How wireless technology can boost US Medicare and Medicaid electronic health record (EHR) incentive programs for eligible professionals, eligible hospitals and critical access hospitals as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology
Healthcare organizations have ever-increasing challenges for generating revenues and controlling expenses, while providing a high level of quality care. With the burgeoning cost of doing business as a healthcare provider and the expectations for an influx of new patients under healthcare legislation, providers must consider all means necessary to streamline business practices. More than ever before, clinics and hospitals must provide the most efficient environment possible for the practitioner to maintain the same quality of care for patients. One mechanism to improve the efficiency of practitioners is to leverage existing IT technologies. More fully, the federal government has also identified this opportunity and has developed an incentive program to jump start health IT (HIT) implementations.
In 2009, President Barack Obama signed into law the American Recovery and Reinvestment Act of 2009, H.R. 1. The Act aimed to stimulate the economy through investments in healthcare among other segments. It included over $20 billion to aid in the development of a robust IT infrastructure for healthcare and to assist providers and other entities in adopting and using health IT. This program is managed through the Centers for Medicare and Medicaid Services under the Department of Health and Human Services. The flow chart shows how to determine eligibility for the Nedicare and Medicaid Electronic Health Record (EHR) Incentive Programs. A Medicaid eligible professional may also be eligible for the Medicare incentive and should follow the path of answering no to the question of Medicaid patient volume to determine Medicare eligibility. An eligible professional who qualifies for both programs may only participate in one program. Eligible Professionals eligible to receive EHR incentive payments under Medicare or Medicaid will maximize their payments by choosing the Medicaid EHR Incentive Program.
Health IT
The Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs were established under the Health Information Technology for Economic and Clinical Health Act, or the ‘HITECH Act’, which is part of the Recovery Act. The EHR Incentive Programs under Medicare and Medicaid will provide incentive payments for the ‘meaningful use’ of certified EHR technology. The Medicare and Medicaid EHR Incentive Programs provide incentive payments to eligible professionals (EPs), critical access hospitals, and eligible hospitals as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology. Why electronic health records? Each day, the American health care system conducts more transactions than the New York Stock Exchange, most of them on paper and at risk of human error. The Institute of Medicine estimates there are between 44,000 and 98,000 deaths attributed to medical errors each year, and while not all errors can be prevented by the adoption of EHRs, there is no question that standardized, interoperable systems will move the US in the direction of improved quality and efficiency and reduced errors and waste.
It has been estimated that over half of all clinics have yet to migrate to some sort of EHR system and still use paper. An eligible professional (physician) will receive incentive payments as specified in the legislation), for demonstrating a meaningful use of EHR technology and demonstrated performance during the reporting period for each payment year. If an eligible professional does not demonstrate meaningful use by 2015, his/her reimbursement payments under Medicare will begin to be reduced. No incentive payment will be made after 2016. Note that physicians who do not comply with the Electronic Record requirements will receive diminishing payments from Medicare and Medicaid in subsequent years until they will no longer receive payments. Eligible Hospitals cover most institutions with a handful of exceptions.
EPs who predominantly furnish services in a Health Professional Shortage Area (HPSA) are eligible for a 10 percent increase in the maximum incentive amount. EPs who adopt, implement, upgrade, and meaningfully use EHRs can receive a maximum of $63,750 in incentive payments from Medicaid over a six year period. Most of the funding for HIT investments is designated for incentive payments for adoption of qualified, certified EHRs primarily by physicians and hospital providers. The money is directed through the Medicare and Medicaid programs. The two programs have similarities and differences in their requirements to qualify for the incentive payments and the amount available to providers. Under the Medicaid EHR Incentive Program, incentives can also be paid for the adoption, implementation, or upgrade of certified EHR technology. EHR incentive requirements differ between Medicare and Medicaid as follows:
Medicare
Incentive payments through Medicare (the federal insurance program for those 65 and older) go to non-hospital based physicians and hospitals paid through prospective payment systems that are ‘meaningful users’ of certified EHR systems. In simple terms, ‘meaningful use’ requires that the EHR be installed and actively used to collect and share patient information and to support improved clinical care. Meaningful use criteria for physicians include ePrescribing, electronic reporting of clinical quality data, and that the certified EHR is connected for the electronic exchange of health information. Meaningful use criteria for hospitals are similar to those for physicians but do not include ePrescribing.
Medicaid
Incentive payments through Medicaid (the federal/state program for low-income individuals) go to non-hospital based providers and hospitals. Providers include not only physicians but also dentists, nurse practitioners, certified nurse midwives, and, under specific circumstances, physician’s assistants. In addition to hospitals, federally qualified health centers (FQHCs) and rural health clinics may receive Medicaid incentives for EHR adoption. The Department of Health and Human Services (HHS) released a package of regulations clarifying the definition of achieving ‘meaningful use’ of electronic health record systems. Eligible providers and hospitals must meet the meaningful use criteria to qualify for government incentives and bonus payments for the adoption of EHR systems. The criterion can be complicated, particularly for hospitals, but certified EHR vendors cover the definition of meaningful use with their solutions. From a high level, meaningful use requires that EHRs be able to ‘exchange electronic health information with, and integrate such information from, other sources’ without specifying network infrastructure requirements. The legislation also emphasizes the security and privacy of health information without requiring specific security technologies as part of the EHR solution.
Wireless and EMR
There is an implicit relationship between the adoption of electronic health record systems and the existence of a fast, reliable, and secure wireless network. Eligible hospitals and clinics need to provide these wireless networks mainly to provide real time access to EMRs but also to support improved asset management, mobile workers, administration of medications and digitized records. Hospitals and clinics are relying more on wireless enabled equipment and practitioners are already relying on smart handheld devices of which there are thousands of applications that providers use every day. Although many hospitals and clinics already have some sort of wireless connectivity, older 802.11 a,b,g technologies that are most common are not adequate for the capacity necessary to stream large image files. Further, hospitals notoriously are a bastion of radio frequency noise limiting the quality and reliability of wireless connectivity. Most wireless devices do not have the ability to negotiate rapidly changing RF noise. User demands on Wi-Fi networks continue to rise quickly across every segment of the industry, and as a direct result, great radio performance matters more than ever. Achieving that high performance is no small challenge in the face of high AP density, high client counts, and interference — requiring the use of every technology tool available to better control and improve radio behavior in the environment.
The latest generation of Wi-Fi chipsets are bringing a potentially useful new addition to the toolkit: transmit beamforming with explicit feedback (commonly referred to as “TxBF”). TxBF can offer gains under the right circumstances, but it has some inherent limitations that mean it cannot solve the performance challenge all by itself, despite some vigorous vendor marketing claims to the contrary. Used in combination with adaptive antennas, though, TxBF can become an essential tool in a comprehensive approach to achieving maximum radio performance in today’s challenging environments. Moreover, the government incentives for EHR implementations include any technologies that enable the transmission of electronic information, and as virtually all devices are Wi-Fi enabled, the incentive also applies to wireless networks.
By Ruckus Wireless