1. Economic Stimulus Overview
We will begin the presentation shortly.

2. The Obama Stimulus
• The American Recovery & Reinvestment Act
(ARRA) is a $787 billion stimulus package that
became law in February 2009.
• The stimulus is not related to healthcare
reform legislation.
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3. The Obama Stimulus
• $20 billion in incentives for meaningful use of certified
EMR technology:
– Medicare: $44,000 per doctor
– Medicaid: $63,750 per doctor
• Incentive money is per Doctor; not per Practice.
– Incentive money goes directly to the Doctor; there is no
aggregator.
• There are penalties:
– Beginning in 2015, Medicare Physicians not demonstrating meaningful use of
EMR technology will have their Medicare fee schedule reduced:
• 2015: -1%
• 2016: -2%
• 2017 and beyond: -3%
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4. Medicare/Medicaid
Incentive Overview
• Providers must select either the Medicare or
Medicaid program, they cannot select both.
• Providers are allowed to change their program
election…but only once.
– If changing programs, doctors start at the payment year
level that you would have had in your original program.
– Can’t change programs after 2014.
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5. Medicare/Medicaid Incentive Overview
Meaningful Use 2011-2012
• Functional measures have been replaced by
Core Objectives and a Menu Set.
– Doctors must abide by all Core Objectives.
– Doctors must abide by 5 of 10 Menu items.
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6. Medicare/Medicaid: “Meaningful Use”
Core Objectives
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7. Medicare/Medicaid: “Meaningful Use”
Menu Set
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8. Demonstrating “Meaningful Use”
• Medicare
– Year 1 – 90 days of continuous, meaningful use
– Year 2 – Meaningful use for the entire calendar year
• Medicaid
– Year 1 – Doctor need only adopt, implement or upgrade
– Year 2 – 90 days of continuous, meaningful use
– Year 3 – Meaningful use for the entire calendar year
• Eligible Professionals must provide an attestation
(witness statement) – mechanism TBD.
– Doctors must identify which certified EMR they are using.
– Doctors must describe their performance on all Core
Objectives and Menu Items.
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9. Payment
• Doctor’s will need to provide:
– National Provider Identifier (NPI), business address,
phone etc.
– Taxpayer identification
• The doctor’s participation in the incentive program
will be made public.
• Payment will come in a single, annual payment from
CMS or the State Medicaid agency.
• Payments can be re-assigned.
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10. Clinical Quality Measures
• Part of meaningful use is submitting information on
clinical quality measures (reports on care and care
outcomes).
– Reports on clinical quality measures help the government
identify trends and patterns of care, and provide guidance
for improving care.
• There are now 44 measures
– Three measures required of everyone
– Choice of 3 others, chosen from a subset
• Reporting
– 2011: via attestation
– 2012: through an electronic means
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11. Medicare
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12. Medicare: Eligible Professionals
• Doctors of medicine
• Doctors of osteopathy
• Doctors of dental surgery
• Doctors of dental medicine
• Doctors of podiatric medicine
• Doctors of optometry
• Chiropractors
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13. Medicare Payment Schedule
Incen Incen Incen Incen Incent Incen Incen Total
2011 2012 2013 2014 2015 2016 2017
2011 $18,000 $12,000 $8,000 $4,000 $2,000 - - $44,000
2012 $18,000 $12,000 $8,000 $4,000 $2,000 - $44,000
2013 $15,000 $12,000 $8,000 $4,000 - $39,000
2014 $12,000 $8,000 $4,000 - $24,000
2015 -1% -1% MFS
2016 -1% -2% -3% MFS
2017 -1% -2% -3% -6% MFS
-Medicare providers who practice in health professional shortage areas (HPSA’s) will have
their incentive payments increased 10%.
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14. Medicare Payment Schedule
• Medicare incentive payments are based on 75% of
submitted allowable charges (look to the physicians
Medicare fee schedule).
– Clinic that charges $24,000 or more is eligible for $18,000
incentive (75% of 24k = $18k).
– Clinic that charges $13,300 is eligible for $9,975 (75% of
$13,3000 = $9,975).
– Only for services furnished by the EP.
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15. Medicaid
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16. Medicaid: Eligible Professionals
• Physicians
• Nurse Practitioners
• Dentists
• Certified Nurse Midwifes
• Physician Assistants practicing
in federally qualified health
centers led by a PA
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17. Medicaid: Payment Structure
85% of “Net Average Allowable Costs”
Maximum Incentive Payment is $63,750
Year Incentive
Year 1 $21,250 (25k)
Year 2 $8,500 (10k)
Year 3 $8,500 (10k)
Year 4 $8,500 (10k)
Year 5 $8,500 (10k)
Year 6 $8,500 (10k)
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18. Medicaid Incentives
• Year 1 incentive payments are provided to eligible
providers who are adopters / meaningful users of
certified EMR technology:
– Eligible providers receive up to 85% of net average
allowable costs for their EMR (software, implementation,
training, etc.).
– Last “first” year is 2015 and no payments after 2021.
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19. Medicaid: Eligible Professionals
• A non-hospital-based professional with at least 30% of
their patient volume coming from Medicaid patients.
• A non-hospital-based pediatrician with at least 20% of
his/her patient volume coming from Medicaid patients.
• A professional who practices predominately in a
Federally-qualified health center or rural health clinic
with at least 30% of the professional’s patient volume
coming from Medicaid patients.
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20. Pediatrician Incentive
• The pediatrician incentive is lower, because the
threshold is lower.
• Maximum cumulative incentive = $42,500.
– $14,167 in Year 1
• ($16,667 x 85% = $14,167).
– $5,667 in Years 2-6
• ($6,667 x 85% = $5,667).
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21. How is Patient Volume Defined?
• “at least 30% of patient volume” means that the
physician must be able to attribute 30% of his/her
patient encounters over a 90-day period to Medicaid
patients.
– Numerator: amount of Medicaid patients
– Denominator: total amount of all patients
• “practice predominantly in a federally qualified health
centers” means more than 50% of the time.
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22. What Should I Do Today?
• Start researching your options.
• Consider your technology, maintenance and support
options.
• Don’t wait!
– With nearly 1 million providers going electronic there will
be a line.
– The plans are front loaded, most of the money is available
in the first few years.
• The requirements ramp up over time.
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23. Questions and Answers
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24. Contact
• Todd Krieger
– Cell: 248-227-9167
– Email: todd@glostream.com
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