Impact Of Healthcare For American Recovery And Reinvestment Act On Public Health Organizations

Background of MU

Discuss about the Healthcare for American Recovery and Reinvestment Act.

The paper deals with the effect of the meaningful use on public health organizations. “Meaningful use” is one of the major issues faced by the healthcare executives. It has resulted from the “HITECH ACT” components of the “American Recovery and Reinvestment Act of 2009” (Wright et al., 2013). It is anticipated that using the health information technology in meaningful manner will transform and improve the patient care. Different states are receiving funds and assistance for selecting qualified EHR products that comply with the requirements set by the federal Medicare and Medicaid for “Meaningful Use” (MU) (Chin & Sakuda, 2012). The paper discusses the background of MU and the summary of the requirements of MU. It further discusses the effects of the meeting and not meeting the MU requirements on the healthcare organizations. The paper highlights the issues faced by the healthcare organizations and their possible resolutions. It further discusses the reason behind not meeting the MU requirements.

There is an increasing number of deaths in the United States due to medical errors than breast cancer, motor vehicular accidents and AIDS combined. These preventable errors are mainly due to miscommunication. This demanded better communication and more accountable care for addressing the need of improved “clinical care management”. There is a high momentum created for capturing data for the purpose of care continuity and define measures for monitoring care quality and cost (Henricks, 2011).

In 2004, the “Office of the National Coordinator for Health Information Technology” (ONC) was created for suporting the “US health care system”. In 2009, “the Health Information Technology for Economic and Clinical Health (HITECH) Act” mandated ONC to improve healthcare by adopting “health information technology” (HIT) and for a development of “health information exchange” (HIE) nationwide (US Department of Health and Human Services, 2009). The later is the HIT component of the “American Recovery and Reinvestment Act” (ARRA). ARRA received 17.2 billion dollars for development of HIE and Electronic Health Records (EHR) use (Wilson, 2012). The goal of HITECH Act is to promote the meaningful use of health information technology and qualified EHRs.

Technical assistance is provided to small practices to adopt HIE system such as EHR and meet its requirements for Meaningful Use and to become eligible for financial incentives. The HITECH Act envisions to provide each patient with optimal care. Therefore, the MU of the electronic patient data and the development of the health information exchange nationwide, in the near future, is sure to reduce the health care costs, improve health outcomes, increase staff, patient, and provider’s health care experience (Wilson, 2012).

Summary of the Requirements of MU

In 2010, the ONC in the Department of Health and Human Services published a Final Rule entitled HIT that contains the set of Standards, Specifications for implementations, and certification criteria for EHR technology (Wilson, 2012). The term “Meaningful Use” has no simple definition. The three requirements of MU specified by HITECH Act (Chin & Sakuda, 2012) includes-

• Using the certified electronic tools such EHR in a meaningful manner for instance e-prescribing
• Using the HIE system or technology in a way that assists in exchange of health information electronically to improve the care quality
• Using a certified EHR technology for submitting clinical quality measuresdetermined by the HHS Secretary

MU has a set of objectives laid specifically for eligible hospitals and care providers. For example, the core set of objectives for eligible professionals is to electronically generate and transmit patient prescriptions

There are three stages (Chin & Sakuda, 2012) to meet the definition of MU which are identified by the government-

1. To capture the data electronically
2. Expand stage 1, report the health information, track the clinical conditions (this stage is challenging for most healthcare organizations)
3. Improvement in the care quality and safety as well as the efficiency, performance and health outcomes

The Health information technology such as the “EHR System” functions to incorporate the patient history, patient problem list, demographics, physician clinical notes, computerized orders for prescriptions, comprehensive list of patient’s health complications and medications and electronic view of laboratory and imaging results (Henricks, 2011). Therefore, the benefits of meeting MU requirements of EHR includes expanded access to affordable care, reduced paperwork for physicians and patients,  improved quality of health care, decreased health care costs, prevention of preventable medical errors, higher involvement of the patients and families in management of their own health care, and increased administrative efficiencies (Carter, 2015). The health information technology assists in improving the practice communications. It increases the speed of clinical decision making as electronic, and non-electronic tools help in improved access to patient information and quick identification of patient with specific clinical condition (Goetz et al., 2012).

Hence, greater focus can be laid on the high-priority clinical conditions accessing the comprehensive data. Thus, the MU is not merely focused on the HIT, but on improving and transforming the health care by using it in a meaningful manner. The healthcare organizations that have demonstrated or are meeting the requirements of MU are eligible for gaining financial incentives through Medicaid or Medicare. Professionals, who have participated in the year 2012, were eligible for receiving high incentives and rewards (Henricks, 2011).

