Meaningful Use Subsidies for Health Care Providers, Impacted Areas

Physicians and hospitals each have a list of objectives to qualify for subsidies. For physicians, the goals include:

  • Incorporate at least 50 percent of all lab tests in the electronic medical record (EM).
  • Use the EMR to send preventive care reminders to at least half of all patients over age 50.
  • Record and chart vital signs for all patients over age 2, including blood pressure and BMI.
  • Maintain a list of medications prescribed to 80 percent of all patients.
  • Generate patient lists by condition, such as hypertension, for quality improvement.
  • Make sure that at least 80 percent of patients can obtain their electronic health records within 48 hours.
  • Check insurance eligibility for at least 80 percent of all patients.
  • Implement five clinical decision-support rules that are a high clinical priority.
  • Submit at least 80 percent of all claims to public and private payers electronically.
  • Provide at least 10 percent of all patients timely access to electronic health records.
  • Provide clinical summaries for at least 80 percent of all patient visits.
  • Use CPOE systems for 80 percent of all prescriptions.

For a full list of goals for physicians and hospitals, go to the www.federalregister.gov web site or use this direct link: http://edocket.access.gpo.gov/2010/E9-31217.htm.

Source: Medicare and Medicaid Programs; Electronic Health Record Incentive Program.

Physicians who demonstrate the required use for 90 days in 2011 can qualify for the first of several promised payments. In subsequent years they must demonstrate meeting the meaningful use rules for all 12 months. The way these payments are arranged, a doctor can actually start in either 2011 or 2012 and under the federal schedule still qualify for the full $44,000 in subsidies available per physician.

Key Impacts on Health Care Providers By Category

While the feral government wants to speed along adoption, providers will be challenged to grapple with some of the issues below:

  • Staff Education & Training
  • Business‐Process Analysis of Health Plan Contracts
  • Coverage Determinations, & Documentation
  • Changes to Superbills
  • IT System Changes
  • Increased Documentation Costs
  • Cash Flow Disruption
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Michael F. Arrigo

Michael is Managing Partner & CEO of No World Borders, a leading healthcare management and IT consulting firm. He serves as an expert witness in Federal and State Court and was recently ruled as an expert by a 9th Circuit Federal Judge. He serves as a patent expert witness on intellectual property disputes, both as a Technical Expert and a Damages expert. His vision for the firm is to continue acquisition of skills and technology that support the intersection of clinical data and administrative health data where the eligibility for medically necessary care is determined. He leads a team that provides litigation consulting as well as advisory regarding medical coding, medical billing, medical bill review and HIPAA Privacy and Security best practices for healthcare clients, Meaningful Use of Electronic Health Records. He advises legal teams as an expert witness in HIPAA Privacy and Security, medical coding and billing and usual and customary cost of care, the Affordable Care Act and benefits enrollment, white collar crime, False Claims Act, Anti-Kickback, Stark Law, physician compensation, Insurance bad faith, payor-provider disputes, ERISA plan-third-party administrator disputes, third-party liability, and the Medicare Secondary Payer Act (MSPA) MMSEA Section 111 reporting. He uses these skills in disputes regarding the valuation of pharmaceuticals and drug costs and in the review and audit of pain management and opioid prescribers under state Standards and the Controlled Substances Act. He consults to venture capital and private equity firms on mHealth, Cloud Computing in Healthcare, and Software as a Service. He advises ERISA self-insured employers on cost of care and regulations. Arrigo was recently retained by the U.S. Department of Justice (DOJ) regarding a significant false claims act investigation. He has provided opinions on over $1 billion in health care claims and due diligence on over $8 billion in healthcare mergers and acquisitions. Education: UC Irvine - Economics and Computer Science, University of Southern California - Business, studies at Stanford Medical School - Biomedical Informatics, studies at Harvard Medical School - Bioethics. Trained in over 10 medical specialties in medical billing and coding. Trained by U.S. Patent and Trademark Office (USPTO) and PTAB Judges on patent statutes, rules and case law (as a non-attorney to better advise clients on Technical and Damages aspects of patent construction and claims). Mr. Arrigo has been interviewed quoted in the Wall Street Journal, New York Times, and National Public Radio, Fortune, KNX 1070 Radio, Kaiser Health News, NBC Television News, The Capitol Forum and other media outlets. See https://www.noworldborders.com/news/ and https://www.noworldborders.com/clients/ for more about the company.