By now, many surgeons are aware of the Health Information Technology for Economic and Clinical Health (HITECH) Act. HITECH is part of the American Recovery and Reinvestment Act of 2009 (ARRA), which authorizes the U.S. Department of Health and Human Services to provide financial incentives to eligible professionals (EPs) and hospitals that “meaningfully use” electronic health record (EHR) technology.
In 2010, the Centers for Medicare & Medicaid Services (CMS) published the final rule establishing the criteria physicians must meet in Stage 1 to receive financial incentives. Stage 2 was introduced in a subsequent final rule published in 2012, along with additional modifications to Stage 1. Since implementation of the EHR program, the Bulletin of the American College of Surgeons (ACS) has published columns such as this one to assist surgeons and administrative staff in differentiating the two phases of implementation, to inform surgeons of important deadlines, and to make them aware of the penalties associated with noncompliance and nonparticipation.
What are the EHR incentive payments and penalty amounts?
The Medicare EHR Incentive Program payments began in calendar year 2011. Those EPs who began meeting the Stage 1 meaningful use requirement in 2011 or 2012 are eligible to receive the maximum incentive payment amount of $44,000 over a period of five years.
- If EPs begin in 2013, they may earn a total incentive payment of $39,000 over a period of four years.
- If EPs begin in 2014, they may receive a total incentive payment of $24,000 over a period of three years. No incentives are scheduled for EPs who become meaningful users in 2015 and beyond.
It is important to note that although the Medicare EHR Incentive Program penalties are not applied until calendar year 2015, the performance period for this penalty will occur before the payment penalty year. In other words, surgeons will need to be able to achieve Stage 1 of meaningful use before 2015 to avoid the payment penalty in 2015. Although the incentive payments are set to end by 2016 for those EPs who participate in the program by 2014, the penalties will begin in 2015 and will continue indefinitely. Table 1 describes the incentives and penalties from 2011 to 2015 and beyond.
Table 1. Maximum total amount of EHR incentive payments for a Medicare EP
|Calendar year*||First calendar year in which the EP receives an incentive payment|
|2011||2012||2013||2014||2015 and on|
|2015||2,000||4,000||8,000||8,000||$0; -1 percent of Medicare fee schedule (penalty)|
|2016||2,000||4,000||4,000||$0; -2 percent of Medicare fee schedule (penalty)|
*A calendar year equals a payment year.
What steps should surgeons be taking in 2013 to begin reporting for Stage 1?
In order to begin Stage 1, EPs must first sign up on the CMS registration and attestation system site. EPs may register in this system even before they have certified EHR technology. To meet the meaningful use objectives, EPs must use certified EHR technology that has been approved by the Office of the National Coordinator (ONC). A list of the ONC-certified EHR systems is available.
To begin reporting, an EP must meet the 14 core set measures, as well as select and meet at least five out of 10 menu set measures. EPs must choose at least one of the population and public health measures from the menu set.
EPs also are required to report on three core clinical quality measures to demonstrate meaningful use—blood pressure level, tobacco status, and adult weight screening and follow-up—or three alternate core measures if these three are inapplicable. EPs who are unable to report on the core clinical quality measures may instead report the alternate core measures, which are influenza immunization for patients older than age 50, weight assessment and counseling for children and adolescents, and childhood immunizations. If none of the six core and alternate core measures are applicable, EPs may report zeros for all six denominators.
In addition to the three core measures and alternate core measures, EPs must select and report on three additional measures from a subset of clinical measures most appropriate to an area of practice. If the three additional selected measures have a value of zero in the denominator, the EP will have to attest that the other clinical quality measures, if calculated by the certified EHR technology, have a value of zero in order to be exempt from reporting on additional measures.
For 2013, EPs may choose between two options to report on the EHR program measures:
- EPs may report on all of the EHR measures allowable in 2012 along with the mandatory changes to some measures in 2013.
- EPs may report on all of the measures required in 2012 along with both the mandatory changes for 2013 and the voluntary changes for 2013. The voluntary changes for 2013 will become mandatory in 2014.
Refer to Table 2 for additional information, and visit the ACS Web page to view a list of allowable measures to complete either option.
Table 2. 2013 EHR Incentive Program checklist by year of participation
|First year of participation||Second year of participation||Third year of participation|
|Calendar year 2013||
Choose one of the following:
Choose one of the following:
Choose one of the following:
In the first year of participation, EPs will need to report for a consecutive 90-day reporting period during any point in a calendar year until October 1 of a respective year. EPs also must report for a full calendar year in subsequent years of participation. There will be an exception to this in calendar year 2014, and we will publish more information on this in another EHR program update.
When will Stage 2 begin?
Stage 2 of the program is scheduled to begin in calendar year 2014. Hence, if an EP decides to wait until 2014 to participate in the Medicare EHR Incentive Program, Stage 1 requirements must be completed before beginning Stage 2 (that is, surgeons should report their Stage 1 90-day reporting in 2014; Stage 1 full calendar year reporting should be done in 2015, and then begin Stage 2 requirements in 2016). Updates to 2014 deadlines will be provided as they become available.
I am an EP. I plan to begin reporting immediately. What are the important deadlines for first-time users in 2013 or 2014, and how can I avoid penalties?
See Table 3 for a list of the deadlines and instructions for avoiding penalties.
Table 3. Upcoming EHR Incentive Program Deadlines
|Due date*||EHR Incentive Program reporting specification|
|October 3, 2013||To earn the maximum incentive of $39,000 for 2013, EPs will need to begin their Stage 1 90-day reporting by this date.|
|February 28, 2014||This date is the last day EPs can attest that they reported on the required measures for a 90-day reporting period in 2013.|
|July 3, 2014*||EPs in their first year of reporting in 2014 must begin their 90-day reporting period no later than July 3, 2014, to avoid the 2015 EHR Incentive Program penalty. EPs who begin their first year of reporting in 2014 will be eligible to receive a maximum eligible incentive of $24,000.|
|October 1, 2014*||This is the last day EPs may attest that they reported on the required measures for a 90-day reporting period beginning no later than July 3, 2014. Meeting this deadline will allow EPs to qualify to receive the 2014 EHR incentive payment and avoid the 2015 EHR penalty.|
|October 3, 2014*||The last day that EPs may begin their 90-day reporting to qualify for the 2014 incentive payment. EPs who begin reporting for the first time on this day will not avoid the 2015 EHR penalty.|
*Any updates to 2014 deadlines will be provided in future ACS publications.
What resources are available to begin reporting?
Surgeons may avail themselves of the following resources: