Tuesday, November 16, 2010
By Dan Schulte, J.D.
MDA Legal Counsel
From the November 2010 issue of the Journal
Question: I’m a new dentist and recently purchased a practice. I may accept Medicaid patients and have heard there are funds available from the federal government to dentists who purchase an Electronic Health Record system if they treat Medicaid patients. Is this true? What must be done to obtain the money?
Answer: The American Recovery and Reinvestment Act of 2009 (commonly known as the "Stimulus Bill") includes financial incentives for "eligible professionals" who purchase and demonstrate "meaningful use" of a "certified" EHR system. Financial incentives are available through the Medicare program (a maximum of $44,000) and the Medicaid program (a maximum $63,750).
Dentists are included among the "eligible professionals" who may receive the financial incentives. Generally, a dentist must have 30 percent of his or her patient volume as Medicaid to be eligible. Unlike the Medicare EHR Incentive Program, the Medicaid EHR Incentive Program is voluntary. There is no Medicaid penalty for not adopting EHR. Dentists and other eligible professionals who do not demonstrate meaningful use of an EHR system by 2015 will have their Medicare payments for their services reduced by up to 5 percent beginning in 2018.
Eligible professionals must demonstrate "meaningful use" of a certified EHR system in their practice. Proof of purchase of a certified EHR system alone is not sufficient. What is meant by meaningful use is not yet completely known. On Jan. 13, 2010, CMS released a draft that began the process of defining the requirements for meaningful use. These requirements will be developed in three stages. The Jan. 13, 2010 draft addresses only the stage one requirements. Stage one focuses on the use of the EHR system to capture patient data. Stage two will deal with using the EHR system to report health information and track certain clinical conditions. Stage three is expected to focus on use of the EHR system to improve performance and health outcomes. Space requirements do not allow for a detailed description of the stage 1 meaningful use requirements. This description is available at www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/ehrincentiveprograms.
The EHR system you implement must be certified. Who will provide the required certification is not yet known. On June 24, 2010, a rule was published creating a temporary process whereby entities desiring to become designated certifiers of EHR systems may apply and become so designated. As of the writing of this column no entity has yet received this designation. The specific criteria that any EHR system must meet to obtain certification are also still in process. While these details have not yet been determined, the Stimulus Bill generally calls for all certified EHR systems to be capable of storing individual demographic and clinical health information, providing clinical decision support and order entry, capturing and query of information relative to healthcare quality and the ability to exchange electronic health information with, and integrate such information from, other sources.
Eligible professionals applying to the Medicaid program who meet the requirements for meaningful use of a certified EHR system could be paid up to six annual installments totaling $63,750.
To receive Medicaid’s maximum incentive payments you must: (i) apply no later than 2016 and demonstrate that you meet the Stage 1 meaningful use requirements in the year that you apply; and (2) maintain a track record of Medicaid patients being at least 30 percent of your total patient volume. If you practice in a group and each member of the group can demonstrate both meaningful use and a sufficient record of Medicaid patient volume, each member can receive his or her own incentive payments. If you have previously purchased an EHR system that becomes certified and you can demonstrate meaningful use of it, you will eligible for the same incentive payments. The amount of incentive payments available to you is not limited or increased based on the actual cost of your EHR system.