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Implementing the Health Information Technology for Economic and Clinical Health Act

Currently, most providers lack the information systems necessary to coordinate a patient's care with other health care providers, to monitor a patient's health condition over time, or to record demographic data about the patient.[2] To encourage the adoption of HIT by providers, the Health Information Technology for Economic and Clinical Health Act (HITECH), as included in the American Recovery and Reinvestment Act of 2009 (ARRA), established a voluntary program under which eligible hospitals and physicians meeting certain so-called "meaningful use" criteria can receive incentive payments to improve their health information technology.[3] 

On December 30th 2009, the Centers for Medicare & Medicaid Services (CMS) released its Notice of Proposed Rule Making (NPRM) to establish the incentive payment program and to implement the meaningful use provisions of the HITECH Act (75 Fed. Reg. 1844). CMS has established a staged approach for establishing what is meant by meaningful use of HIT. The NPRM establishes the criteria for meaningful use in Stage 1 only. The meaningful use criteria for stages 2 and 3 will be released by the end of 2011 and 2013 respectively. The criteria for stage 1 are listed under a newly created federal regulatory section, 42 CFR §495.6, which encompasses the 5 health outcome policy priorities of HITECH as well as its 23 quality objectives.

Hospitals and other eligible entities must meet specific criteria to qualify for incentive payments. Payments under the HITECH Act could reach $44,000 for physicians under the Medicare incentive payment system and could mean millions of dollars for hospitals over the 4 year implementation period established by HICTECH.

The Center for Medicare Advocacy (the Center) has submitted comments to CMS on the incentive program rules. The Center encouraged CMS to keep its robust "all or nothing" approach to meaningful use of health information technology. Under this approach, unless a hospital or provider can demonstrate meaningful use in all 23 of the criteria, it would not be eligible to receive HITECH incentive payments.  The Center believes that any investment of public funds to accelerate the adoption of health information technology must improve the quality of care that patients receive, leading to better health outcomes.  The incentive payments should not be used to reward health information technology initiatives unless they meet all of the meaningful use requirements. Rather, meaningful use payments should be used only as an incentive to extend and enhance the delivery of health care. 

Many hospital systems and providers have argued that, for a variety of reasons, currently they cannot meet all of the criteria to qualify for the incentive payments for meaningful use of HIT. The Center, however, recognizes that the purpose of incentive payments for meaningful use is not to reward or reinforce the status quo, or simply digitize paper health records, or automate current administrative processes. Rather, such payments are ultimately to improve the quality of health care for the consumer.

The nation's two largest hospital groups, the American Hospital Association and the Federation of American Hospitals, are urging CMS to abandon the "all or nothing" approach.[4] The Center, on the other hand, argues that it is critical that all of the Stage 1 meaningful use criteria be maintained so that health information technology continues to advance in the later stages of the program. The criteria for Stages 2 and 3 of the program will build on the HIT capabilities that have been established in Stage 1.   Any scaling back of the Stage 1 criteria, therefore, will likely lead to less robust criteria in Stages 2 and 3.  Ultimately, the lack of rigor would undermine the potential of HIT to improve the overall system and promote greater patient involvement in care.

The incentive payments become available in 2011, but neither hospitals nor eligible providers are mandated to begin meaningful use of HIT in 2011. The proposed rule provides ample flexibility for hospitals and eligible providers to choose their own "year 1" to begin their first payment year of meaningful use incentives. Additionally, hospitals and eligible providers are able to receive incentive payments for their first year of meaningful use after demonstrating meaningful use for only 90 consecutive days. 

In its comments, the Center commended CMS on the strength of the rule and its focus on quality, and encouraged the agency to retain its focus on requiring hospitals and eligible providers to adopt all of the electronic health record objectives in order to receive incentive payments. The Center believes that scaling back the quality measures set forth in the proposed rule would be harmful to patients. In addition, the Center feels that it would be inappropriate for the federal government to provide payment incentives to hospitals and other entities for current HIT activities. Rather, meaningful use payments should be an incentive to extend and enhance our healthcare system.