The HITECH Act ignited a fervor in the healthcare industry in the early 2010s. Part of the American Recovery and Reinvestment Act (ARRA) of 2009, the Health Information Technology for Economic and Clinical Health Act (a.k.a. the HITECH Act) incentivizes the adoption and meaningful use of electronic health record (EHR) systems—and penalizes those who fail to do either. According to CMS, eligible providers could receive incentives up to $44,000 through Medicare and up to $63,750 through Medicaid. Conversely, eligible professionals who failed to implement an EMR and/or demonstrate meaningful use by 2015 faced a 1% reduction in payments, with that rate rising over time.
Well, 2015 hit. The deadline—at least for Stage 1—came and went. So, what happened? How did all those eligible professionals do with their mission? Before we examine the HITECH Act AD (after deadline), let me first calm all you PTs, OTs, and SLPs who are reading this: You did not miss any deadlines; you never needed to demonstrate meaningful use. Physical therapists, occupational therapists, and speech-language pathologists are not considered “eligible professionals” per the ARRA. Thus, you cannot earn the incentive associated with demonstrating meaningful use of an EMR—even if you implemented a system that has been certified for meaningful use—nor can you be penalized for failing to meet the requirements. You’re in the clear.
That’s not to say, however, that PTs, OTs, and SLPs won’t ever be considered eligible professionals or that the federal government won’t enact new legislation with more inclusive or intense mandates. That’s why it’s important that all medical professionals, regardless of eligibility, keep the HITECH Act on their radar. So, with that, here are three things to know about the HITECH Act AD (after deadline):
1. As expected, EHR adoption has increased.
According to a Data Brief from the Office of the National Coordinator for Health Information Technology (ONC), EHR adoption certainly has increased since 2008. Beyond that expected trend, the ONC also identified the following:
- By 2014, 76% of non-federal acute care hospitals had adopted a basic EHR system—an “eight-fold increase since 2008,” notes this National Law Review article.
- EHR adoption rates have increased in every state.
- 97% of hospitals have adopted a certified EHR, which makes the prospect of interoperability promising.
2. But healthcare IT hasn’t necessarily improved—and it might be the HITECH Act’s fault.
The author of this op-ed from the Brookings Institution argues that—in accordance with our capitalistic society—consumers choose products based on the problems they have. The products that best meet customer demands prevail: “no one pays for Excel to enter in a few random numbers. Customers buy it to do a specific kind of analysis with ease and speed. If it was very difficult to work with Excel or it did not have much functionality, then many potential customers would have stuck with their paper spreadsheets or would have purchased better alternative software.” The HITECH Act has disrupted this trend, though. As this EHR Intelligence article explains, “The EHRs and health IT products only need to meet minimum requirements to be certified by the Office of the National Coordinator for Health IT (ONC) and become available on the healthcare marketplace.” So healthcare professionals shop the best and the worst together; and the HITECH Act and meaningful use requirements make them rush to select something—anything—in order to avoid penalties and gain incentives. Essentially, they’re adopting technology without truly determining what they need out of the product, and now they “have to manage EHR technology that has an excess of data entry requirements and lacks true interoperability.”
The Brookings Institution isn’t alone in its conclusions. According to an interview-based study by the Journal of the American Medical Informatics Association, EHRs developed per HITECH Act requirements have usability issues, do not properly support multidisciplinary teamwork, and are ineffective at incorporating quality measures into care delivery. (From this perspective, it’s a very good thing PTs, OTs, and SLPs were left out of this HITECH hullabaloo.) Researchers in the study echoed the Brookings Institution’s sentiments about increasing competition in the marketplace. Both also seemed hopeful that the shift to pay-for-performance will improve the current health IT landscape.
3. Demonstrating meaningful use doesn’t have all parties happy, either.
Currently, eligible professionals are in Stage 2 of the the three-stage meaningful use program. (As I said at the beginning of this post, the Stage 1 deadline, which focused on EHR adoption, has passed.) Now, per Stage 2 requirements, eligible professionals must “show that more than 5% of all their patients view, download, or transmit to a third party their health information during a 1-year reporting period. Providers also must demonstrate that more than 5% of their patients used the EHR's electronic messaging function to send the provider an email message,” explains MedPage Today. Physicians’ groups have argued, though, that those requirements are too challenging to meet, especially for specialists and surgeons, who might not have ongoing relationships with their patients, and for those with patients in rural areas that have poor Internet connectivity. In response to those concerns, CMS has suggested less stringent requirements via a new proposed rule, which has made physicians happy.
Patient advocates, on the other hand: not so much. In an April 13 statement, Debra Ness, president of the National Partnership for Women and Families, called the proposed changes “a startling and unwelcome departure from the administration’s commitment to health transformation that produces higher value, more patient- and family-centered care.” She further argues that Triple Aim success depends on patients “being equal and engaged partners...of their health and their care.” Whether or not the suggested Stage 2 changes happen, eligible professionals will still need to up their ante come Stage 3, which proposes that 25% of patients view online, download, or transmit health information.
As you can see, the HITECH Act is not without its faults, and now that the industry is living in the post-deadline era, working its way through the meaningful use stages, it is finally able to start evolving in response to those faults. But that evolution will have to come through legislative reform rather than the free market, which means the process could be slow and riddled with red tape. There’s a general consensus, though, that the pay-for-performance switch should help fast-track change. Only time will tell.