Q & A

Do Rural Health Clinics qualify for Medicare incentives?

According to the CMS website, "An eligible hospital for Medicare incentive payments is a 'subsection (d) hospital' that is paid under the hospital inpatient prospective payment system."

According to an Issue Brief released by the American Hospital Association "The payment incentives in the American Recovery and Reinvestment Act of 2009 (ARRA) are available to each hospital that is a meaningful user of a certified electronic health record (EHR); ARRA defines a hospital as a Medicare subsection (d) hospital, which is a general, acute care, short-term hospital."

Are podiatrists eligible for EHR incentives? They are trained extensively and hold qualifications for surgery, independent diagnosis, and prescription privileges, including all DEA schedules.

Can states stipulate when eligible professionals and/or facilities can apply for and receive Medicaid incentives for EHR meaningful use? RECs and HIEs seem to concentrating their services on primary care, but can other can other specialty practices (such as mental health) apply for the funds as soon as they are available?

For both of these questions, the answer probably comes down to how much each "specialized" practice can incorporate the 25 core Meaningful Use requirements into their process. We recently pointed to an observer who claims the HHS has essentially cut specialists out of the HITECH incentive program.

While not quite as stark, recently released comments from the American Academy of Orthopaedic Surgeons sound similar concerns.

As for specialists in mental health, there is currently legislation before Congress that would expand HITECH to include those providers. We are not sure of its status.

Are mid-level providers (NP/PA) eligible for EHR incentives?

According to the CMS EHR Incentive Fact Sheets, Eligible Professionals (EPs) "are physicians, dentists, nurse practitioners, certified nurse midwives, and physician assistants practicing predominantly in a Federally Qualified Health Center or Rural Health Clinic (FQHC/RHC) that is directed by a physician assistant."

I work for a critical access hospital. We know that our hospital will qualify for ARRA funding (if we meet MU reporting). But we also have a hospital-owned physicians practice -- are we also able to get the $44K/year for those providers as well?

The answer may depend on the status of the providers in your hospital-owned physicians practice, as far as where they conduct the majority of their work. According to the fact sheets on the CMS website, the proposed MU rule "establishes that EPs must also not be hospital-based, meaning they do not provide 'substantially all of his or her professional services in a hospital setting.'" By that definition, yes, your physicians in your hospital-owned practice qualify, as long as they don't work primarily in the hospital. Please see the below question and answer regarding "who gets the money" in such a case.

As a community health center we are under the impression that the stimulus/incentive payments would go to the health center itself, not the individual physicians/providers. So, my question is "who gets the money?"

I think the answer you need can be found on the HHS Fact Sheet Pages for the Medicare and Medicaid programs, where it says that Eligible Professionals must "not be hospital-based, meaning they do not provide 'substantially all of his or her professional services in a hospital setting.' 'Substantially all' is defined to mean that 90 percent or more of the services are performed in the hospital setting."

If your physicians perform more than 90% of their services in your health center, the health center, not the physicians, receives the payments, provided it meets the definition of an acute care hospital, which is "a primary health care facility where the average length of patient stay is 25 days or fewer. Hospitals with an average length of stay of 25 days or fewer and with a CMS Certification Number (CCN) that has the last four digits in the series 0001 - 0879 are eligible."

Are there any provisions for financial incentives for implementing an EHR, either through the government or other resources (such as payers, foundations, etc.), for healthcare providers who do not meet the MU eligibility criteria for Medicaid or Medicare incentives (such as those who are primarily self-pay or payer reimbursed)?

Via the website for the American Academy for Family Physicians (www.aafp.org), we found this list (PDF) compiled by the Certification Commission for Healthcare Information Technology (CCHIT). We should note, however, that the article and list were dated 2008, so while there are a number of programs listed, we don't know how many are still active or available. Please consult CCHIT.org for information about specific program status.

We have clinics staffed by paid physicians. In order for the acute IP side of the hospital to receive ARRA funding, do these clinics have to demonstrate MU as well?

While it's possible the definitions may change when the final MU rule is released, your best option for finding information that speaks to your situation is to go to the CMS fact sheet page.

Under the recently passed law, many of our primary and specialty care physicians who were not previously eligible for the incentive programs are now eligible. These physicians do not work in the hospital but some of them are paid by the hospital and the hospital paid for and installed the outpatient EHR. Would the stimulus payments go to the individual provider? If so, can the provider reassign the payments to the parent organization?

