Thursday, December 6, 2012

10 Billion Dollars in Electronic Health Record Incentives

EHR incentive payments have reached over $9 billion to 177,100 physicians and hospitals through November and are estimated to reach $10 billion by the end of the year. Robert Anthony, from the CMS Office of eHealth Standards and Services, gave an update at the December 5, 2012 meeting of the Health IT Policy Committee (see below). “We saw a large number of hospitals come in November: 525 hospitals were paid by either Medicare or Medicaid,” he said. This was in addition to the 12,250 new EP's paid during that month. "The incentive payments were almost $1 billion more in November. We are on track for the end of December to hit the $10 billion mark for EHR incentives," he added.

Mr. Anthony reported that the most popular meaningful use menu objectives for physicians are those related to drug formulary, immunization registries; and generating patient lists. For hospitals they were advance directives, drug formulary, and clinical laboratory test results. For e-copy of health information a large majority of physicians and hospitals took exclusions due to patients not requesting a copy of there health information. However performance on this measure was very high where it applied. Hopefully in this next year consumers will begin to demand greater access to their health information.

He also reported data from the Regional Extension Centers which showed some the unresolved practice issues, provider engagement and administrative being the biggest challenges. This data also showed unresolved vendor issue challenges, with delays in implementation and problems with upgrade being substantial problems. This data is also broken out by practice type and it is interesting to see the results stratified by hospital or practice setting and especially the differences in rural and underserved areas.

A recent HHS Office of Inspector General (OIG) report found that the Medicare portion of the meaningful use program is vulnerable to fraud and abuse. After an article in the New York Times highlighting the report, some have been saying that this is a nail in the coffin for the program, and that the report points to the failure of the efforts and the funding so far has been wasted. There is even talk that the EHR Incentive Program should be sacrificed on the fiscal cliff altar. I think it would be wise examine the details of the report, and also look to the future as we continue down this path.

The OIG report states that CMS didn’t verify the information doctors and hospitals self-reported about how their EHR systems function and recommended that CMS "obtain and review supporting documentation from selected professionals and hospitals prior to payment to verify the accuracy of their self-reported information.” But CMS told the OIG that "prepayment reviews would increase the burden on practitioners and hospitals and could delay incentive payments."

Linda Fishman, from the American Hospital Association, said, "The OIG report contains no evidence of improper payments," Fishman said. "Hospitals take seriously their obligations to provide accurate reports to Medicare, and are working diligently to comply with the highly complex regulatory requirements in the meaningful use program. In addition, CMS is currently conducting audits of hospitals that have received meaningful use payments." Echoing these sentiments American Medical Association Board Chair Steven J. Stack, MD said, "We oppose prepay audits in the meaningful use program, as they would impose additional burdens on physicians who already face separate program requirements for multiple Medicare health IT and quality programs."

While there have certainly been some challenges, I think we need to give the program time to work. As Congress looks for ways to avoid the "fiscal cliff" and find places to reduce federal expenditures, they should think very carefully before breaking the promise to providers and hospitals who have made some serious investments on this meaningful use journey. As Farzad Mostashari recently said, "We have crossed to a new shore and the boats are burned behind us. There is no going back..."

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