Incentive Programs for EHR Adoption Growing

Certification Commission’s research finds over $700 million in funding

CHICAGO – Sept. 25, 2008 – Momentum is building behind incentives for physicians to adopt electronic health records (EHRs) in their medical practices, boosted by the assurance that EHR software approved by the Certification Commission for Healthcare Information Technology (CCHIT®) can deliver concrete benefits.

In its first search for programs that have sprung up to subsidize physician adoption of health information technology over the past two years, the Certification Commission found 90 initiatives in the public and private sectors.  The 90 programs in the CCHIT Incentive Index™ catalog represent at least $700 million in potential funding for EHR software and implementation costs. Of those programs:

  • 50 have been launched by hospital organizations in response to federal “safe harbor” regulations announced in 2006.  Under those rules, hospitals can subsidize up to 85 percent of certain costs for physicians to acquire, implement and maintain EHRs which are CCHIT Certified® for their offices.
  • 40 incentive programs are being offered by government agencies, insurance plans, employer coalitions and public-private partnerships, of which 20 explicitly call for CCHIT Certified technology. For the rest, the certification of EHR products constitutes a first step in the selection process.

“As we dug deeper to research the real impacts of certification, the results surprised us, as we found many more incentive programs -- and more funding – to be available than we expected at this point,” said Mark Leavitt, M.D., Ph.D., Commission chair.  “Although we started our first certification in ambulatory care just 2-1/2 years ago, we’re already seeing evidence of a major redirection of investment toward adoption of EHRs in that setting.”

Bridges to Excellence offers bonuses for use of CCHIT Certified EHRs

Most recently, Bridges to Excellence, a nationwide program for healthcare quality improvement, has chosen to deem use of a CCHIT Certified EHR as sufficient qualification to demonstrate use of electronic information at levels that put physicians in line for monetary bonuses as a reward for superior management of patients with chronic ailments.

Two of the Newtown, Conn.-based organization’s programs reward physicians who systematically organize their practices to monitor the health of their patients and intervene expeditiously to prevent or lessen the effects of problems associated with chronic illnesses. By using a CCHIT Certified  EHR, physicians under the Physician Office Link program can get up to a $50 bonus per year for each patient whose treatment meets expectations of at least one clinical improvement program, such as for diabetes, heart or back-pain care. Alternatively, physicians can get up to $125 per year for each patient treated under a new program rewarding superior results of care provided under a comprehensive patient management approach known as the “medical home” care model.

“Transforming a physician practice into a 21st century patient-centered care center requires a significant amount of time and money on the part of the physicians in that practice,” said Francois de Brantes, CEO of Bridges to Excellence. “Our research shows that the results in higher quality and lower cost of care are worth the effort, and we have to make the process of being recognized for that effort as hassle-free as possible. Leveraging the CCHIT certification helps us do just that without sacrificing the rigor of the overall assessment of the practice’s transformation.”

The Bridges to Excellence pay-for-performance initiative is supported by 80 participating purchasers of healthcare for their employees, including computer giants Cisco, Intel and Oracle, telecommunication companies AT&T and Verizon, and large employers General Electric, 3M, UPS and IBM. The participating employers support rewards and quality recognition through health plans in 16 state or regional healthcare markets. More than 12,000 physicians have been recognized through this initiative. Details are available at http://www.bridgestoexcellence.org/PhysicianOffice.

Broad availability of incentives, substantial funding support

Information from the newly compiled CCHIT Incentive Index shows that at least 43,000 physicians are being offered subsidies or participation in state or local initiatives. This is a conservative estimate; numbers of physicians affected by the programs were either available or calculable in 41 of the 90 total programs identified, said John Morrissey, the report’s author and the Commission’s communication manager. Equally conservative is the finding that incentive programs are pouring at least $700 million into the healthcare field for adoption of EHRs and other health IT; that figure is based on 36 programs reporting current and anticipated financial investments and commitments.

The programs include the federal government’s biggest initiative to date, the $150 million Medicare demonstration project that will provide incentive payments to 1,200 physician practices for using certified EHRs to improve quality of patient care. The largest known regional commitment to accelerate adoption of certified interoperable EHRs is in New York, which is distributing $157 million already to regional networks and community alliances of physician practices representing more than 18,000 physicians and is poised to announce a new round of funding in November.

“New York is making unprecedented public investment in a statewide health information infrastructure. Having technical accountability mechanisms in place like CCHIT certification for interoperable EHRs, including electronic prescribing, is necessary to help ensure clinicians and patients are realizing value and the public’s investment produces the expected quality and efficiency gains,” said Lori M. Evans, deputy commissioner of the New York Department of Health’s Office of Health Information Technology Transformation.  “The progress of CCHIT is also a key part of the equation to advance new reimbursement models that require standardized information from certified EHRs to assess outcomes and performance.”

Adoption-incentive activity is especially high in the Northeast, from New York City up through New England. For example:

  • New York City’s Primary Care Information Project has committed $60 million, mainly to physicians who work in high-poverty areas.
  • Vermont has established a health IT fund expected to raise $32 million over seven years as a stable source of public funding for EHRs and operation of a statewide health information exchange.
  • Massachusetts has passed a law appropriating $25 million to launch a statewide EHR system, in which hospitals and community health centers must participate by 2015. The same law requires hospitals to implement CCHIT Certified systems for computerized provider order entry by 2012.

Many of the programs place special emphasis on providing EHR capabilities to rural and medically underserved areas. Two examples:

  • Hawaii, where the state’s Blue Cross Blue Shield plan has committed $20 million to finance up to half the cost of an EHR for about 1,000 physicians, capped at $20,000 per physician.
  • The Pacific Northwest, where a public-private partnership granted $1 million in 2007 to 52 clinics, physician practices and community health IT projects in Washington, Oregon, Idaho and Alaska. Another $1 million in funding will be announced Oct. 1.

A complete list of initiatives in the CCHIT Incentive Index, which will be updated as new programs come to the Commission’s attention, can be found at www.cchit.org/incentive-programs and http://ehrdecisions.com/incentive-programs.

Commission to certify stand-alone e-prescribing

The CCHIT Incentive Index does not yet include what may become one of the largest new incentive programs offered. Under recent legislation (Medicare Improvements for Patients and Providers Act, or MIPPA), Medicare payment bonuses will become available for any physician who uses qualified electronic prescribing technology beginning in 2009.  Although the Commission requires e-prescribing in certified EHR systems, it has not been certifying stand-alone e-prescribing products.  But that situation will soon change: At its Sept. 23 meeting, the CCHIT Board of Commissioners officially gave the go-ahead to develop certification for stand-alone e-prescribing systems. After public comments and a pilot test, the Commission expects to launch this new program by July 2009.

Resources for physicians

In addition to the catalog of initiatives available to physicians, the Commission plans a series of audio reports for physicians beginning on Sept. 30 to describe the significant enhancements made to the certification program since its inception in 2006, to educate them about what they should expect from newly certified 08 Ambulatory EHRs and to describe the benefits of using a certified EHR. Details about these reports will be available at www.ehrdecisions.com.

About CCHIT

The Certification Commission for Healthcare Information Technology (CCHIT®) is an independent, nonprofit organization that has been recognized by the federal government as an official certification body for electronic health record products. Its mission is to accelerate the adoption of health information technology by creating a credible, sustainable product certification program. The certification requirements are based on widely accepted industry standards and involve the work of hundreds of expert volunteers and input from a variety of stakeholders throughout the health care industry. More information on CCHIT and CCHIT Certified® products is available at www.cchit.org.