According to the "Fact Sheet: Proposed Requirements for EHR Medicaid Incentive Program", which can be found on the HIT page for the Centers for Medicare & Medicaid Services, "entities promoting the adoption of certified EHR technology may be designated by states for EPs (Eligible Professionals) to voluntarily assign their incentive payments." The statute allows EPs to assign their incentive payments to their employers or to state-designated "entities that promote the adoption of certified EHR technology."

There is similar language on the Medicare Fact Sheet page as well. Presumably, now that the physicians you mention in your question are eligible for incentive payments, these options should be available to them.

Has "meaningful use" been clearly defined?

Given that the comment period on CMS' Meaningful Use proposal only recently closed, and we are still waiting for the release of the final rule, the short answer is "No." Ideally, once officials sift through all the comments and make their final decisions, the definition of "meaningful use" needs to be clear in order for providers to move forward.

In order to be eligible for the stimulus funds what does a medical group actually have to do during the 90-day period that would qualify them for the stimulus funds? Please provide whatever information you can on what has to be done to qualify for our stimulus funds which we believe we will be entitled to as we have an EMR and we just need to "plug and play."

When the Meaningful Use proposal was released at the end of last year, Healthcare IT News posted the 25 Stage 1 Meaningful Use criteria for eligible providers. Regarding the required capability to exchange information, Criterion #20 reads:

"Objective: Capability to exchange key clinical information (for example, problem list, medication list, allergies, and diagnostic test results), among providers of care and patient authorized entities electronically. Measure: Performed at least one test of certified EHR technology's capacity to electronically exchange key clinical information."

I represent a physician practice with 5 offices and 10+ doctors, that has had an EMR in place for more than 5 years. I want to apply for stimulus funds (i.e. $44,000 per doctor in my practice) before Jan 1, 2011. What is the process to get these funds? What do I need to do, and when?

To determine the most likely funding avenue for your practice, see the CMS Medicare & Medicaid Incentive Fact Sheets found on the "Meaningful Use" page of the CMS Web site.

Our organization provides pediatric rehab therapy (OT & Speech) and mental health therapy by licensed practitioners primarily for the autism and developmentally disabled population.  We offer services on-site in a clinic setting and off-site in a home or community-based setting. Approximately 75% of our total revenue is Medicaid. According to ARRA/HITECH, are we required to implement an EMR and, if so, are we eligible for stimulus money?

Medicaid eligible professionals (EPs) are defined as: "Physicians, dentists, nurse practitioners, certified nurse midwives, and physician assistants practicing predominantly in a Federally Qualified Health Center or Rural Health Clinic (FQHC/RHC) that is directed by a physician assistant. Eligible hospitals that may participate are acute care hospitals and children's hospitals." By that definition, you would not be eligible. Presumably, then, you would not be required to implement an EMR. That said, what isn't clear is whether, without an EMR, you run the risk of reduced Medicaid payments after the five-year incentive program is over, as per the HITECH provisions

Are radiologists eligible for stimulus funds? We have a very large investment in PACS systems to send images and interpretations (reports) to clinicians.

According to the CMS incentive fact sheets, a Medicare Eligible Professional (EP) "is a doctor of medicine or osteopathy, a doctor of dental surgery or dental medicine, a doctor of podiatric medicine, a doctor of optometry, or a chiropractor, who is legally authorized to practice under state law." Based on this definition, radiologists, whom are MDs, qualify for incentives. Special thanks to readers Leigh Burchell and Paula Infeld for their assistance in correcting this response - June 18, 2010. Click here for the Eligible Provider criteria for meaningful use.

Will ambulatory surgical centers be eligible for incentive payments under the Recovery Act's Medicare and Medicaid electronic health record (EHR) incentive programs?

From CMS's FAQ: Ambulatory surgical centers are not eligible. The following types of institutional providers are eligible for incentive payments under Medicare and/or Medicaid provided they meet the applicable criteria. Under Medicare, institutional providers eligible to receive the EHR incentive payments include "subsection (d) hospitals" as defined under section 1886 of the Social Security Act and critical access hospitals. Under Medicaid these institutional providers are acute care hospitals and children's hospitals.

Which office of federal government provides this money and are there any websites providing forms and information for physicians?

