them
in a manner that should, at least in theory, improve the quality and efficiency of
healthcare. The final tally is still years off, but adoption has clearly increased and I
believe this substantial investment is also paying off in ways that weren't necessar-
ily predicted up front. It has become a driver for innovation. We will look at specific
examples of these innovative new technologies in
Chapters 4
through
7
.
