HITArkansas can help Arkansas health care providers qualify for up to $63,750 in government funding tied to the “meaningful use” of an electronic health records system (EHR).

Because health information technology and exchange has such potential to improve patient care and lower costs, Congress included money in the American Recovery and Reinvestment Act of 2009 (the economic stimulus bill) to encourage providers to implement EHRs in their practice or facility. Arkansas health care providers who install and become certified "meaningful users" of EHRs may be eligible for incentive payments or reimbursements of $44,000 to $63,750 through the program. 

Meaningful use has 3 main components:

• The use of a certified EHR system in a meaningful manner (e.g. e-Prescribing)
• The use of certified EHR technology for electronic exchange of health information in order to improve quality of health care
• The use of certified EHR technology to submit clinical quality and other measures

To help providers achieve meaningful use, the stimulus bill included funding for a number of Health Information Technology Regional Extension Centers (HITRECs) around the country. As the HITREC for the state of Arkansas, HITArkansas, a division of the Arkansas Foundation for Medical Care, will provide:

• On-site technical assistance with EHR adoption
• Education on selection, implementation and use of an EHR system
• Group purchasing of EHR systems and technical support to leverage
  volume discounts
• End-to-end project management support of EHR implementation
• Access to current information on meaningful use and best practices from around the country through the National Learning Consortium
• Support for practice and workflow redesign to achieve meaningful use of EHR system
• Certification of provider as a meaningful user

Government funding covers 90% of the costs of providing this assistance. The remaining 10% will come from other sources, including a nominal fee charged to providers.

Providers must choose whether to pursue funding through either the Medicare or Medicaid route. Funding amounts, caseload criteria and timelines are different for each of the two routes. Once a payment is received through one program, providers have one opportunity to switch to the other program.

MEDICARE PROVIDER INCENTIVES AND REQUIREMENTS:

• Incentives most likely will start in calendar year 2011 and end in 2015
• Physicians may receive payments up to $44,000 over five years if EHR usage begins by 2012.
• Claims payments will be reduced by up to 3% if providers don’t implement EHRs by 2015
• Eligible providers include MDs, DOs, dentists, optometrists, podiatrists and chiropractors; however, HITArkansas is currently charged with assisting only primary care providers in priority areas of the state.
• Professionals who provide the majority of their services in a hospital setting are not eligible for Medicare incentive payments.
• Bonus payments are based on 75% of Medicare claims, subject to caps (providers billing at least $24,000 to Medicare would claim the maximum $18,000 bonus); health care providers in “provider shortage areas” are eligible for 10% increase over their eligible amount.

MEDICAID PROVIDER INCENTIVES AND REQUIREMENTS:

• Providers must have a 30% Medicaid caseload. Pediatricians who fall short of the 30% Medicaid caseload requirement, but have a minimum of a 20% Medicaid caseload, may receive payment that is 2/3 of the allowable reimbursement.
• Physicians can receive up to $21,250 the first year to offset the cost of installing a certified EHR system, and up to $8,500 per year for five more years to support “meaningful use” of the technology. Total reimbursements cannot exceed $63,750 per physician.
• Providers can begin the process as late as 2016.
• Medicaid payments are not reduced if a provider does not adopt certified EHR technology.
• Providers include physicians, dentists, nurse midwives, nurse practitioners, physician assistants in rural health clinics or federally qualified health centers led by a PA, children’s hospitals and acute-care hospitals.

 Participating providers/practices will be expected to:

• Submit a pre-application with complete information to initiate onsite visits.
• Complete, sign and return a provider service agreement.*
• Develop a practice EHR implementation team with a minimum of three members, drawn from the clinic director, medical director, nursing staff, office manager, IT staff or quality improvement staff.
• Provide HITArkansas access to this team via scheduled on-site visits and/or conference calls.
• Provide HITArkansas access to practice staff members, facility and existing software/hardware to evaluate current workflow and delivery system design.
• Work with HITArkansas staff to develop a reasonable timeline for the transition to EHRs and commit to adhering to that timeline.
• Work with selected EHR vendor and vendor project manager, trainer(s), and customer support (IT), with HITArkansas staff serving as liaison to facilitate the transition/implementation process.
• Attend in-service training conducted by HITArkansas quality specialists to understand/learn about change concepts (PDSA) and continuous quality improvement (CQI) in an effort to ensure sustainability.
• If required, participate in periodic evaluation surveys of HITArkansas staff.
• Commit to pursuing maximum EHR functionality and incorporating meaningful use criteria.

*The provider service agreement will include these elements:

• Demographic indicators
• A commitment from the practice to adopt an EHR and achieve meaningful use
• A list of the support services the REC is offering the provider/practice
• A "go live" date by which the provider/practice will be using the EHR