Watch our tutorial:  Hitech Stimulus Plan   

We have prepared two tutorials to help you understand the HITECH stimulus plan, clinic Pro's response and how it affects your practice.  In the first tutorial, we will discuss what is known about the stimulus plan.  In the second tutorial, we will discuss the unknowns, the multitudes of questions that have yet to be answered.  Before the plan can be effectively administered, these questions will need answers. 

The stimulus plan was created as a cost saving measure.  By encouraging doctors and hospitals to share information about patient treatment, costly medical mistakes can be avoided.  This is especially important when more than one physician is prescribing medications that may interact with each other.  The stimulus bill will also eliminate costly duplication of tests if all of the treating physicians have access to previous medical history.  The third focus of the act is to gather data about treatment protocols and their outcomes.  It is this portion of the act that has raised concern amongst medical professionals.  Let's just take an example.  Suppose that there are 10 treatment modalities for atrial fibrillation.  After gathering data for 10 years, the government has determined that five of the treatments are more effective than the rest.  Will doctors be forced to choose one of the five treatments even though another protocol might be more effective for a particular patient?  That, in a nutshell, is the concern.  If we focus entirely on outcome, are we missing important individual differences?

Let's talk about what we know.  The following types of providers are eligible to receive stimulus incentives.  They are medical doctors, osteopaths, podiatrists, dentist surgeons, optometrists and chiropractors.  We also know that in the health care profession people are scrambling to come up with an EMR.  It has attracted investor interest much like the programs that focus on green energy. Everyone wants a piece of the pie. 

If you fit in one of these categories as a healthcare provider, you can qualify to receive stimulus incentives if you adopt an EHR/EMR program and can demonstrate meaningful use of that program.  The stimulus bill defines meaningful use by citing three characteristics:  #1 The EMR must be certified  #2 The EMR must be capable of exchanging personal health information and #3 the EMR must be capable of collecting and submitting treatment data.  The stimulus or incentive money is not tied in any way to the purchase price of the EMR.  It is tied to claim submission to the two government programs: Medicare and Medicaid.  If you do not submit claims to Medicare or Medicaid, you are not eligible.  You do not have to participate or submit claims as a participating provider with Medicare to be eligible.

Your reimbursement or incentive will be based on the allowed charges that you are submitting to Medicare.  For the first two years, the stimulus plan caps the reimbursement at $18,000.  In order to qualify for the maximum reimbursement, you must have submitted 25,000 in allowable Medicare charges.  That is 133% of the maximum reimbursement.  If you submit only 12,000 in allowable charges, your maximum reimbursement would be approximately $9,000.  As you can see, the maximum reimbursement is capped every year, depending on when you qualify and when you submit for reimbursement.  In all, you can receive up to a total of $44,000 over a period of five years from Medicare.  To be eligible for Medicaid reimbursement, at least 30% of your patient must be receiving medical assistance.  For pediatricians only, this percentage is lowered to 20%.  If you choose to receive Medicaid reimbursement, you can receive up to $64,000.  You cannot collect from both Medicare and Medicaid.  You must choose your reimbursement vehicle.

We have displayed the Medicare reimbursement schedule on a graph to make it easier to understand.  In the first year that the stimulus plan incentives are available, the year 2011, you can collect up to $18,000.  In the second year, 2012, you can also collect up to $18,000.  You will notice that if you do not have an EMR in place by 2013, the total reimbursement that you can collect is smaller.  There is an incentive built into the plan for early adoption of a qualifying EMR.

On the screen, you will see a list of providers that are not eligible for Medicare reimbursement.  Any hospital based physician is not eligible because the hospital usually provides the EMR.  This includes anesthesiologists and emergency room doctors.  There are other professionals such as physician assistants, psychologists, physical therapists and occupational therapists that are not eligible under the Medicare plan.  On the bottom of the screen, we have a list of professionals such as nurse practitioners, physician assistants and certified midwives that may be eligible under the Medicaid plan if they meet the 30% qualifying factor.  This concludes the first part of the tutorial which covers all of the things that we know about the stimulus plan. 

Now let's go on to the unknowns, the multitudes of questions that still need to be answered before money is disbursed.  First of all, we do not know what type of paperwork you might need to submit to request reimbursement nor do we know how the money will be disbursed.  It may come as a lump sum payment annually or as installments.  The timing of the disbursement is not known.  There are also certain specialties that may not qualify even though they are staffed by medical doctors.  For example, a sports clinic or an industrial clinic may not qualify because they do not serve Medicare or Medicaid patients.  A psychiatrist may also be ineligible based on the population that is served.  Remember, the stimulus program is designed specifically to reduce costs for the two federal insurance programs, Medicare and Medicaid.

As a software vendor, we are looking specifically at the qualifications of meaningful use.  First of all, your EMR must be certified.  Right now there is only one organization that is currently certifying EMR's – CCHIT.  This includes the ability to electronically prescribe, order and receive lab tests, record immunizations, record exam results and meet a series of criteria relating to the security of the EMR that dictate who has access to the information and the level of access that each staff member can be granted.  Since optometrists and chiropractors do not need many of the requirements of the current certification, it would make sense that an alternative certification be available.  We do not know if this will happen.  We also do not know if there will be a less costly alternative to CCHIT.

Another large unknown is the extent to which interoperability will be implemented and how that implementation will take place.  It is anticipated that requirements may develop to share imaging and radiology, force reporting to CDC or other agencies, implement registry entries for immunizations or even exchange information with personal health records that patients are maintaining.  From our perspective, that would be the best scenario.  We would like to see the patient in charge of their health care through their own individual personal health record or PHR.  The method of exchanging information is also unknown.  We currently send electronic billing information through an ANSI format.  Lab requests are handled by HL7 format.  XML is an easy way to import and export data.  It should be considered as one of the options.

 The final big unknown is how data will be collected about treatment protocol and outcomes.  There are no standards whatsoever at this point in time.  Even though the standards are supposed to be in place by the end of 2009, most people in the industry expect that they will be evolving over the next five years, in other words --a moving target. It is so much fun to try to hit a moving target.

So what is Clinic Pro's response to all of the stimulus information?  First of all, we have developed and released our online personal health record or PHR.  This is available today.  This personal health record was developed so that patients could complete their entire medical history prior to coming  to your office.  This will eliminate the clipboard with 10 sheets of paper to fill out.  When the patient enters your office, their complete medical history will be available to our online EMR.  While we currently have a desktop EMR, we think it is important to move everything online.  We are developing an online scheduler.  We are developing the ability for you to record vitals, immunizations, diagnoses and procedures online.  We will be taking our touchscreen templates online.  In the next two weeks, we will be testing our ability to receive lab results and display them for your office.  We are building a lab order interface.  We are partnering with an electronic prescription software company.  All of these plans are aimed specifically at certification.  As part of her emphasis on online capabilities, you will be able to download a small program to a USB drive and access your online EMR from any computer with Internet access.  You would also be able to use a netbook computer or wireless handheld.  In the future, we are also looking at access via your cellphone.  We want you to be able to connect to your EMR and to patient records from where ever you are.

We also want to share with you our business model.  From our perspective, a person's health care should begin with the patient and end with the patient.  At all times, the patient should be kept in the communication loop.  The patient should receive regular communication from his or her doctor.  The doctor should make patient education materials available.  When a patient goes into the hospital, the discharge summary and hospital records should be available to the patient.  Medication history and allergy information should be available to emergency personnel when they respond to a medical situation.  First and foremost, the patient should always be aware of the doctor's treatment and recommendations.  In the past, electronic medical records have been used mostly by the doctor.  The patient never sees the information.  With our business model, you - the doctor - will be sharing your exam notes and test results with the patient online.  That way, the patient can review your recommendations and your education material at their leisure.  They can share it with their families.  Health care will become a family affair, like it should be. 

With our online personal health record, you can get started today receiving quality information from your new patients.  Please take time to download and look at the complete medical history that is available to you right now.