Meaningful Stimulus Dollars for HIT

The passage of the American Recovery and Reinvestment Act provided important incentives to doctors to give up their paper records and transition to electronic health records (EHR).  According to a 2009 CompTIA study, 59 percent of healthcare providers indicated they definitely or probably will take advantage of stimulus dollars for healthcare IT projects. 

Under the HiTech Act (which was signed into law as a part of the Recovery Act), most doctors can receive up to $44,000 in Medicare rebates over a five-year period as an incentive to implement “meaningful use” of EHRs.  We certainly expect a large portion of these rebates will flow to VARs that build and install HIT systems for small medical practices.  Clearly, these rebates present an unprecedented market opportunity for CompTIA members to provide the services and software doctors will need to make the transition.

However, until recently, there has been a general hold on adopting HIT, because the definition of “meaningful use” had not been established.  This meant that VARs could not be specific about the systems requirements necessary to accommodate “meaningful use” of EHRs – which of course is the key to the $44,000 in rebates.  Now, at last, CMS has released the final rules on what will constitute “meaningful use”, at least for calendar years 2011 and 2012.

CMS has announced a set of “objectives” and “measures” for both doctors and hospitals.  Basically, an “objective” is the required goal and a “measure” is the criteria for determining whether an objective has been achieved.  While most objectives and measures are the same for both doctors and hospitals, a few apply only to hospitals and a few apply only to doctors.  So getting this straight can be tricky.  Further, CMS will implement these objective and measures in three phases, so this adds another overlay of fuzziness.  

Charts, prepared by Robin Raiford, RN-BC, CPHIMS, FHIMSS, executive director of federal affairs at the Eclipsys Corporation, provide a more detailed understanding of how the objectives and measures relate.

Let’s first turn to Phase I, which cover years 2011 and 2012.  To achieve meaningful use during Phase I, doctors will be judged against 15 “core” requirements and 10 “menu” items.  Each of the 15 core requirements must be met; however, for the ten menu items, each medical practitioner will satisfy the “meaningful use” standard by achieving only five that best suit their compliance capabilities at the time.  This will certainly allow small medical practices a better opportunity to transition into full compliance.  The objective here is to provide flexibility so that small practices can succeed in making the transition to EHR. 

Let’s take a single example here.  During Phase I, one of the 15 core requirements that must be achieved by a medical practitioner is, “Record smoking status for patients 13 years old or older.”

During Phase I (2011 and 2012) this core requirement will be satisfied, provided, “More than 50 percent of all unique patients 13 years old or older seen by the EP or admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) have smoking status recorded.”

It is logical to assume that this 50 percent requirement will be increased in Phases II and III, but even so, we now know that to satisfy meaningful use, one of the factors required to be built into the system is the ability to record smoking status for patients 13 year or older. 

As HIT systems are implemented and medical facilities show greater understanding and ability to embrace the meaningful use of EHRs, Phase II (beginning 2013) and Phase III (beginning 2015) of the implementation most likely will increase the compliance standards.  So, in the example above, we would expect the 50 percent compliance requirement to be increased, until 100 percent compliance is phased in.  Indeed, CMS has stated that it is confident that within a decade 90–100 percent of participating medical facilities will be in full compliance, with all required objectives.

As HIT moves into play, we anticipate that large medical facilities and hospital systems will be serviced by larger IT companies.  However, what about small IT companies that would be working with hospitals in rural Tennessee or a private physician in the middle of Montana?  These small IT companies must be included in the conversation today as they are the ones that will likely be implementing these solutions.  

Future HIT growth forecasts vary depending on assumptions, but most predict substantial increases in spending over the next five years.  One research firm, MarketsandMarkets, forecasts an annual HIT growth rate of 16.1 percent (CAGR) through 2014.  Clearly, there is an immediate opportunity for VARs, as well as future growth. 

So, now that we have objective criteria for assessing “meaningful use” during Phase I, VARs can move forward to assist their medical clients to achieve full compliance.