Health insurers and organizations are backing the U.S. Department of Health and Human Services and its newly issued regulations for implementing the Medicare and Medicaid electronic health records (EHR) incentive programs.

The Medicare and Medicaid EHR incentive programs are part of the Health Information Technology for Economic and Clinical Health Act (HITECH) of 2009, which, in turn is part of the American Recovery and Reinvestment Act signed into law in 2009.

The EHR provision authorizes Medicare and Medicaid to distribute $18 billion in incentive payments to physicians and hospitals that are meaningful users of EHR systems.

Last week, the Centers for Medicare and Medicaid Service (CMS), an arm of HHS, sent an 864-page draft of the final rule for the “Medicare and Medicaid Programs; Electronic Health Record Incentive Program” to the Office of the Federal Register for publication.

HHS also sent the Federal Register office a 228-page final rule relating to “Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology.”

Both rules will help create a set of standards for implementing the first of a three-stage plan to shift to EHR systems. Regulators are expected to use the criteria to determine whether providers are making enough “meaningful use” of EHR systems to qualify for incentive payments.

Meaningful Use Standards

CMS says that the requirements for meaningful use incentive payments will be implemented over a multi-year period, in which additional requirements will be phased in at the end of 2011 and end of 2013 in order to raise the bar for performance on IT.

According to CMS, stage one will focus primarily on “establishing the functionalities in certified EHR technology that will allow for continuous quality improvement and ease of information exchange.”

The majority of physicians don’t have electronic tools, so stage one primarily focuses on creating electronic versions for traditional health records such as physicians’ charts, says Charles Kennedy, vice president of health IT at WellPoint and a member of the federal IT committee that created the “meaningful use” guidelines.

As part of the regulation, providers must meet 15 core requirements and five of 10 additional objectives to qualify as meaningful EHR users during Stage 1.

But due to consideration of comments received, CMS says, claim submission and eligibility verification check objectives have been eliminated from the Stage 1 meaningful use standards.

CMS says that over 75 percent of people who commented on these two objectives included in the proposed rule wanted them eliminated from the final rule, noting that they believe the objectives are not part of traditional EHR technology.

Since the HITECH Act is “largely a clinical goal,” eligibility verification checks and claim submission are not an area to focus on in order to improve the quality of care people are receiving, Kennedy says.

CMS says that Stage 2 will “encourage the use of health IT for continuous quality improvement at the point of care and the exchange of information in the most structured format possible,” and that Stage 3 criteria will “focus on promoting improvements in quality, safety and efficiency leading to improved health outcomes.”

Reactions

“In general, we support the HITECH Act,” Kennedy says. “Adoption that is correctly designed and used appropriately will improve the quality of care.”

Reed Tuckson, executive vice president and chief of medical affairs at UnitedHealth Group also supports the HHS “meaningful use” standards for EHRs.

“This is a positive step to promote polices that encourage physicians, other health professionals and hospitals to adopt technology that meaningfully advances the quality, cost-effectiveness and interoperability of health care delivery,” Tuckson says in a statement.

“We stand ready to work with the administration to rapidly advance both the sophistication of these products and their wider use by physicians and hospitals.”

America’s Health Insurance Plans (AHIP), Washington, has also given its vote of confidence for the HITECH Act and the meaningful use criteria.

Karen Ignani, president and chief executive officer of AHIP says in a statement, “Broad adoption and meaningful use of health information technology by providers is essential to creating an efficient, high-performing 21st-century health care system.”

Many health plans have been rewarding providers using EHR systems and look forward to working with the Department to further develop and encourage health information technology, Ignani says.

The Blue Cross and Blue Shield Association, Chicago, says it also supports nationwide adoption of health information technology, including EHRs, but is concerned that the HITECH Act overlooks the contributions that health plans, such as the Blues, can make to promoting EHR adoption.

Health plans already have established the infrastructure for exchanging clinical data, administrative data, and clinically meaningful claims data, the association says.

Joel Slackman, managing director of the association says that “until the majority of physicians are using EHRs and all EHRs are using uniform approaches, the best source or electronic data is claims data.” Only claims records contain information about the cost of care, he says.

Expectations

Some skeptics question whether EHR systems will do much to hold down health care spending, but advocates say the systems will improve the quality, safety and efficiency of care and may reduce costs.

As the EHR incentive programs are implemented, over time people will see more and more evidence that the quality of care is improving, Kennedy says.

But, people shouldn’t get their hopes up that this initial adoption of technology will transform the health care system right away, Kennedy says.

“This is the first step down a path of 10 years that will lead to significant changes in health care,” he added.

“My only major concern [with the HITECH Act and EHR incentive programs] is inappropriately elevated expectations.”

What people can expect to see, however, is “the foundation of electronic enablement,” he says. It will be in a series of years that we will see new initiatives and changes that will improve the health care system, he adds.

What to Know

Health insurance agents and brokers should know two things about the HITECH Act, Kennedy says.

First, they should know what is going on, namely that incentives for more electronic care delivery are available. “They should also make their clients or employer groups aware of this,” he says, so that clients can make an informed decision when choosing a provider by factoring in if a physician is using health information technology or not.