GE Healthcare Camden Group Insights Blog

How are Meaningful Use Incentive Payments Spent?

Posted by Matthew Smith on Feb 21, 2013 4:51:00 PM

The three-physician, four-nurse practitioner practice in Phoenix was building a new facility when the incentive program was announced, so by the time the checks arrived, the investments needed to bring the technology infrastructure to meaningful use readiness had already been made. But there was a community room in the new building that the group had envisioned as space for wellness classes. Together, they decided their meaningful use checks would go toward hiring a teacher to conduct weekly tai chi classes. They also made other small technology purchases to improve the existing IT.

The question of what to do with meaningful use money is one that every practice needs to discuss early on, as the Acacia practice did, before each physician goes through the attestation process. Being on the same page not only will help a practice achieve its goals, which very well could be contingent on everyone receiving the maximum incentive amount, but it also could prevent hurt feelings. In addition, it could avoid a lawsuit if a physician thinks he is entitled to pocketing money that the practice expects to keep.

“There are no guidelines in the statute in terms of how the money is spent,” said Michele Mann, principal at the technology consulting firm CSC. “So that really does, to some degree, become a business decision.”

It’s not unlike the questions associated with the money accountable care organizations receive, said Robert Williams, MD, director at Deloitte Consulting. ACOs operate under arrangements through which shared savings from providing efficient, quality care are distributed among participating parties. Some practices may reinvest those funds into the practice. Others may make the checks part of a physician’s compensation package.

Incentive Pay Decisions

Many practices decide on incentive pay by falling back on existing business arrangements that require all revenue generated by each employee or partner to be reassigned back to the practice. But because this is not normal, fee-for-service revenue, there may be confusion, especially because each physician is responsible for attesting to his or her achievement of meaningful use.

The program, which allows doctors to receive Medicare or Medicaid incentive money for demonstrating meaningful use of electronic health records, is based on paying individual doctors or other qualified practitioners, rather than the practice in total.

Although administrators may think it is clear that all incentive money will go back to the practice, having the conversation ahead of time can prevent sticky situations later.

Some practice partners feel confident enough in their relationship with fellow partners and employees that a verbal agreement is sufficient. But many experts agree that, whatever a practice decides, it should be put in writing.

“You are adding insult to injury, because you are asking them to do all of this — it’s not a lot of work, but it’s still work they have to do — and they are not recognizing the actual incentive money themselves, so it can clearly become a little contentious,” Mann said.

Danielle Sink, MD, one of the partners at Acacia Internal Medicine Specialists, said financial arrangements have always been clear among everyone involved. But the practice found itself in the middle of a lawsuit a few years ago, when a physician tried to challenge a decision about incentive pay. Dr. Sink said the practice prevailed in the lawsuit, but it was very time-consuming and costly to defend. The practice now puts everything in writing, and everyone involved in an arrangement is required to sign off.

Reassigning Versus Individual Bonuses

It’s very rare for full incentive checks to go back to individual physicians in a multidoctor practice, given the large practicewide investment necessary to meet meaningful use. But a practice also should ensure that things are handled fairly and equitably, especially for physicians who may have taken on more than the others.

Dr. Sink handled all the legwork involved with making sure the practice met meaningful use requirements and managing the decisions that were made with the money. Because these extra job responsibilities took time away from patient care, when the meaningful use checks arrived, the practice gave her some off the top as compensation.

A practice may decide to distribute the money to physicians as opposed to reinvesting in the practice. Mann recommends that the money be reassigned to the practice. Then the practice can use productivity as a relative percentage to determine who gets how much. “At the end of the day, the docs are the ones who are really having to use the system in a meaningful way to get the incentive money,” she said.

Michael Schrager, MD, managing partner of Central Coast Family Care, a nine-physician medical practice in Santa Maria, Calif., said all physicians at his practice are allowed to keep their bonus checks, but the “windfall” comes with a caveat.

The practice establishes goals it wants to meet each year, and the costs associated with reaching them are divided evenly among partners. If the doctors decide to spend meaningful use funds on themselves, they must come up with the agreed-upon investment amounts needed to reach the goals. The partners meet monthly to talk about upcoming projects and expenses. Every decision must be approved by each partner.

How to Spend the Money

Eric Finocchiaro, RPh, director at Deloitte Consulting, said for many practices the decision of what to do with the money was part of the decision to go after meaningful use in the first place. Doctors had to assign the incentive money into the budgets to achieve meaningful use.

