ARRA Update: Opportunities and Risks for Health IT

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The American Recovery and Reinvestment Act of 2009 (ARRA), signed into law on February 17, includes $19 billion in funding for health care IT initiatives through the Health Information Technology for Economic and Clinical Health Act (HITECH). How these funds will be distributed, however, remains unclear, and radiology practices and hospital radiology departments hoping to receive HITECH funding should begin planning a strategy immediately.
“The ARRA is, if nothing else, an extraordinarily ambitious law. Health IT has gone from an essential component, a supporting backbone to our health care system, indirectly funded, not regulated, to a directly and heavily regulated, heavily subsidized industry of its own, and it happened in minutes.” --Howard Burde, JD
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Chuck Christian, CIO
“The questions that are going to be answered for us in the next weeks and months are: Who has the money, where is it, how do I get on the list, and how do I line up my organization to get access to it?” according to Charles Christian, CIO and health systems manager of Good Samaritan Hospital, Vincennes, Ind, and chair of the board of directors of the Healthcare Information and Management Systems Society (HIMSS). Christian, who copresented A Strategic Approach to Managing Opportunities and Risks for Health IT in Economic Stimulus at the HIMSS meeting in Chicago on April 6, urged members of the imaging community to take an active role in shaping the terms contained in the legislation, noting, “The act not only authorizes the funds, but it also appropriates the funds: The money is there.” At issue is the legislation’s reliance on the term meaningful use. Seventeen billion of the $19 billion in funding is reserved to pay incentives, through Medicare and Medicaid, for physicians and hospitals implementing health IT by 2014. The other $2 billion will be distributed through the Office of the National Coordinator for Health IT for projects including a health-information exchange infrastructure, standards development, and state grants to further the adoption of electronic medical records (EMRs). In order to qualify for these incentives, however, a provider must demonstrate meaningful use of certified EMR technology, raising two questions: How is meaningful use defined, and what will the certifying body be? Howard Burde, JD, Christian’s copresenter at the HIMSS conference, is a HIMSS board member, and a partner and leader of the health law practice group at Blank Rome LLP, Philadelphia. He says, “The ARRA is, if nothing else, an extraordinarily ambitious law. Health IT has gone from an essential component, a supporting backbone to our health care system, indirectly funded, not regulated, to a directly and heavily regulated, heavily subsidized industry of its own, and it happened in minutes.” Burde warns providers that the incentives provided by HITECH should not be viewed as handouts. “They could make meaningful use so burdensome and so difficult that providers will have a tough time complying and, therefore, a tough time drawing down Medicare and Medicaid funds,” he says. So far, there are still more questions than answers regarding the language used in the legislation. The Certification Commission for Healthcare Information Technology (CCHIT) seems like a natural choice for the certifying body, but a decision is yet to be made. According to John Morrissey, press officer for CCHIT, “All we know, at this point, is that the language of the law says that the Office of the National Coordinator may keep or recognize a voluntary certifying body or bodies, and we are the only one to keep at this point, and we are the only one officially recognized, but we are waiting for the official word.” Morrissey anticipates knowing more in the coming month. He says, “They have to have a plan of action by the end of this year, and the number of regulatory and approval processes that this constitutes is not trivial, so in order to get through that process, they’re going to have to make some decisions in a fairly expeditious way.” (See sidebar for more information on the ARRA timeline.) Meanwhile, HIMSS has stepped up to the plate on the term meaningful use, volunteering its own definition for adoption by CMS. For hospitals to be eligible for incentive payments, HIMSS suggests that they must use health IT in a meaningful manner, which would include exchanging electronic health information to improve the quality of care, as well as submitting clinical quality measures and other measures selected by the secretary of HHS. Hospitals would also have to meet the meaningful-use definition within a specified time frame. For physicians to be eligible, HIMSS recommends defining the use of health IT in a meaningful manner as including electronic prescribing, the exchange of electronic health information to improve the quality of care, the ability to add clinical decision support to order entry, and the submission of clinical quality measures. HIMSS also recommended that CCHIT be recognized as the certifying body for EMRs, to ensure continuity. Until more is known about the processes through which funding will be distributed, Christian urges providers to determine whether applying for the incentives will increase their Medicare or Medicaid payments. He says, “If you raise your hand and take the Medicaid provisions, you forfeit the Medicare provisions. You have to do the math. If you have a higher Medicaid population, you will fare better from the stimulus using the Medicaid calculations than you would using the Medicare calculations.” Online payment calculators and worksheets are available on the HIMSS Web site at http://www.himss.org/EconomicStimulus/. Christian identifies several steps to ARRA readiness. These include implementation of an internal team, including administration, either a CFO or a CEO, IT, finance, medical records, internal audit, and a representative from the medical staff; identifying the health care czar in your state who will help lead the state’s health care IT discussion; monitoring Web resources (see sidebar); and finding out what your vendors are doing in order to become certified, particularly if you’re in the middle of a negotiation. He also recommends educating your medical staff. “How many of you have a plan for how you will partner with your medical staff in connecting the hospital EMR to their practices?” he asks. “If you don’t have one, it might be a good time to start thinking about it, because when you start having a conversation with your medical staff about these things, I think they are going to have a lot of questions. You need to formalize what that opportunity is and what that plan is.” Remember that installing the technology is only the first step. “I promise you, this is not going to be administered like the bank bailouts,” Christian notes. “The health care industry is actually expected to do the work, and illustrate the outcome of that work, before we are going to have access to a nickel of that money.”
ONLINE RESOURCES

Online Resources
A one-stop shop on the American Recovery and Reinvestment Act: www.himss.org/EconomicStimulus


Summary: www.himss.org/content/files/HIMSSSummaryOfARRA.pdf

FAQ:www.himss.org/EconomicStimulus/docs/HIMSS_FAQs_ARRA.pdf

Office of the National Coordinator:www.hhs.gov/healthit

Recovery information:www.recovery.gov

Grant-activity monitoring:grantsadvantage.org

ARRA Timeline for 2009
February 17 The American Recovery and Reinvestment Act was signed into law.
February 19 Federal agencies began reporting their formal block-grant awards.
March 3 Federal agencies began reporting the use of funds.
April 3 States were required to claim funds allocated by the act.
May 2 Federal agencies were to make Performance Plans publications available and to begin reporting on their allocation for entitlement programs.
May 15 Detailed agency financial reports are to become available.
May 18 Health IT (HIT) Policy Committee members are to be appointed. HIT Standards Committee members are to be appointed, and the secretary of HHS is required to publish a notice describing the Regional Program (Health Information Extension Program).
December 31 The secretary of HHS must adopt standards, implementation specifications, and certification criteria.