Sill Unanswered EHR Stimulus and Meaningful Use Questions

NOTE: I had this post sitting ready to be posted back in July and never got around to it. I think it’s still pretty relevant even though we are a few months farther along. Some of the time frames might not be quite right now, but the sentiments are interesting.

DKBerry sent me a passionate email in reference to this Modern Healthcare article about the EHR subsidies unanswered questions and the possibility of EHR Stimulus money flowing in May 2011. While I don’t agree completely with DKBerry, I have to admit that it’s quite disturbing that an 800 page meaningful use final rule later and we still have lots of questions. The following is DKBerry’s reaction/summary of the article:

Trudel makes it sound like a doc could validate his meaningful use on 30 April (end of the first possible 90 day period for reimbursement) … and would get paid by CMS in May.  Wonder how long she has worked for CMS?

I especially like this line …

John Halamka, committee co-chairman, asked whether the reimbursements paid to office-based physicians would be counted by the Internal Revenue Service as taxable income. Trudel said that question was out of her purview.”

Of course its taxable income Dr. Halmaka!  It’s based on Medicare reimbursement payments … and that’s revenue.  Had the bozzos who set up this idiotic incentive program provided tax credits instead of partial reimbursements for meaningful use adoption of a certified EHR … then maybe they would have gotten more than 15 docs to sign up.

You will love the dialog between Judith Faulkner (Epic Systems) and Doug Fridsma (ONCHIT).

Faulkner asked whether he thought “we’re going to make” the Jan. 1, 2011, start date by having both these certification and testing organizations and vendors with tested products in place by then.

Fridsma made no promises.”

He said his hope is that having multiple testing and certifications organizations authorized will “eliminate some of the bottlenecks.” Still, he said, there will be “challenges” to get systems certified if providers “bundle” pieces of EHR systems together to achieve meaningful use, a common scenario at many hospitals.

We are working as hard as we can to meet those timelines and get the capability in place,” Fridsma said.

I appreciate that you are working as hard as you can … but that’s not good enough.  ONC has to get it done now.  Any date after 30 September and its costing hospitals money.  They are going to be still screwing around with this in January … 2 years after they put it out in ARRA.  If I were a doc I would just say screw it … I’m closing my panel to Medicare patients.  This isn’t worth the pain and effort.

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John Lynn

John Lynn

John Lynn is the Founder of the, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference,, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.


  • John… Man I was really spun up when I wrote that note wasn’t I?

    Just checked and as I suspected I sent it to you after midnight! Wonder how many cups of coffee I had that night? Checked my other suspicion and yes … I had just finished watching my Texas Rangers lose to Oakland A’s when I sent you that note! TEX fans hate those west coast trips that don’t get over until midnight or later. Especially staying up late when they lose.

    Reading what I wrote back at the end of July still has some partial relevancy. We have 2 ARRA certification bodies and it’s technically possible for hospitals to certify MU by 1 Jan and ambulatory certification to be in place by the end of April and be paid in May by CMS.

    Would be interesting to hear from RECs and vendors on their predictions on the percentage of their ambulatory clients who they think will get earliest MU credit.

    TEX is on a 7 game win streak. I’m in a good mood.

  • As I think about it, we should get ready for a couple hospitals that are highly connected to the HITECH act legislation and rule making process to announce that they have met meaningful use. The question will be how many outside of that achieve meaningful use and get the EMR stimulus money.

    Texas has been killing it baby!! I’m sad I’m going to miss their trip to LA by 2 days. Otherwise, I’d go see the game.

  • On the medicare side, you can begin your year one stage one 90 day attestation period on Jan 1st 2011. Then on April 1st 2011 you can attest and apply for the year one incentive money, which is supposed to then be remitted in May. Then you have to wait to Jan 1st 2012 to start a full year MU reporting period, with application for year two stage one payment not available ’til Jan 1st, 2013.

    Medicaid is an entirely different issue. Some states may opt to not even participate (they have to voluntarily administer it, and have a 10% unfunded “resonable administrative expenses” liability), leaving providers who come in under Medicaid pt visit volume criteria in the lurch should a state Medicaid agency bail. This will make RECs that recruited such docs look very bad.

    Medicaid patient enrollment is starting to spike up rapidly as the economy continues to struggle and people lose their health coverage. Some state Medicaid programs may go totally bust. Nevada Medcaid is in dire straits at the moment.

    The whole thing is a mess.

  • Holding a press conference to announce that “We’re Well-Connected Health Care System” has met ONC’s MU standard is going to be impossible to validate.

    -ONC will publicized the success story to pressure competition and other providers to achieve MU

    -IT contractor will want to publicize WWCHCS successfully deployed our software in its marketing literature

    -WWCHCS will market its achievement to the communities it serves and physicians it seeks to engage

    Am sure we will find out down the road that WWCHCS didn’t really quite achieve the level of MU for all its provider physicians and clinics and CMS IG will investigate but HHS will determine after the fact that WWCHCS did “good enough” … so the bar could end up being changed for those supportive HCOs.

  • Bobby… saw this piece this afternoon in the daily Health IT Strategist email. Could not find a matching CMS press release though. Way it reads it sounds “this last round of funds … for 49 states, DC, PR, VI. Odds can’t be that NV is the missing 50th state do you think?

    “Medicaid programs receive CMS matching funds
    Four state Medicaid programs will receive more than $6.9 million in total matching funds from the CMS to help them implement the electronic health record incentive program created by the stimulus law. This last round of funds brings the total matching dollars awarded to $81.44 million, for 49 states and the District of Columbia, Puerto Rico and the U.S.Virgin Islands, the CMS said.

    “Massachusetts received the largest share in the latest round of funding, securing $3.56 million in federal matching funds, while Ohio, Hawaii and North Dakota received $2.29 million, $836,000, and $226,000, respectively. The funds will help the states analyze providers’ current use of health information technology, address barriers to EHR use and plan out a strategy for administering incentive payments, the CMS said in a news release.

    “The HITECH provisions of the stimulus law stipulate that eligible Medicaid providers can receive up to 85% of $75,000 – or $63,750 – in incentive payments over six years for EHR implementation, use and support services.

    “In addition, the act provides a 90% federal match for states’ planning and administration expenses, and 100% federal financial participation for state spending on incentive payments.”

  • Now all 50 States plus PR and USVI have requested planning funds. Even NV.

    Don’t knock Trudel. She’s been at CMS 25 years and is very savvy.

    Yes, it’s taxable income, there’s a FAQ on CMS’ website about this.

    Some States are planning to start their Medicaid EHR Incentive Programs in January and start making incentive payments in late Jan/early Feb, I heard. No 90-day period for AIU

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