For others, the bonus checks are a way to make necessary upgrades to the practice, or simply pay for the ongoing costs associated with converting to electronic records. Some of the more popular uses include:

Buying or replacing IT hardware/tools. Many early adopters of EHRs found themselves in need of new systems when meaningful use requirements were made clear. Others had to adopt EHRs for the first time. For many, those purchases were either financed or came out of capital budgets that needed to be replenished when the checks arrived.

Dr. Schrager and his partners decided not to take any chances on failing to meet the second of five stages of meaningful use, so they invested in software that monitors the practice’s readiness for all the objectives for the next stage. It shows them where improvements are needed and where a physician may be struggling.

“It’s important not to just spend the money,” he said. “If you are going to keep going in this project, the meaningful use criteria get more stringent, and the old ones don’t go away.”

Additional staff. The conversion to the electronic world may mean many hours of manpower to enter patient information, that previously lived in paper charts, into the EHR. Sumana Reddy, MD, owner of Acacia Family Medical Group, a four-physician practice in Salinas, Calif., said she decided not to let that burden fall on the physicians. She hired two temporary workers to input some of the data, including medication and problem lists, and an additional staff member to scan old records into the charts. That meant extra staff costs and a reduced patient volume while the doctors learned the new system. Had it not been for the meaningful use money, Dr. Reddy would have had to forgo pay for herself for a few months, something she has done a few times in the past. “This was not some huge gift,” she said.

Staff development. Dr. Schrager said his practice does not do direct bonuses to employees, but it will use some of the meaningful use money on improving morale through team building and staff development projects. They have developed a curriculum for support staff, for example, where employees can learn skills related to their areas of work.

New services. As many payers move toward outcome-based pay models, practices may want to consider using the money to offer wellness services such as smoking cessation and weight management classes. Dr. Sink said even though tai chi classes had nothing to do with EHRs, she and her partners believed it was a good use of the money because of the benefits to her elderly patients, especially those with arthritis.

Dr. Sink said she and her partners are always discussing ways to improve their practice. So far, they have not come up with an exciting way to spend their next round of meaningful use funds.

“But we’ll do the same kind of thing,” she said. “We don’t owe any debt, so we’ll save the money, and the things that come up that are appropriate, we’ll discuss it and then use it.”

Meaningful Use, Meaningful Use Incentives



Topics: EHR, EMR, Meaningful Use, CMS, Health IT, Electronic Health Record, Meaningful Use Attestation, Incentive Payment

Meaningful Use Audits to Ask for More Documentation

Posted by Matthew Smith on Jan 30, 2013 10:24:00 AM

Meaningful Use AuditsBeginning in the summer of 2012, the Department of Health and Human Services’ Office of Inspector General started conducting a limited number of audits of organizations that have attested to electronic health records meaningful use under Stage 1.

During an educational session at HIMSS13, Mac McMillan, CEO at health information security consultancy CynergisTek Inc., will walk through the early stages of the audit program and what is to come. Audits in the initial phase were very simple as organizations were sent a list of questions they could answer without a lot of documentation--basically asking that organizations reaffirm what had already been attested.

A second phase (later in 2012) was more comprehensive with about 10 pages of questions asking for detailed information such as how an organization is using the EHR’s capabilities and how well it performs. For instance:

  • Does the EHR generate a log?
  • Can you manipulate, view and print the log?
  • Is the EHR configured for role-based privileges assigned to persons using it?

While these initial audit programs were rather simple with little or no measurement of performance, not being truthful could really hurt an organization later if it has a reportable data breach, McMillan warns. For instance, even in these basic early audits, organizations had to re-attest that they have conducted a HIPAA-mandated security risk assessment and update it regularly. “If you aren’t honest in the audit then have a breach, and the investigation shows you didn’t do the risk assessment required under meaningful use, you’re in trouble,” McMillan says.

At some point, McMillan believes, someone in government is going to say, “I want to see a real audit run,” and the program will get tougher with real teeth. That time could come with Stage 2. He sees the early audits as the start of preparing EHR users for a more comprehensive program. “You need to get serious about your attestations and your documentation around attestation so you can be prepared to document it when the audits come.”

The session during the pre-conference Meaningful Use Symposium on March 3, “Meaningful Use Audits--What Your Provider Organization Needs to Know,” is scheduled at 2:30 p.m.

To learn more about Health Directions' approach to EHR, Meaningful Use, and details concertning the audits, please contact Health Directions via the button below:

Electronic Health Records EHR Assessment

Topics: EHR, Meaningful Use, Electronic Health Records, Electronic Medical Records, Health IT, Meaningful Use Attestation, EHR Audit

CMS Pays over $900 Million in November Meaningful Use Incentives

Posted by Matthew Smith on Dec 28, 2012 2:14:00 PM

Meaningful UseThe Centers for Medicare and Medicaid Services (CMS) has released the November 2012 figures for its EHR incentive payouts. The meaningful use program added

  • 8,859 Medicare eligible professionals (EPs),
  • 4,173 Medicaid EPs, and
  • 79 hospitals to its ranks of active participants, which took part in the $9.32 billion in incentives that CMS has paid out since the program began. 

