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In a recent New York Times article, a trend was discussed that was taking doctors out of large clinics to smaller or even single-provider practices where they were able to control when and how they see their patients.

By stepping off the big-clinic treadmill, where doctors are sometimes asked to see a different patient every 15 minutes, Dr. Batlle has joined the vanguard of physicians trying to redefine health care. These doctors spend more time with patients, emphasize prevention and education to keep them healthy and can handle many medical problems without referrals to specialists.

Further into the article, the Dr. Batlle describes the medical office technology that he uses that helps him keep down his office costs by eliminating the need for paper charts and even an office staff member that spends their time setting appointments. None of the examples in the article are actually named, but it does explain that consultants are often used to identify the products that are right for their client practices.

At first, this seemed like another stimulus driven piece, but as I read it I realized that the current administration and the Recovery Act are minor players here. Even if there was no plan in place, this trend and the move to electronic medical records has been a long time coming, and something that experts in the field have been talking about for years.

If you read closely, you will see that the product that the doctors are talking about in the article are not your traditional EMR products that attempt to make a diagnosis based on screen after screen of check boxes and drop-downs. The products that are used in the articles seem to be focused on helping run the office itself, giving the doctor more time with the patients.

If you are currently in the market for an EMR product, talk to those companies that offer this type of product. If you are using a consultant to find the perfect technology for you, make sure they show you everything the market has to offer!

This document was created for two reasons: to familiarize you with the stipulations of the current stimulus package that are relevant to using an EMR in your practice; and, to prepare you against marketing spin, rumor, misinformation etc. The stimulus package has now been passed into federal law, the related healthcare IT portions will be written into a “CFR,” or Code of Federal Regulations. Much of the impact and requirements of the stimulus bonus for providers remains vague and to be defined by specific parties by early 2010. For your protection, we’ve outlined some relevant facts here. For your reference, the entire American Recovery and Reinvestment Act (ARRA) is available at www.recovery.gov.

• The HITECH Act – Pages 112 through 165 outline the adoption of Healthcare Information Technology and are known as the “HITECH” act. The Act outlines payments to physicians making “meaningful” use of a “certified” Electronic Health Record (EHR). It is left to the Department of Health and Human Services (HHS) to determine what constitutes “meaningful use” and it has been left to the National Institute for Standards and Technology (NIST) to determine what “certified” means. At HHS, the Obama Administration has given the Office of the National Coordinator for Healthcare IT (ONCHIT), led by Dr. David Blumenthal, the responsibilities for defining what “meaningful use” means and NIST the responsibility for defining what a “certified” will be. Those definitions are due by early 2010.

• Important Fact #1 – It is not mandatory. You may elect to participate or not. Nothing in the law requires you to purchase or use an EMR. You are still in control of the destiny of your practice and we encourage no one to make decisions out of fear. Medicare reimbursements may decline beginning in the year 2016 by 1% per year if a practice is not participating by then. While the law does indicate there will be penalties, Congress has never allowed Medicare penalties to take effect in the past (the backlash has been significant whenever it was tried).

• Important Fact #2 - How and when would you get paid? The amount of total reimbursement a physician is eligible for is capped and identified on an annual basis. It has not been identified specifically when and how these payments will be made (i.e. increases to Medicare reimbursements or annual bonus checks). The EARLIEST you are eligible is beginning in 2011 but it is clear that all investments will be made by you and not the government; Congress has allowed for reimbursement of expenses but not advancing any payments to make purchases, install equipment, or perform training/implementation. The amounts that you will be eligible for are as follows:

2011: $15,000 or $18,000 – depending if you follow the Medicare program or Medicaid Program
2012: $12,000
2013: $ 8,000
2014: $ 4,000
2015: $ 2,000

The amounts decline if you do not participate before the end of 2012. Beginning in 2016, Medicare will reduce reimbursement by 1% per year through year 2019 (total 3%) if a practice has not adopted. Keep in mind though that Congress has never allowed Medicare penalties to take effect in the past when it tried to vote for them (it does not happen automatically).

• Important Fact #3 - No vendor can yet claim to be “certified” to enable you to earn stimulus money. The National Institute for Standards and Technology (NIST) has until December 31, 2009 to provide certification requirements. Former voluntary standards bodies, like CCHIT, remain voluntary. Any person/vendor/consulting organization claiming to know otherwise is speculating. When anyone quotes specifics, ask them for language from the actual ARRA bill itself (from Congress) or CFR (code of federal regulations) language. If something is not in the bill or in a CFR created by the Executive Branch it won’t be defensible and will likely not be true. Vendor selection is an important decision for your practice and your selected vendor owes you fairness. simplifyMD created the industry’s first “Customer Bill of Rights,” to protect you and it is written into every one of our contracts.