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 Final rules for the U.S. Department of Health & Human Services’ (HHS) Health Information Technology for Economic and Clinical Health (HITECH) electronic health records (EHR) program, released July 13, will make it easier for health care practitioners to qualify for EHR utilization incentives — with greater flexibility, fewer requirements, and lower reporting thresholds, according to department officials.

However, health care providers can still face difficulties in adopting EHR systems, HHS National Coordinator for Health Information Technology David Blumenthal, M.D. acknowledged during a press conference.

The HHS’ Centers for Medicare & Medicaid Services (CMS) estimates only about one- to two-thirds of eligible health care professionals will qualify for limited-time payment bonuses that, beginning in 2011, will be offered under the Medicare and Medicaid programs for health care practitioners who install EHR systems and meet criteria for the “meaningful use” of those records systems in patient care.

The AOA Health Information Technology Subcommittee is hoping optometrists will exceed those national EHR implementation averages and is offering a range of educational programs and services to help, according to Chair Philip Gross, O.D. (see related article).

The EHR incentive programs, as slated to take effect next year, reflect a number of successful efforts by AOA over the past two years to shape both the authorizing legislation and the program rules, according to AOA Advocacy Group Director Jon Hymes.

“During late 2008 and early 2009, the AOA secured important changes to the health information technology (HIT) provisions of President Obama’s economic stimulus bill that are aimed at allowing for recognition and participation of ODs in Medicare and Medicaid EHR physician adoption incentive programs,” Hymes said. “Since enactment of the legislation in February 2009, the AOA has monitored and provided input to CMS with regard to the agency’s development of regulations to implement these incentive programs.”  

Additional efforts by organized optometry will be necessary on both the legislative and regulatory fronts, Hymes said.

Utilization criteria

Authorized last year under the American Recovery and Reinvestment Act (ARRA), the HITECH incentive program will allow health care practitioners who meet EHR utilization requirements to qualify for up to $44,000 in Medicare payment bonuses over a five-year period (up to $48,400 in federally designated health profession shortage areas) or up to $63,750 over six years under Medicaid. Health care practitioners who are not “meaningful users” of EHRs will face Medicare phased payment reductions, gradually increasing from 1 percent to as much as 5 percent, beginning in 2015.

All optometrists who provide physician services to Medicare beneficiaries are eligible for the Medicare incentives. 

The Medicaid incentives are only available to doctors who demonstrate that Medicare patient constitute 30 percent of their patient volume.

Practitioners can take part in either the Medicare or Medicaid incentive but not both. Most optometric practices will probably in the Medicare EHR incentive program, the AOA Advocacy group notes.

To participate in the incentive programs, health care practitioners must first install properly certified EHR software (see related article). They must also then meet EHR utilization requirements outlined in last month’s final rule.

The EHR utilization criteria outlined in the final rule is designed to be “ambitious but achievable,” Dr. Blumenthal said.

To qualify for incentives during the first year of the program, a health care practitioner will have to meet 20 utilization objectives (see related story) consisting of:

• 15 core objectives that all health care practitioners will have to achieve, and
• Five additional objectives, which a health care practitioner can select from a “menu” of 10.

Core objectives include the tasks essential to creating any medical record, including the entry of basic data such as patients’ vital signs and demographics, active medications and allergies, up-to-date problem lists of current and active diagnoses, and smoking status, according to the HHS.

“They comprise the basic functions that enable EHRs to support improved health care,” Dr. Blumenthal said.

The menu of 10 additional tasks, from which providers can select “gives providers latitude to pick their own path toward full EHR implementation and meaningful use,” he said.

Health care practitioners would have had to meet 25 objectives under a set of utilization requirements proposed by HHS earlier this year.

Reporting thresholds for each objective have been reduced, and in many cases simplified, compared with the utilization requirements initially proposed by the HHS.

For example, to meet the objective for electronic prescribing, health care practitioners will now be required to issue 40 percent of their prescriptions electronically – as opposed to the 75 percent originally proposed by HHS.

Among the core objectives will be the reporting of designated quality of care measures.

Health care practitioners will be able to report up to six measures – depending on applicability to practice.

The department initially planned to allow practitioners to report from a roster of 44 measures.

To meet a clinical decision making support objective, a practitioner will now have to implement only one clinical decision rule in the practice EHR system, as opposed to the five originally proposed by HHS.

The final EHR utilization criteria issued last month reflects comments from more than 2,000 health-related organizations – including AOA – many of whom contended that the EHR utilization criteria originally proposed by HHS were too inflexible.

The EHR utilization criteria announced last month will be applicable in 2011 and 2012.

The HHS estimates about 550,000 to 600,000 U.S. health care practitioners are eligible to participate in the Medicare EHR incentive program.

The department believes from 10 percent to 36 percent of those practitioners will meet utilization requirements and qualify for payments during 2011, the first year of the incentive program.

The department predicts that 36 percent to 70 percent will qualify by 2019, the last year during which federal EHR incentives will be offered.

While most optometric practices will probably participate in the Medicare EHR incentive program, the AOA Advocacy Group is taking steps to ensure that optometrists can, instead, take part in the Medicaid incentive program if they wish to. 

While the CMS has specifically confirmed that optometrists are eligible for the Medicare incentives, the agency says only that optometrists are potentially eligible for Medicaid incentives, depending on state law.

Under the CMS regulations, optometrists in those states that recognize ODs as providers of physician services under Medicaid will be eligible for Medicaid EHR incentives. That means, in most states, optometrists would be excluded.

Lawmakers in Congress have clearly indicated they intend for ODs to be recognized as physicians and able to participate fully in either the Medicare or Medicaid EHR program, Hymes said.    

The AOA Advocacy Group is currently conducting a study to determine where ODs will, and will not be, eligible for the Medicaid EHR incentive programs.

The AOA Advocacy Group is also assessing a range of regulatory, legislative and legal steps that could be taken to “improve these flawed Medicaid EHR regulations,” Hymes said.

For additional information on the final EHR meaningful use criteria, see the AOA Web site Electronic Health Records page (www.aoa.org/EHR).