CMS paid out $913 million in November, over $200 million more than they doled out the month before.

2012 saw over 52,000 new eligible professionals and nearly 2,000 hospitals committing to developing EHR systems in order to receive government incentives, with practicing physicians representing the majority of EPs. 1,315 podiatrists and 993 optometrists came on board, as well, joining 4,016 nurse practitioners, 1,936 dentists, and 186 physician assistants vying for government recognition of their technological efforts.

The skyrocketing payments are good news for CMS, which has made EHR implementation a priority in recent years. Individual practitioners and smaller healthcare networks make up over 80% of the program’s participants, which means EHRs are not just restricted to large hospitals, but are spreading into communities in a big way. Patient engagement objectives like clinical care summaries and electronic reminders remain the least popular aspects of the program, but Anthony notes that the attestation data shows that physicians are very willing to provide electronic copies of patient information to those customers who know about the availability of the feature.

“I think that speaks a lot to how on target we are at bringing meaningful use into the spectrum of what’s good for the public,” said Neil Calman, MD, a member of the policy committee. “Now we have the data about how right on this initiative is.”

Topics: EHR, EMR, Meaningful Use, Electronic Health Records, Electronic Medical Records, CMS, Health IT, Meaningful Use Attestation

Stage 2 Update: Understanding Meaningful Use Program Requirements

Posted by Matthew Smith on Nov 8, 2012 1:27:00 PM

J Dynia photo (Mobile) resized 600Stage 2 Update: Understanding Meaningful Use Program Requirements to Qualify for Incentive Payments

Presented by Jennifer Dynia, 3:20-4:20 PM

ILMGMA Downstate Conference

Friday, November 9, 2012

Summary: This session is designed to help medical office staff understand what is required by the several hundred pages of rules and regulations that make up the CMS EHR Incentive Program in order to receive the Meaningful Use incentives and/or avoid the associated penalties.

The session will break down the rules and regulations to their simplest form and will present a practical, vendor-specific approach to participating in the Program.

Program Objectives
At the completion of this program, the participant should be able to:

  • Define what is meant by “Meaningful Use” (MU) and understand its origins
  • Identify the available incentive dollars and the associated penalties
  • Identify the Stage 1 and Stage 2 MU Core and Menu Measures
  • Propose and explain a project management approach for achieving Meaningful Use

Topics: EHR, EMR, Meaningful Use, Meaningful Use Attestation, Stage 2, Stage 2 Meaningful Use

EHR incentives to exceed $8 billion in Oct. 2012

Posted by Matthew Smith on Nov 8, 2012 11:57:00 AM

Meaningful Use IncentivesAlthough fewer recipients received incentives in October than September, payouts from the EHR Incentive Programs exceeded those from previous months, according to the Centers for Medicare & Medicaid Services (CMS). The addition of October payouts should raise the total number of EHR incentive payments well over the $8 billion mark.

The uptick in the amount of payments stems from the number of hospitals that have successfully demonstrated meaningful use. CMS estimates that approximately 400 hospitals have accounted for $480 million of $645 million payments disbursed in October 2012. That portion of the total sum represents 75% of all payments made last month.

Not since December 2011 has similar number of hospitals received payments through the EHR Incentive Programs. At that time, 539 hospitals were beneficiaries of meaningful use incentives: 190 for Medicare, 349 for Medicaid. CMS has not yet released specifics about the breakdown of hospitals receiving payments in October.  Either way, last month signifies a milestone for hospitals, which are required to attest for meaningful use according to the fiscal year. And expectations are that the next couple of months should continue the trend for hospitals. 

Whereas hospital attestations and payments are up, provider attestation and payments are notably down. In September, a total of 12,858 eligible professionals received incentives through either Medicare or Medicaid. In October, that total diminished by close to four thousand EPs with an estimated 9,050 providers reported as having received payments. These figures are unsurprising given that EPs report according to the calendar year, and Oct. 3 was the deadline for beginning the 90-day attestation period required in Stage 1 Meaningful Use.

The upswing in meaningful payments should not be expected until after the close of 2012.