For information on grant and other funding opportunities stemming from the HITECH provisions of the ARRA, go to the HITECH Funding Opportunities page on the HHS website. FAQ sheets and instructions for applications are available for each of the programs.

As the Administrator for an independent pathology laboratory we are in the midst of implementation of EMR to connect us with our outside clinics and hospitals we service. To date, we have yet to find the available qualifications that fit our practice for incentive measures. Could you please tell me how our particular practice would qualify?

Based on my review of the CMS Fact Sheets for both Medicare and Medicaid Incentive program, I don't think a lab of this type qualifies. It doesn't appear to fall under any of the "Eligible Professional" definitions. However, you may want to contact the providers you'll be linking to and discuss with them their understanding of how your organization could stand to benefit from the initiative.

Do community mental health centers and substance abuse treatment facilities qualify for Medicaid incentive payments?

HR 1 of ARRA states, "The term 'health care provider' includes a hospital, skilled nursing facility, nursing facility, home health entity or other long term care facility, health care clinic, community mental health center (as defined in section 1913(b)(1)), renal dialysis facility, blood center, ambulatory surgical center described in section 1833(i) of the Social Security Act, emergency medical services provider, Federally qualified health center, group practice, a pharmacist, a pharmacy, a laboratory, a physician (as defined in section 1861(r) of the Social Security Act), a practitioner (as described in section 1842(b)(18)(C) of the Social Security Act)."

Do Pharmacists working in community pharmacies qualify for HIT incentives?  Currently, pharmacies pay to use HIT (e.g., e-Rx) while prescribers get incentives.  Pharmacists could provide more comprehensive medication therapy management services if they were connected to EMR/EHRs.

Great question. HR 1 of ARRA includes pharmacists and pharmacies as "providers." New information on phamacists' eligibility for IT loans was recently announced - see the Healthcare IT News coverage on this.

To qualify for "Meaningful Use" and the government funds, how long does a physician have to be demonstrating "Meaningful Use"? I've seen reference to the prior year. Does that mean a full year? A calendar year?

Greenway Medical Technologies and the Healthcare Information Management and Systems Society released information on ARRA issues, which states, "An eligible professional (physician) will receive incentive payments as specified in the legislation, for the first five years (fiscal year 2011 - fiscal year 2015), for demonstrating a meaningful use of EHR technology and demonstrated performance during the reporting period for each payment year. If an eligible professional does not demonstrate meaningful use by 2015, his/her reimbursement payments under Medicare will begin to be reduced. No incentive payment will be made after 2016." Caveat: Greenway and HIMSS advise readers to refer to HR 1 of ARRA or seek professional counsel on financial matters. They remind readers that the information in their report cannot be relied on as legal advice.

Do dentists qualify for "meaningful use" incentives?

The American Dental Association has information on ARRA incentives as they relate to healthcare IT. A summary fact sheet available on their site here notes:

"Private practitioners, including dentists, may qualify for Medicaid incentive payments related to the adoption of Health Information Technology. For qualified practitioners (30 percent Medicaid case share), Medicaid would reimburse a significant share of both the costs of adpoting HIT and/or reasonable administrative costs."

For a large medical practice with many physicians, is the ARRA reimbursement allowed per physician, or just for the medical group?

The reimbursement is permitted per "eligible professional," as long as the eligible professional demonstrates "meaningful use of an EHR" and participates in Medicare. An eligible professional means physician, as defined in section 1861(r) of the Social Security Act -- this says "The term 'physician', when used in connection with the performance of any function or action, means (1) a doctor of medicine or osteopathy legally authorized to practice medicine and surgery by the State in which he performs such function or action..." (http://www.ssa.gov/OP_Home/ssact/title18/1861.htm). One important exception is if the physician is employed by a hospital; in that case, the hospital, not the physician, is eligible for the reimbursement.

There's a nice summary about the impact on physician practices at the Health IT Law Blog which begins: "Physician practices are eligible to receive up to $44,000 per physician for meaningful use of certified EHR technology..."

What is in the stimulus for nursing homes? If a nursing home already has an EMR, can they get funds?

Nursing homes are included under the bill as providers, and are therefore eligible for incentives.

ARRA states: "HEALTH INFORMATION TECHNOLOGY AND QUALITY SEC. 3000. DEFINITIONS. (3) HEALTH CARE PROVIDER - The term 'health care provider' includes a hospital, skilled nursing facility, nursing facility, home health entity or other long term care facility... and any other category of health care facility, entity, practitioner, or clinician determined appropriate by the Secretary."

