The Path to Paperless

Bonuses and Penalties for EMR

Start planning now if you hope to win bonuses.

By Peter J. Polack, MD, FACS

It wasn't too long ago that most physicians were eyeing electronic medical records as a pipe dream. Now, those same physicians are feeling under the gun to implement EMR, as the Federal government is now mandating. Although the exact specifics of those mandates are not spelled out yet, there is certainly enough of a framework for physicians to take note.

As part of the American Recovery and Reinvestment Act of 2009 (ARRA), also known as the Stimulus Bill, there will be both financial incentives and penalties for EMR adoption (or lack thereof). And these hinge upon what is known as "Meaningful Use of EMR."

The US Dept of Health and Human Services (HHS) has outlined specific objectives and measures, by the years 2011, 2013 and 2015, for certain criteria such as improving quality and safety, improving care coordination and engaging patients and families. These are laid out in what is known as the Meaningful Use Matrix. These will probably become more detailed as the time approaches and the various stakeholders give the HHS their input.

Bonuses and Penalties

Practices that implement EMR to these standards by certain deadlines stand to receive significant bonuses, particularly if they start within the next year or so. Depending upon your implementation date, bonuses can range from a high of $18,000 down to $2,000.

Although many decry the costs of EMR implementation, which run anywhere from $10,000 to $50,000 per provider, depending on the system, these incentives would definitely go a long way to offset these costs.

Practices that don't meet the Meaningful Use objectives will face financial penalties, beginning in 2015. These will be in the form of cuts in Medicare and Medicaid payments ranging from 1% to a maximum of 5% for the latest adopters.

What Is a Certified System?

Part of the Meaningful Use standards require the use of "certified EHR (EMR) technology." At press time, the front-runner for certification of EMR software is the Certification Commission for Health Information Technology (CCHIT), a non-profit organization funded by various entities, including corporations and physician groups. It was recognized by HHS as a certifying body in 2006, though there have been questions about possible conflicts of interest. To date, no other group has had as much input or influence in the certification process.

Physicians should be aware of which software vendors have CCHIT-certification.They should also seek a vendor with a track record of successful EMR installations in ophthalmology practices.

Meeting Timelines

According to MBA HealthGroup, a reasonable time frame to expect for EMR implementation is about 18 months to two years from initial research to full "meaningful use."

Practices that are already implementing EMR have a good chance of getting the higher financial incentives. But those that have been wishing that the whole idea of EMR was just a fleeting fad may not only miss out on these incentives but may also face cuts in their reimbursement. OM

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Peter J. Polack, MD, FACS, is co-managing partner for Ocala Eye, a multisubspecialty ophthalmology practice located in Ocala, Fla. He is also founder of Emedikon, an online practice management resource for physicians and administrators.