Corey sent me the following question:

Are imaging costs recoupable under the HITECH act?

Corey,
There are 2 major sections to receive stimulus money from the HITECH act. One is through Medicare and the other is through Medicaid. The Medicare related stimulus money doesn’t have any provisions on how you use the money you receive. It is paid out as a bonus on your Medicare reimbursement. So, you could use the EMR stimulus money that’s paid out through Medicare for anything you want, including imaging costs.

Medicaid on the other hand has to be for qualified expenses (or some similar term like that). I personally haven’t seen any details on what HHS will consider an expense that can qualify for the stimulus money. Plus, I won’t be surprised if each state has different definitions of what expenses will qualify under Medicaid. I have mixed feelings on whether imaging costs will be covered by the Medicaid section of the HITECH act. I guess I could see it going either way. If I’ve missed where this is specified, please let me know in the comments.

Check out the previous EMR and HIPAA EHR Stimulus Question and Answers and please send us other questions you might have in the comments.

Tom’s previous guest post about meaningful use and healthcare IT seems to have struck a chord with some of my readers. Here’s an example of one email (posted with permission) from the always passionate Al Borge, MD, I received in response to Tom’s post. The most interesting part of Al’s email is his last comment about the Medicare penalties that ARRA will impose.

>>> As for the burden of meeting Meaningful Use criteria being too stringent for small practices to meet, this is again an excuse to avoid change.

“Change” for change’s sake is not the way to go… the change that you are talking about is BAD change, and that’s not the way to go.

Look- physicians aren’t just a bunch of luddies that are ignoring high tech out of ignorance. When it comes to technology, we’re usually the first to buy tablet PC’s, the first to buy/significantly use the latest and greatest cell phones as well as have several internet accounts for our homes, offices, and for mobile apps. We buy some of the best cars on the market and cherish a whole host of other electronic “toys” that we use daily.

The problem with the EMR is that most of the EHR systems out there today are simply 1) unaffordable, 2) workflow killers, 3) are being coopted by Big Government in schemes like P4P that later are used against us to pay us less.

The vendor inspired dogma that the EHR saves money, decreases errors, and increases quality has yet to be proven in a side-to-side test against paper and against simple, basic EMRs. Until these claims are proven, most docs will sit on the sidelines. Most of us are not that stupid to believe this crap.

What we see is that a lot of lobbying money is being spent in an effort to get our politicians to enact laws to straddle physicians with the high cost and complexity of an “Obama” HITECH ready EHR, most of which have as high as a 50% deinstallation rate (based on numerous sources) and as has been recently reported by the CDC, owns only a 6% market share among practicing clinicians.

>>> Buying an EMR system and using only half the features will undoubtedly lead to the system not generating the ROI it is capable of providing.

As long as paper records or a “basic” EMR returns a good ROI, it’ll be a hard sell for vendors to force doctors into using a budget and workflow busting EHR.

>>> Being forced to meet Meaningful Use is a way of ensuring offices are using their EMR system in a way that will provide them with the benefits it is designed to provide.

This one is scary- under President Obama are we now living in such a Communist state that Big Government has the power to force its citizens, which in this case are physicians to go against their better judgements and to buy EHR systems that they do not care to use? You have to be kidding me…

This is truly a Healthcare train that is out of control. The day that I get hit with a Medicare 5% tax/penalty I’ll simply pass it onto my elderly Medicare patients as a yearly “Obama tax” thaty THEY, not I will have to absorb. No pay, no see.

Time again for everyone’s favorite topic (or so it seems), EHR stimulus questions and answers. Today’s EMR stimulus question comes from Jamie who asked the following question on a previous post:

Does anyone know whether or not the government is implementing some kind of incentive benefit for non-Medicare/Medicaid users? Or are these practices totally out of luck?

The short answer (at least for now) is not really. The ARRA EHR stimulus money is provided through Medicare and Medicaid programs as “bonuses” for those who show “meaningful use” of a “certified EHR.”

With that said, there are some grants available for special situations. For example, they have a beacon communities program which are given to organizations that will supposedly take EHR software to the next level and be examples for their communities of what can be done with IT and EMR software.

I’ve heard there’s other grants that people can apply for also, but I’m not sure all of the details. I also hear that there might be some EMR stimulus money available in the latest healthcare reform bill. For example, I read somewhere recently that the healthcare reform bill includes some stimulus money for long term care which has basically been left out of stimulus money as well.

Clinics interested in EMR software should also be able to get some help from the RECs and HITRCs. At least their stated mission is to assist doctors to adopt and meaningfully use EMR software. I think the jury’s still out on how helpful these RECs will actually be. It’s a nice idea, but could go horribly wrong if not done right.

I won’t go into all the details here, but not qualifying for the EMR stimulus money might just be the best thing that’s happened to your practice. That means you won’t be distracted and you don’t need to wait. You can hone in on the other EMR benefits and start reaping those benefits without all the bureaucracy.

EMR and HIPAA Answer to EMR Stimulus Quesitons
When’s the earliest we can get the ARRA EMR Stimulus Money?
Medicare Related EMR Stimulus Money
The earliest payments for those wanting the $44k per provider of stimulus money from Medicare will be Spring of 2011. Providers will need to show “meaningful use” of a “certified EHR” for 90 days in 2011 to be able to qualify for the first year payment of $18k. So, the very first checks won’t be sent out until at least Spring of 2011.
Medicaid Related EMR Stimulus Money
Unfortunately, we don’t really know the answer to this question. It’s also made even more difficult since each state will be able to decide when and how they are going to pay out the $63,750 in EMR stimulus money for Medicaid providers. I imagine some will model the Medicare schedule, but with 50 states we’re going to likely see a lot of different methods.