As a refresher, here are the numbers as of September 2012:

Registrations: 20,010 of 307,129 YTD

  • EPs: 16,315 (Medicare), 3,611 (Medicaid)
  • EHs: 85 (Medicare/Medicaid)

Incentives: $571,932,099 of $7,716,136,726 YTD

  • EPs: 8,313 for $149,447,251 (Medicare); 4,545 for $90,125,539 (Medicaid)
  • EHs: 137 for $229,901,012 (Medicare); 142 for $102,458,297 (Medicaid)

Topics: EHR, EMR, Meaningful Use, Electronic Health Records, Hospitals, HIT, Meaningful Use Attestation

CMS Releases 2014 Meaningful Use Quick Reference Grids

Posted by Matthew Smith on Nov 7, 2012 1:52:00 PM

Meaningful UseThe Centers for Medicare and Medicaid Services (CMS) has released updated reference grids for Stage 1 and Stage 2 meaningful use requirements, detailing how meaningful use objectives align with EHR certification criteria.

Each quick reference grid includes the meaningful use objectives and which group of physicians those objectives apply to, the core set and menu set of measures, and the EHR certification criteria that correlate with those measures.

These updated Stage 1 and Stage 2 grids can be accessed in PDF form from

Topics: Meaningful Use, CMS, Meaningful Use Attestation

Meaningful Use Incentive Payments Reach $2.6 Billion

Posted by Matthew Smith on Oct 24, 2012 2:51:00 PM

Meaningful Use IncentivesAbout half of eligible providers (EPs) have registered for EHR incentive payments, according to spokespersons from the Centers for Medicare & Medicaid Services (CMS), which administers the incentive programs. The officials shared program figures through September 2012 during the HIMSS Government Health IT Virtual Briefing on Oct. 17.

With some growing pains, the meaningful use program has emerged as a model for multi-stakeholder collaboration in healthcare, Rob Tagalicod, director of CMS’s Office of Health Standards and Services, commented. Nearly 81 percent of hospitals have registered.

Although registration doesn’t necessarily mean that providers will participate, “we’re really happy with these numbers,” Elizabeth Shinberg Holland, director of CMS’s HIT Initiatives Group, said.

As of September, about $7.7 billion has been disbursed through meaningful use incentive payments — about $1.4 billion for Medicare EPs, $1.2 billion to Medicaid EPs and about 4.8 billion to eligible hospitals.

Among the most common EHR menu objectives chosen for attestation, CMS has found, are immunization registry, drug formulary and patient lists for EPs and advance directives, drug formulary and clinical lab results for eligible hospitals.

Among the least popular menu objectives for EPs are transitions of care and patient reminders, and transitions of care and syndromic surveillance for hospitals.

“It is a little concerning to us,” Holland said, that the least popular menu objectives are also ones that tend to involve interoperability. That’s a sign that the pursuit of interoperability remains a hurdle, Holland said.

Among signs of progress, Holland added, Medicare providers who have been meaningful users for 90 days tend to use EHRs for every patient and appear to be embracing the technology as part of their workflow, even if they’re deferring on some menu objectives.

Looking at the current state of EHR adoption in the United States, Holland said, it’s important to keep in mind that although there’s been a lot of success -- with many providers continuing through Stage 2 to clinical data demonstrations -- some providers are just now thinking of adopting EHRs.

Topics: EHR, EMR, Meaningful Use, Electronic Health Records, HealthIT, Meaningful Use Attestation

CMS Releases Corrections for Stage 2 Meaningful Use Final Rule

Posted by Matthew Smith on Oct 23, 2012 8:49:00 PM

CMS, EHR, Meaningful UseYesterday, CMS published a 10-page document in the Federal Register, which provides some minor corrections to the Stage 2 Meaningful Use Final Rule for the EHR Incentive Programs. The Stage 2 Final Rule was originally published on September 4, 2012, and provides new criteria that eligible professionals, eligible hospitals, and critical access hospitals must meet to successfully participate in the EHR Incentive Programs.

The corrections can also be accessed from a link on the EHR Incentive Programs Stage 2 webpage.

Make sure you are prepared for Stage 2 of the EHR Incentive Programs by visiting the Stage 2 webpage of the EHR Incentive Programs website. Resources include helpful tipsheets that explain meaningful use changes in Stage 2.

Topics: EHR, Meaningful Use, Electronic Health Records, CMS, Meaningful Use Attestation, CMS Incentive Payments

Meaningful Use: An Illustrated Infographic

Posted by Matthew Smith on Oct 3, 2012 10:06:00 PM
Meaningful Use Infographic
Meaningful Use infographic created by Greenway.

Topics: Meaningful Use, Medicare, Medicaid, Meaningful Use Attestation, Healthcare Infographics, Medicare MU, Stage 2 Meaningful Use

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