According to Chin and Sakuda (2012), those failed to demonstrate MU and non-adopters of MU even after the year 2015 and later will have a “payment adjustment to their Medicare reimbursement”. The payment is initially reduced by 1% and is increased by 1% per year that the health care professionals eligible for Medicare do not demonstrate MU to a maximum of 5% (Pipersburgh, 2011). However, there are no penalties imposed on the eligible adopters who opted the Medicaid method (Marcotte et al., 2012). It means that there is no payment adjustment to their Medicaid reimbursement is they have qualified but chooses not to adopt MU. On the other hand, if an eligible professional implement the certified EHR and upgrades it in the first year, then they may not have to demonstrate MU for receiving the first year’s payment (Centers for Medicare & Medicaid Services (CMS), HHS, 2010).

The Effects of Meeting / not Meeting the MU Requirements

Despite being aware of the positive effects of MU, various health care organizations fail to apply for MU incentives. Goetz et al., (2012) and Chin and Sakuda, (2012) summarised the issues faced by the healthcare organisations as lack of financial investments for implementing EHRs, high level of efforts required to redesign the workflow, lack of  time required for initial physician and staff training, and burden of recruiting new staff for HIT support. These issues are a matter of grave concern, particularly in rural areas. Inefficiency to handle the database of information created by EHR and provision of highly accurate data for laboratories is another major challenge (Wright et al., 2013).

Chin and Sakuda, (2012) suggested a strategy for adopting HIT and meeting the MU requirements. For example, a hospital with no EHR can focus on the following-

• Perform a financial assessment and calculate the return on investment. Select staff for creating EHR team
• Perform a  readiness assessment, evaluate the  computer skills of staff, review the needs of hardware and softwares, analyze the current workflow
• The plan as to which position to reach in future, and define EHR goals accordingly. Draft an implementation plan as an internal project.
• Evaluate the certified vendors and work on planning implementation of EHR
• Start the implementation process and installation of the Further, work on customization, Backup, Testing and establishing the downtime procedures
• Review of goals, status of MU, reporting of clinical measurements, and subsequent phase planning

Conclusion

Based on the above discussion it can be concluded that the HITECH Act developed by the federal government and the EHR incentive or penalty programs is sure to ssincrease the frequency of MU in near future. MU dictates how an eligible hospital and professional can implement HIT. The certification standards specify the capabilities to be possessed by EHRs to meet the MU requirements. Thus, there is a greater expectation for exchanging the health and the laboratory information electronically.

References

Carter, J. T. (2015). Electronic medical records and quality improvement. Neurosurgery Clinics of North America, 26(2), 245-251.

Centers for Medicare & Medicaid Services (CMS), HHS. (2010). Medicare and Medicaid programs; electronic health record incentive program. Final rule. Federal register, 75(144), 44313.

Chin, B. J., & Sakuda, C. M. I. (2012). Transforming and improving health care through meaningful use of health information technology. Hawai’i Journal of Medicine & Public Health, 71(4 Suppl 1), 50.

Goetz, G. D., Kuzel, A. J., Feng, L. B., DeShazo, J. P., & Love, L. E. (2012). EHRs in primary care practices: benefits, challenges, and successful strategies. The American journal of managed care, 18(2), e48-54.

Henricks, W. H. (2011). ” Meaningful use” of electronic health records and its relevance to laboratories and pathologists. Journal of pathology informatics, 2(1), 7.

Marcotte, L., Seidman, J., Trudel, K., Berwick, D. M., Blumenthal, D., Mostashari, F., & Jain, S. H. (2012). Achieving meaningful use of health information technology: a guide for physicians to the EHR incentive programs. Archives of internal medicine, 172(9), 731-736.

Pipersburgh, J. (2011). The push to increase the use of EHR technology by hospitals and physicians in the United States through the HITECH Act and the Medicare incentive program. Journal of health care finance, 38(2), 54.

US Department of Health and Human Services. (2009). Office of the National Coordinator for Health Information Technology (ONC). Southeast Regional HIT-HIE Collaboration (SERCH): Final Report; ONC State Health Policy Consortium Project: Health Information Exchange in Disaster Preparedness and Response.

Wilson, D. J. (2012). Fiscal spending jobs multipliers: Evidence from the 2009 American Recovery and Reinvestment Act. American Economic Journal: Economic Policy, 4(3), 251-282.

Wright, A., Henkin, S., Feblowitz, J., McCoy, A. B., Bates, D. W., & Sittig, D. F. (2013). Early results of the meaningful use program for electronic health records. New England Journal of Medicine, 368(8), 779-780.