EHR Incentives and Product Certification
In the August magazine, Mark Leavitt, MD, PhD, describes how product certification reduces risk and effort in selecting electronic health record systems. Certification also plays a role in promoting financial incentives for physician practices that adopt EHRs.
Organizations offering incentives necessarily put eligibility requirements around EHR systems to ensure that participating systems can deliver baseline benefits in quality measurement and improvement. Certification from a recognized body offers them a “solid qualifying mechanism” to do that, Leavitt says.
Leavitt is chair of the Certification Commission for Healthcare Information Technology, an independent, private-sector organizations that certifies EHR products and their networks. Facilitating incentive programs fits with CCHIT’s overall goal of accelerating health IT adoption in both ambulatory and inpatient settings.
Financial incentives are an important accelerator because the economics of EHR systems don’t favor physician practices, Leavitt says. The systems are expensive to purchase, expensive to implement, and the return on investment is challenging. Much of the savings that systems create are in efficiencies of the healthcare system, not efficiencies of the office.
“If your system warns of a drug interaction and you avoid it,” Leavitt says, “you didn’t actually make any extra money for your office—you saved an expensive hospitalization for the system and the patient. And yet you bought the system.”
Incentives can help address this issue of reimbursement. “We need those who are going to benefit—and in most case that is the people who are buying the healthcare and paying for the healthcare—to share some of those savings, if they do materialize, to help pay for the EHRs,” Leavitt says.
Initiatives Taking Shape
Today’s incentive programs are initial attempts—facing challenges of their own and likely to change over time. However, physicians currently may be eligible to participate in pilot and established programs in both the public and private sector.
This year the Centers for Medicare and Medicaid Services launched a nationwide demonstration project that will offer bonus payments to physician practices that adopt a certified EHR and use it measure and improve quality. At the state level, some states offer health IT grants or loans, often targeted to specific care populations or areas.
On private side, payers may offer adoption incentives. Physicians may also be eligible for discounts on liability insurance. Certified products are likely to meet program requirements in both cases, and they may carry the greatest assurance that an EHR system will qualify for the program.
The Stark Law exception and anti-kickback safe harbor allow hospitals and payers to donate IT software and services to physician practices. Here, too, the simplest and lowest-risk method to meet program qualifications is to look for a certified product, according to Leavitt. CCHIT offers a list of products that specifically meet the Stark and anti-kickback exceptions.
Certification Moving in Tandem
Product certification can only move as quickly as the industry when it comes to pay-for-performance initiatives. As programs take shape and begin to align, product certification will move in tandem, Leavitt says.
When certification began, products were required only to collect structured data. At the time, no one knew exactly what data incentive programs would require, Leavitt explains. Certification sought to ensure that systems began collecting data in structured form so that once the initiatives materialized, practices would already have the data they needed.
Collecting the data is the bigger challenge, Leavitt notes, more so than creating the eventual output. Once the reporting requirements are standardized, certification will then specify that systems be capable of generating the required reports.
There is a virtuous cycle in quality measurement and EHRs. Traditionally quality measures have been drawn from claims data and are thus designed within the limits of claims data, Leavitt notes. EHRs offer a much richer source of clinical data. Once quality measures and EHR systems meet in the middle, he says, the entire industry will benefit from better quality measurement and less work in collecting and reporting data.
Certification criteria for ambulatory products is available in detail online. The CCHIT site also offers lists of certified products and educational material on certification.