EMR and HIPAA Reader Submitted Question:
Is there a way for a provider to get stimulus money for EMR if not currently a Medicare provider?

Besides Medicare, there is also stimulus money available through Medicaid. In fact, Medicaid has more money per provider available than Medicare, but also has different requirements to obtain the EMR stimulus money. Outside of that, ONC has a number of grants that might be available for organizations that qualify and want to go through the grant writing process. Otherwise, NO there is no stimulus money if you don’t take Medicare, Medicaid or qualify for some special grants.

Check out all of EMR and HIPAA’s EMR Stimulus Questions and Answers.

I knew that it was only a matter of time before someone put together an EHR stimulus calculator and I finally found one here. The basic idea is you input your details and then it calculates how much EHR stimulus money you qualify (under the Medicare side of the stimulus money). I think that a calculator like this is important since the amount of EHR stimulus money you get depends on the amount of allowable Medicare charges.

Now, I’m not exactly sure how the calculator linked to above is calculating the Medicare allowable charges. You’ll see I left a comment asking this very question. Does anyone know of other EHR stimulus calculators like this one?

As I mentioned in my previous post on the ARRA EHR stimulus payments under Medicare, a clinic needs to have at least $24k in allowable charges in order to receive the full EMR stimulus money of $18k. This poll is an attempt to get an idea of if most doctors offices have over $24k in allowable charges or not. I imagine Obama and company looked at this number when planning for ARRA, but I haven’t seen any data on how many clinics will be eligible for the full $18k in EMR stimulus money.

Thanks for the input. I think it will also be interesting to see how many people respond that they don’t take Medicare either. I probably should also do something similar for Medicaid. I guess that’s a future post.

UPDATE: Many of you will find my presentation on the ARRA EMR Simulus money of interest.

There’s been a lot of talk (including myself) about the EHR stimulus money. It seems like meaningful use has taken the cake with most of the discussion with certified EHR taking a cozy second place. What I haven’t seen very much of is some practical analysis of the EHR stimulus money and the amount of money various practices will receive. So, I’m going to try to do my part to create some of this practical EHR stimulus money content.

I’m sure that most people have seen a chart like this one describing the $44,000 of EHR stimulus money you can receive from ARRA:

Source: http://hitanalyst.files.wordpress.com/2009/02/hitech2.jpg?w=500&h=234

Basically, the schedule shows you that you can earn UP TO $18,000 in 2011 (assuming of course that you can show “meaningful use” on a “certified EHR”). What hasn’t been discussed is how many doctors will be eligible for the full $18,000 in stimulus money and how many would only be eligible for $10k or $5k in stimulus money and how much allowable Medicare charges you’ll need to have to receive the full reimbursement.

The EHR stimulus Medicare payments will be paid based on 75% of the submitted allowable charges. For example, a doctors office which has allowable Medicare charges totally $24k or more will be eligible to receive the full $18k in EHR stimulus money. A clinic with $13.3k in allowable Medicare charges would only be eligible for $10k in EHR stimulus money. You can do the math for your own clinic.

Maybe this is a non issue for most clinics. I don’t know. I’ve never seen any published average reimbursement rates for a doctor. $24k doesn’t seem like a lot of Medicare reimbursement, but certainly there are some doctors who are under that amount. Later today I’ll post a poll so we can get a better idea of the average reimbursement rates for a doctor.

What’s most important is for people to know that they’ll only be getting 75% of their Medicare allowable charges up to the cap.

There are a bunch of myths being perpetuated right now around ARRA and the HITECH act. I’ve been on a number of conference calls and read a number of people perpetuating these myths. Some might call it poor communication and others might call it downright unethical talk. I’ll leave any judgment to someone else, but I believe these myths could lead to major problems in HIT.

Here’s the first myth I’d like to debunk here and now:
Myth: The EHR Stimulus bill (often referred to as ARRA or the HITECH Act) REQUIRES doctors to use EHR and be interoperable.

Reality: The government has no ability to actually require the use on an EHR. ARRA and the HITECH act do require you to use a certified EHR and show “meaningful use” IF (that’s a big IF) you want to receive the potential $44k in stimulus money avoid the 1-5% medicare/medicaid penalties that will go in force a few years down the road.

That means that if you’re not interested in the government stimulus money then you’ll need an EHR. However, I have a feeling that a large number of people are going to sit back and take the penalties and forget about the stimulus money. In fact, don’t be surprised if many just stop taking medicare/medicaid in response. The point being that it’s a requirement to get money, but not a legal requirement that a doctor use an EHR. I have a feeling those not using an EHR will still have lots of company for the forseeable future.

The interoperability falls under the same story. However, you may not even have to have an interoperable EHR at all if interoperability isn’t part of the EHR certification and “meaningful use” requirements. That part we’ll just have to wait and see.

Moral of the Story: Select an EHR because it makes sense for you and your practice. Don’t focus on the stimulus money and you’ll be much happier in the end.

John Chilmark has posted a couple of Medicare and Medicaid reimbursement charts that I think are worth looking at. I’ll leave the discussion of the reimbursement schedules on Jonh’s blog:
HITECH Act Reimbursement Schedule
Medicaid Reimbursement Schedule

I just recently found John’s blog and think you should all check it out. He’s very thoughtful in his posts and the ones I’ve read have been well written and on target.