Q: What is ARRA or "the stimulus" and what does it mean for medical practices?
A: The HITECH provisions of the American Recovery and Reinvestment Act of 2009 (ARRA), also known as the "economic stimulus plan", provide significant financial incentives to assist physicians in the purchase, implementation and meaningful use of a certified electronic health records (EHR) system.

Q: Who is eligible to receive stimulus dollars under ARRA/HITECH?
A: The ARRA outlines two separate EHR incentive programs - a Medicare program and a Medicaid program. Each has its own set of eligibility requirements under the proposed rules.

Under the Medicare program, it has been proposed that an 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." A qualifying EP must demonstrate meaningful use of an EHR as defined by CMS during the specified reporting period.

Under the Medicaid program, it has been proposed that EPs include "physicians, dentists, certified nurse-midwives, nurse practitioners, and physician assistants who are practicing in Federally Qualified Health Centers (FQHCs) or Rural Health Clinics (RHCs) led by a physician assistant."
A qualifying EP must demonstrate meaningful use through a means determined by the State and meet Medicaid volume percentages - 20% for pediatricians, 30% for others.

EPs may not receive incentives from both Medicare and Medicaid. EPs must choose to participate in either the Medicare or Medicaid program. They will have one opportunity through the course of the stimulus funding to switch to the other program.

Q: So, what is meant by "meaningful use" and is there a definition?
A: Meaningful use is a central concept under ARRA/HITECH. Purchasing EHR does not, on its own, qualify you to receive stimulus dollars. A provider must actually make "meaningful use" of this technology, as defined by CMS. The proposed rule announced on December 30 is the closest the federal government has come to defining the term. It consists three stages, the first beginning in 2011 and consisting of 25 measures. At the conclusion of a 60 day public comment period, the final definition will be released.

Q: What is meant by "certified" and is Sage certified?
A: Sage has maintained (and continues to maintain) current certification with the Certification Committee for Health Information Technology (CCHIT) since its inception in 2006. Alongside the CMS announcement, the ONC announced an initial set of standards, implementation specifications, and certification criteria for EHR systems. CCHIT is expected to incorporate these requirements into its certification and to be one of the certification bodies officially recognized by the ONC (though probably not the only one). Sage is committed to meeting all certification standards required by the ONC.

Q: As a physician, how will I receive payment from the federal government and how will they calculate my payment?
A: Providers will receive incentives in the form of additional reimbursement from Medicare or Medicaid.

Under the Medicare program, payments will be calculated by multiplying the allowable charges by 75% and paying reimbursement bonuses up to the capped amount for the year. So, in order to earn the maximum incentive in 2011 ($18,000), you will need to submit claims with allowable charges of $24,000 or more. Qualified eligible providers who do not meet this threshold will receive an amount less than the $18,000 maximum, in proportion to submitted allowable charges.

Under the Medicaid program, an EP may receive "up to 85 percent of the net average allowable costs for certified EHR technology, including support and training (determined on the basis of studies that the Secretary will undertake)" and will receive up to $25,000 in the first year, and up to an additional $10,000 in subsequent reporting years up to the maximum.

Q: Does ARRA require my practice to adopt EHR and participate in the CMS program? Aside from missing out on the incentives, are there any penalties specified if I choose not participate or to adopt EHR?
A: While neither ARRA nor the latest announcement from CMS "require" adoption of EHR, providers who fail to demonstrate meaningful use in the 2014 timeframe face reduction of Medicare payments by 1% a year starting in 2015 and continuing through 2017, with the option to lower fees to 95% of the regular fee schedule. So, in order to gain a full picture of the impact of this decision, medical practices will need to assess the total cost of these penalties over time in addition to the loss of the incentives. There are no penalties associated with the Medicaid program.

Q: My practice does not see Medicare or Medicaid patients. What are the incentives for my practice to adopt EHR and demonstrate meaningful use?
A. There are no specific provisions under ARRA to incentivize providers other than through Medicare/Medicaid reimbursement. However, the door is open for HHS to offer additional incentives after 2011 based on adoption levels. Also, industry experts predict that private insurers will follow suit and begin to offer incentives and/or penalties based on certain meaningful use criteria, including reporting of quality measures.

Q: Will Sage guarantee that our practice will receive stimulus dollars by using Sage products?
A: Sage guarantees our EHR Product Suite will meet the certification criteria for Meaningful Use set by the Office of the National Coordinator for Health Information ("ONC"). We will modify that offering as necessary to maintain compliance. If we do not, we will credit you up to 12 months of software support.*

Q. How do we begin the process or apply for the funds?
A. Medicare funds will be paid through your carrier or your Medicare Administrative Contractor (MAC) on a rolling basis based on an "attestation process." CMS has proposed to require, for the first year of the bonus program, a 90-day period for which "eligible providers" to attest that they have complied with the 25 measures of "meaningful use" - and are using a qualified system. This written "attestation" will likely be forms you will need to complete to prove that you have a qualified system, and are complying with the 25 criteria for meaningful use. At this time, there is no further detail about the attestation process.

Q. When is the distribution of the money going to happen?
A. CMS proposes that it will be distributed on a "rolling basis" after the attestation is received. There is no defined time period you'll need to wait between submitting your attestation and actually receiving the check.

Q. We are a group practice of 8 providers and we bill under the same tax ID. Are we eligible for one meaningful use payment or one payment for each provider?
A. The payments are made per eligible professional, not per practice.

Q. Wouldn't it be a requirement for a physician to have available a "portal" or similar setup in order for the provider to meet the definition of meaningful use?
A. The meaningful use criteria include several criteria related to communicating to patients. There are many practices planning to conduct this communication via a portal, but it is not required.

Q. Have the stage 2 requirements for meaningful use been outlined? Also, if you sign up can you opt out after the first year or do you have to complete the whole program?
A. No, details regarding "stage two" have not yet been provided. This is an annual program, and you can start -- or leave -- at any time.

Q. What is the difference between CCHIT certification and "meaningful use" certification?
A. CCHIT certifies a comprehensive suite of EHR functionality. Sage Intergy EHR V5.5 is CCHIT certified for 2008. Meaningful Use certification will likely be a small subset of the CCHIT certification. Details of how EHR's will be tested, certified and certifying bodies for "Meaningful Use" have not yet been announced.