Where can I access public information on HITECH?

There are many online resources for information on the HITECH Act. You'll get all the news and analysis on HITECH right here at Priming the Pump, but here are some more great places to find the information you need:

• CMS fact sheet on ARRA healthcare IT funding and incentives


• HITECH Act Breach Notification Guidance
• HHS' Recovery Act main resources page


• List of HHS' health information technology projects under the stimulus package


• Healthcare IT ARRA implementation plan (PDF)

We already have and use an EHR - are we eligible for stimulus money?

Yes. If your healthcare organization can be identified by ONC as demonstrating meaningful use of your EHR and related systems, you can participate in the program. For more information on what procedures could constitute "meaningful use," click here

CMS initially described the following as integral parts of incentive-worthy procedures: "Meaningful use of a certified EHR, the electronic exchange of health information to improve the quality of health care, and reporting on clinical quality and other measures using certified EHR technology."

If our EHR isn't certified, can we still get incentive funds?

No. Certification is a qualification for getting ARRA funding, so you must be certified  by 2010 in order to collect data and meaningfully use it by 2010. Bonuses under ARRA will be available 2011 on 2010 data. BUT: (caveat) -- under ARRA, HHS must determine a certification body, which they haven't chosen yet. Most experts feel they will choose CCHIT because there is no time to set up another certification body. There also may be other factors involved, such as what certs per year HHS will require under ARRA. Currently, providers are optionally able to update or expand their CCHIT certification each year.

That said, CCHIT, following a June 18 update to its criteria, listed the following as one of its "new paths to certification" of EHRs:

"A simplified, low cost site-level certification. This program would enable providers who self-develop or assemble EHRs from noncertified sources to also qualify for the ARRA incentives."

What IT systems and solutions, in addition to EHR/CPOE, can get our hospital stimulus funding?

This is a complicated question because it has not been defined yet under meaningful use. Experts have speculated what may be required. The bottom line will be hospitals and providers will need to collect data on patients and show they have improved outcomes.

Is CCHIT certifying specific versions/releases of vendors' EHRs, or are they just certifying by vendor/product?

CCHIT certifies by products and types of care; ambulatory, inpatient, cardiology, etc. Each year, a vendor can upgrade their certification that year if they chose to do so, but it will cost them money. Some vendors like to do it to impress potential buyers. It is not required in order to prove certification. A vendor will say what year they are certified when they advertise their product.

What is the FINAL deadline for eligibility in receiving the HITECH stimulus funds? Does our implementation have to be COMPLETE, or just launched?

By October 1, 2011, a provider will have to prove they have used data in a meaningful way the year prior in order to receive bonuses. Each year after that, for five years, bonuses will decrease. HHS has not said how much time they will require for the meaningful use, but most experts say at least six months. There are a number of imaginary deadlines involved. Getting the proper programs in place, collecting the data accurately, using the data to improve care. It's not something that can happen over night. Some experts claim there are not enough trained experts to help hospitals and providers to transition to the kind of use needed, so the sooner a provider starts, the better. BUT, after 2016, providers who have not adopted EHRs and have shown they use them meaningfully, will receive decreases in Medicare payments.

FAQ at the Centers for Medicare and Medicaid Services site (hhs.gov)

What will be done to help prepare providers to take advantage of the incentive payments for the meaningful use of an Electronic Health Record (EHR)?

Are physicians who practice in hospital-based ambulatory clinics eligible to receive the Recovery Act's Medicare or Medicaid electronic health record (EHR) incentive payments?

What if my Electronic Health Record (EHR) system costs much more than the incentive the government will pay? May I request additional funds?

How will eligible providers and hospitals apply for incentives if they are using certified EHRs in accordance with the standards established by Health and Human Services (HHS) under the HITECH portion of the Recovery Act?

What is the maximum incentive an eligible professional can earn for using an Electronic Health Record under Medicaid?

Will ambulatory surgical centers be eligible for incentive payments under the Recovery Act's Medicare and Medicaid electronic health record (EHR) incentive programs?

If an eligible professional uses a certified EHR in a meaningful way in accordance with the adopted regulations, could that professional receive both the Medicare EHR payment incentive as well as the Medicaid EHR payment incentive?

How will the public know who has received incentive payments under the Recovery Act?

View all FAQs at HHS.gov.