Who Qualifies for the EMR/EHR Healthcare Stimulus?

The HITECH Act specifies that physicians can qualify for $44,000 or more in economic stimulus incentives for adopting an EHR. What does this exactly mean? Does your practice qualify? Here are a few answers concerning HITECH incentives from WaveTwo:

Are HITECH incentives per physician or per office?

HITECH incentives are paid on a per provider basis. For example, a practice with two physicians and a nurse practitioner using an EHR could qualify for $132,000 in Medicare incentives.

What types of health care providers can qualify for HITECH incentives?

The American Recovery and Reinvestment Act of 2009 (ARRA – start on page 114) details that the following all qualify for HITECH incentives:

  • Hospitals
  • Skilled nursing facilities
  • Nursing facilities
  • Home health entities
  • Long term care facilities
  • Health care clinics
  • Community mental health centers
  • Renal dialysis facilities
  • Blood centers
  • Ambulatory surgical centers
  • Emergency medical service providers
  • Federally qualified health centers (FQHC)
  • Group practices
  • Pharmacists
  • Laboratories
  • Physicians (See below)
  • Practitioners (See below)
  • Indian Health Service providers
  • Rural health clinics
  • Therapists

What types of physicians qualify for HITECH incentives?

The following types of practices can all qualify for $44,000 or more in HITECH stimulus incentives according to the definitions in the Social Security Act, section 1861(r):

  • Doctor of Medicine or Osteopathy – M.D. or D.O.
  • Doctor of Dental Surgery or Medicine – D.D.S or D.D.M
  • Doctor of Podiatric Medicine – D.P.M.
  • Doctor of Optometry – O.D.
  • Chiropractor – D.C.

What types of medical practitioners are included in HITECH?

In addition to the list above, ARRA references "providers as defined in the Social Security Act, section 1842" as qualifying for HITECH incentives. This includes:

  • A physician assistant, nurse practitioner, or clinical nurse specialist
  • A certified registered nurse anesthetist
  • A certified nurse-midwife
  • A clinical social worker
  • A clinical psychologist
  • A registered dietitian or nutrition professional

Which geographic areas qualify for HITECH incentives?

ARRA specifies the following regions and territories as qualifying for HITECH incentives:

  • All 50 US states
  • The District of Columbia
  • Puerto Rico
  • The Virgin Islands
  • Guam
  • American Samoa
  • The Northern Mariana Islands

What types of medical practices do not qualify for HITECH incentives?

The following types of practices do not qualify for incentives based on our current understanding of the program:

  • Free clinics that don’t bill Medicare or Medicaid
  • Physical therapists
  • Hospital-based physicians such as pathologists, anesthesiologists or emergency physicians
  • Acupuncturists and other holistic providers
  • Any practice not eligible for Medicare or Medicaid payments

What are the potential Medicare/Medicaid reimbursements for hospitals?

Example of how a hospital would qualify for the maximum Medicare incentives (Medicaid works differently). For each year the facility delays implementing a certified EHR, potential reimbursements are lowered:

Situation:

  • Hospital A has 200 Medicare discharges per week, i.e. 10,400 annually
  • The threshold for the Medicare incentives to kick in begins in excess of 1,499 discharges annually – for each discharge we’ll assume the reimbursement is $200 (actual rate not yet determined)
  • After the first year, the reimbursements decrease over time
  • The four year cap is $11 million

Potential Reimbursement (if discharges remain constant over 4 years and the facility becomes a meaningful EHR user in 2011):

  • Year 1 – 1.78M
  • Year 2 – 1.3M
  • Year 3 – 890K
  • Year 4 – 445K

Total – 4.45M above and beyond the base $2M provided without Medicare incentives

Note: a hospital can be reimbursed by Medicare or Medicaid but not both. There is also a transition factor built in that reduces the amount based on the year of adoption of a certified EHR.