There is no doubt that the HITECH Act has been an important catalyst in helping jettison the healthcare industry into the 21st Century. A change that was desparately needed but one which would NOT likely have come about without a little help from Uncle Sam.
Interviewed regarding his new book, The New New Deal: The Hidden Story of Change in the Obama Era (Simon & Schuster), TIME magazine correspondent Michael Grunwald, sez the following about HITECH:
A central pillar of that mammoth, $800 billion dollar legislation, of course, is devoted to digitizing the nation's medical records and rewiring healthcare for the 21st century...
Although I agree with Michael that the Obama administration deserves credit for taking advantage of the political climate to "sneak this through," the reality is that some of the best and brightest had been working on the problem (both private and public sectors) for well over twenty years.
No one that knows anything about how Washington works believes that this huge piece of legisation sprang into existence after Obama took the oath of office.
If you need tools that will help with your compliance initiatives then check out the HSG Store. Do you need an Internet Lawyer with HITECH /HIPAA experience?
This article addresses the kinds of information that must be tracked in order to receive your EHR Incentives under the meaningful use stage 1 requirements. Clearly there is quite a bit of information that needs to be tracked, most of which will be coming from a provider's EHR system. However, the information in an EHR system is not static. Therefore, providers must capture all required information to legally attest to HITECH Act compliance as a snapshot in a point in time, which is not a trivial task given the complexity of the objectives.
We assume that most readers are now familiar with the concept of meaningful use, but we will nonetheless provide a brief introduction to set the stage. We will also discuss other issues regarding meaningful use such as the attestation process, CMS audits, and tools that can help you comply. The focus here will be on Stage 1 meaningful use objectives and measures. Stages 2 and 3 remain too ill defined to warrant further comment at this time.
If you need tools that will help with your compliance initiatives then check out the HSG Store. Do you need an Internet Lawyer with HITECH /HIPAA experience?
The current version of Healthcare IT News (inset paper edition) indicates that there are 525 certified EHRs for ambulatory practices. It is somewhat startling that the market can support so many players and there will surely be consolidation in the future. However, if you are looking for the right EHR for your practice today this is what you have to contend with. Our EHR Toolkit will help you jumpstart your selection initiative.
If you need tools that will help with your compliance initiatives then check out the HSG Store. Do you need an Internet Lawyer with HITECH / HIPAA experience?
What are the requirements for Stage 1 of Meaningful Use (2011 and 2012)? Meaningful use includes both a core set and a menu set of objectives that are specific to eligible professionals or eligible hospitals and CAHs.
For eligible professionals, there are a total of 25 meaningful use objectives. To qualify for an incentive payment, 20 of these 25 objectives must be met.
There are 15 required core objectives.
The remaining 5 objectives may be chosen from the list of 10 menu set objectives.
For eligible hospitals and CAHs, there are a total of 24 meaningful use objectives. To qualify for an incentive payment, 19 of these 24 objectives must be met.
There are 14 required core objectives.
The remaining 5 objectives may be chosen from the list of 10 menu set objectives.
The information pertaining to meaningful use compliance must be tracked for each eligible professional ("EP") in a practice. Therefore, you will need a rigoruous and systematic methodology for gathering and reporting the information.
If you need tools that will help with your compliance initiatives then check out the HSG Store. Do you need an Internet Lawyer with HITECH / HIPAA experience?
Essentially an eligible professional ("EP") or eligible hospital ("EH") will be signing a legal document (electronically), probably under penalty of perjury, that they have met the Stage 1 Meaningful Use Requirements (see this presentation and/or spreadsheet for a more readable format of the objectices and measures) and are therefore entitled to receive their EHR Incentives. Each EP (e.g. doctor) in a private practice will need to make this attestation. Therefore's each doctor's compliance efforts will have to be tracked separately. EPs and EHs need to be careful regarding who they listen to with respect to this legal obligation. Both the EHR vendors and CMS have a vested interest in over simplification, given their respective agendas, which can more or less be summarized as encouraging the rapid adoption of certified meaningul use technologies. This does not, standing alone, imply sinister motives on the part of these organizations, but neither should it encourage a cavelier attidude toward a legally binding agreement on the part of EPs and EHs. After all, it is NOT the EHR vendors or CMS that is signing under penalty of perjury.
If you need tools that will help with your compliance initiatives then check out the HSG Store. Do you need an Internet Lawyer with HITECH / HIPAA experience?
Any provider attesting to receive an EHR incentive payment for either the Medicare EHR Incentive Program or the Medicaid EHR Incentive Program potentially may be subject to an audit. Here's what you need to know to make sure you're prepared:
Overview of the CMS EHR Incentive Programs Audits
All providers attesting to receive an EHR incentive payment for either Medicare or Medicaid EHR Incentive Programs should retain ALL relevant supporting documentation (in either paper or electronic format used in the completion of the Attestation Module responses). Documentation to support the attestation should be retained for six years post-attestation. Documentation to support payment calculations (such as cost report data) should continue to follow the current documentation retention processes.
CMS, and its contractors, will perform audits on Medicare and dually-eligible (Medicare and Medicaid) providers.
States, and their contractors, will perform audits on Medicaid providers.
CMS and states will also manage appeals processes.
Preparing for an Audit
To ensure you are prepared for a potential audit, save the supporting electronic or paper documentation that support your attestation. Also save the documentation to support your Clinical Quality Measures (CQMs). Hospitals should also maintain documentation to support their payment calculations.
Upon audit, the documentation will be used to validate that the provider accurately attested and submitted CQMs, as well as to verify that the incentive payment was accurate.
Details of the Audits
There are numerous pre-payment edit checks built into the EHR Incentive Programs' systems to detect inaccuracies in eligibility, reporting and payment.
Post-payment audits will also be completed during the course of the EHR Incentive Programs.
If, based on an audit, a provider is found to not be eligible for an EHR incentive payment, the payment will be recouped.
CMS will be implementing an appeals process for eligible professionals, eligible hospitals and critical access hospitals that participate in the Medicare EHR Incentive Program. More information about this process will be posted to the CMS Web site soon.
States will implement appeals processes for the Medicaid EHR Incentive Program. For more information about these appeals, please contact your State Medicaid Agency.
Clearly there is quite a bit of information that needs to be tracked, most of which will be coming from the provider's EHR system. However, the information in an EHR system is not static and therefore providers must capture all their required information to legally attest as a snapshot of a point in time and be able to relate this information back to the applicable meaningful use stage 1 requirements at a granular level. This reporting burden is non trivial and should be attacked in a formal and rigorous manner.
If you need tools that will help with your compliance initiatives then check out the HSG Store. Do you need an Internet Lawyer with HITECH / HIPAA experience?
Here's what the ONC says is all you have to do to meet the Meaningful Use Requirements and get your EHR incentives:
Successfully register for the Medicare EHR Incentive Program;
Meet meaningful use criteria using certified EHR technology; and
Successfully attest, using CMS' Web-based system, that you have met meaningful use criteria using certified EHR technology.
Of course, meeting these requirements are not quite as straightforward as ONC leads one to believe, despite the fact that ONC has done yeoman's work in providing high quality and enormously useful content, that only gets you so far. As discussed below, eligible professionals (EP) and eligible hospitals (EH) will have to "legally attest" that the requirements have been met. This requires knowledge (and tracking) of the specific regulations that apply. Why? So that when an audit comes EPs and EHs can make a good faith argument that they have attested according to applicable law. Despite the fact that the raw data for attesting legally is contained within your EHR, your EHR software generally provides little or any guidance regarding how to meet the legal requirements. For that you need a different kind of tool and/or a much deeper understanding of the controlling regulations.
Summary of Attestation
How will I attest for the Medicare and Medicaid Incentive Programs?
Medicare eligible professionals, eligible hospitals and critical access hospitals will have to demonstrate meaningful use through CMS' web-based Registration and Attestation System. In the Medicare & Medicaid EHR Incentive Program Registration and Attestation System, providers will fill in numerators and denominators for the meaningful use objectives and clinical quality measures, indicate if they qualify for exclusions to specific objectives, and legally attest that they have successfully demonstrated meaningful use. A complete EHR system will provide a report of the numerators, denominators and other information. Then you will need to enter that data into our online Attestation System. Providers will qualify for a Medicare EHR incentive payment upon completing a successful online submission through the Attestation System—immediately after you submit your results you will see a summary of your attestation, and whether or not it was successful. The Attestation System for the Medicare EHR Incentive Program will open on April 18, 2011.
For the Medicaid EHR Incentive Program, providers will follow a similar process using their state's Attestation System. Check here to see states' scheduled launch dates for their Medicaid EHR Incentive Programs: http://www.cms.gov/apps/files/statecontacts.pdf.
If you need tools that will help with your compliance initiatives then check out the HSG Store. Do you need an Internet Lawyer with HITECH / HIPAA experience?
Here's one family practitioner's testimonial as to why EHRs are an important mission critical part of a practice (for the full interview click on the link above). Sure Dr. Brull is happy to get the EHR incentive dollars, BUT she is much happier that she is providing better care to her patients (and likely sleeps better because of it).
You can't manage want you don't measure and track. In this case, automatic notices made a huge difference in the life of three patients.
If you need tools that will help with your compliance initiatives then check out the HSG Store. Do you need an Internet Lawyer with HITECH / HIPAAexperience?
A central pillar of that mammoth, $800 billion dollar legislation, of course, is devoted to digitizing the nation's medical records and rewiring healthcare for the 21st century...
