We have prepared two tutorials to help you understand the
HITECH stimulus plan, clinic Pro's response and how it affects your practice.
In the first tutorial, we will discuss what is known about the stimulus plan.
In the second tutorial, we will discuss the unknowns, the multitudes of
questions that have yet to be answered. Before the plan can be effectively
administered, these questions will need answers.
The stimulus plan was created as a cost saving measure. By
encouraging doctors and hospitals to share information about patient treatment,
costly medical mistakes can be avoided. This is especially important when more
than one physician is prescribing medications that may interact with each
other. The stimulus bill will also eliminate costly duplication of tests if all
of the treating physicians have access to previous medical history. The third
focus of the act is to gather data about treatment protocols and their
outcomes. It is this portion of the act that has raised concern amongst medical
professionals. Let's just take an example. Suppose that there are 10 treatment
modalities for atrial fibrillation. After gathering data for 10 years, the
government has determined that five of the treatments are more effective than
the rest. Will doctors be forced to choose one of the five treatments even
though another protocol might be more effective for a particular patient? That,
in a nutshell, is the concern. If we focus entirely on outcome, are we missing
important individual differences?
Let's talk about what we know. The following types of
providers are eligible to receive stimulus incentives. They are medical
doctors, osteopaths, podiatrists, dentist surgeons, optometrists and
chiropractors. We also know that in the health care profession people are
scrambling to come up with an EMR. It has attracted investor interest much like
the programs that focus on green energy. Everyone wants a piece of the pie.
If you fit in one of these categories as a healthcare
provider, you can qualify to receive stimulus incentives if you adopt an EHR/EMR
program and can demonstrate meaningful use of that program. The stimulus bill
defines meaningful use by citing three characteristics: #1 The EMR must be
certified #2 The EMR must be capable of exchanging personal health information
and #3 the EMR must be capable of collecting and submitting treatment data. The
stimulus or incentive money is not tied in any way to the purchase price of the
EMR. It is tied to claim submission to the two government programs: Medicare
and Medicaid. If you do not submit claims to Medicare or Medicaid, you are not
eligible. You do not have to participate or submit claims as a participating
provider with Medicare to be eligible.
Your reimbursement or incentive will be based on the
allowed charges that you are submitting to Medicare. For the first two years,
the stimulus plan caps the reimbursement at $18,000. In order to qualify for
the maximum reimbursement, you must have submitted 25,000 in allowable Medicare
charges. That is 133% of the maximum reimbursement. If you submit only 12,000
in allowable charges, your maximum reimbursement would be approximately $9,000.
As you can see,
the maximum reimbursement is capped every year, depending on when you qualify
and when you submit for reimbursement.
In all, you can receive up to a total of $44,000 over a period of five
years from Medicare. To be eligible for Medicaid reimbursement, at least 30% of
your patient must be receiving medical assistance. For pediatricians only, this
percentage is lowered to 20%. If you choose to receive Medicaid reimbursement,
you can receive up to $64,000. You cannot collect from both Medicare and
Medicaid. You must choose your reimbursement vehicle.
We have displayed the Medicare reimbursement schedule on a
graph to make it easier to understand. In the first year that the stimulus plan
incentives are available, the year 2011, you can collect up to $18,000. In the
second year, 2012, you can also collect up to $18,000. You will notice that if
you do not have an EMR in place by 2013, the total reimbursement that you can
collect is smaller. There is an incentive built into the plan for early
adoption of a qualifying EMR.
On the screen, you will see a list of providers that are
not eligible for Medicare reimbursement. Any hospital based physician is not
eligible because the hospital usually provides the EMR. This includes
anesthesiologists and emergency room doctors. There are other professionals
such as physician assistants, psychologists, physical therapists and
occupational therapists that are not eligible under the Medicare plan. On the
bottom of the screen, we have a list of professionals such as nurse
practitioners, physician assistants and certified midwives that may be eligible
under the Medicaid plan if they meet the 30% qualifying factor. This concludes
the first part of the tutorial which covers all of the things that we know about
the stimulus plan.
Now let's go on to the unknowns, the multitudes of
questions that still need to be answered before money is disbursed. First of
all, we do not know what type of paperwork you might need to submit to request
reimbursement nor do we know how the money will be disbursed. It may come as a
lump sum payment annually or as installments. The timing of the disbursement is
not known. There are also certain specialties that may not qualify even though
they are staffed by medical doctors. For example, a sports clinic or an
industrial clinic may not qualify because they do not serve Medicare or Medicaid
patients. A psychiatrist may also be ineligible based on the population that is
served. Remember, the stimulus program is designed specifically to reduce costs
for the two federal insurance programs, Medicare and Medicaid.
As a software vendor, we are looking specifically at the
qualifications of meaningful use. First of all, your EMR must be certified.
Right now there is only one organization that is currently certifying EMR's –
CCHIT. This includes the ability to electronically prescribe, order and receive
lab tests, record immunizations, record exam results and meet a series of
criteria relating to the security of the EMR that dictate who has access to the
information and the level of access that each staff member can be granted.
Since optometrists and chiropractors do not need many of the requirements of the
current certification, it would make sense that an alternative certification be
available. We do not know if this will happen. We also do not know if there
will be a less costly alternative to CCHIT.
Another large unknown is the extent to which
interoperability will be implemented and how that implementation will take
place. It is anticipated that requirements may develop to share imaging and
radiology, force reporting to CDC or other agencies, implement registry entries
for immunizations or even exchange information with personal health records that
patients are maintaining. From our perspective, that would be the best
scenario. We would like to see the patient in charge of their health care
through their own individual personal health record or PHR. The method of
exchanging information is also unknown. We currently send electronic billing
information through an ANSI format. Lab requests are handled by HL7 format.
XML is an easy way to import and export data. It should be considered as one of
the options.
The final big unknown is how data will be collected about
treatment protocol and outcomes. There are no standards whatsoever at this
point in time. Even though the standards are supposed to be in place by the end
of 2009, most people in the industry expect that they will be evolving over the
next five years, in other words --a moving target. It is so much fun to try to
hit a moving target.
So what is Clinic Pro's response to all of the stimulus
information? First of all, we have developed and released our online personal
health record or PHR. This is available today. This personal health record was
developed so that patients could complete their entire medical history prior to
coming to your office. This will eliminate the clipboard with 10 sheets of
paper to fill out. When the patient enters your office, their complete medical
history will be available to our online EMR. While we currently have a desktop
EMR, we think it is important to move everything online. We are developing an
online scheduler. We are developing the ability for you to record vitals,
immunizations, diagnoses and procedures online. We will be taking our
touchscreen templates online. In the next two weeks, we will be testing our
ability to receive lab results and display them for your office. We are
building a lab order interface. We are partnering with an electronic
prescription software company. All of these plans are aimed specifically at
certification. As part of her emphasis on online capabilities, you will be able
to download a small program to a USB drive and access your online EMR from any
computer with Internet access. You would also be able to use a netbook computer
or wireless handheld. In the future, we are also looking at access via your
cellphone. We want you to be able to connect to your EMR and to patient records
from where ever you are.
We also want to share with you our business model. From
our perspective, a person's health care should begin with the patient and end
with the patient. At all times, the patient should be kept in the communication
loop. The patient should receive regular communication from his or her doctor.
The doctor should make patient education materials available. When a patient
goes into the hospital, the discharge summary and hospital records should be
available to the patient. Medication history and allergy information should be
available to emergency personnel when they respond to a medical situation.
First and foremost, the patient should always be aware of the doctor's treatment
and recommendations. In the past, electronic medical records have been used
mostly by the doctor. The patient never sees the information. With our
business model, you - the doctor - will be sharing your exam notes and test
results with the patient online. That way, the patient can review your
recommendations and your education material at their leisure. They can share it
with their families. Health care will become a family affair, like it should
be.
With our online personal health record, you can get started
today receiving quality information from your new patients. Please take time to
download and look at the complete medical history that is available to you right
now.Then visit our
website at ClinicPro.com to download a working version of the practice
management and EMR software. You can add patients, create billing and record
encounters. It is a perfect way to evaluate our software. If you prefer, call
us at 866-333-2776 to discuss your software needs and schedule an online demo.
Working with one of trainers one-on-one, you can see ClinicPro in action and get
your questions answered firsthand. It is an excellent way to evaluate
ClinicPro.
We look forward to working with you
to meet your software needs, now and in the future. Call us today or visit our
website for more information.
