Final rules for e-health rewards unveiled

The federal government has issued new regulations defining the "meaningful use" of electronic medical records, a requirement doctors must fulfill in order to gain funds from a $27-billion pot set aside in the 2009 stimulus law, The New York Times reports. "A doctor can receive up to $44,000 under Medicare and $63,750 under Medicaid, while a hospital can receive millions of dollars, depending on its size." These final rules are significantly less stringent than an early proposed version, but the president of the American Hospital Association said most hospitals may still struggle to surmount them (Pear, 7/13).

The AHA's vice president of policy told Kaiser Health News, "The requirements may still be out of reach for many American hospitals." Under the final rules, "doctors will have to meet 15 objectives, and at least five from a list of 10 more. Hospitals will have to meet 14 objectives, and at least five more goals." Objectives include things like recording whether patients smoke and incorporating medication lists into records. The earlier draft version required doctors to meet 25 objectives and hospitals to meet 23 (Galewitz, 7/13). 

The Dallas Morning News: The payments are scheduled to begin in May of next year. "Providers that don't participate will see their Medicare payments reduced by 1 percent, beginning in 2015. In later years, the penalty grows to 3 percent." Many do not have records in place now. "Despite years of technological development, most hospitals and physician offices, including in North Texas, cannot electronically share information or even record patient data. As a result, patients who move between doctors, or between hospitals, have trouble coordinating their care" (Michaels, 7/14).

The Associated Press: "As lawyers pored over the [hundreds of pages of] text of the regulations, the American Medical Association said it was withholding judgment. … Federal officials said they tried to address doctors' complaints that the initial draft of the rule asked them to do too much, too quickly. More than half of family doctors practice in groups of four or fewer. A majority of small and medium offices have opted not to adopt electronic records because of costs and unresolved questions, according to the American Academy of Family Physicians" (Alonso-Zaldivar, 7/13).

Modern Healthcare: What does the public get out of these investments? "The goals behind meaningful EHR use are said to be improving the quality, safety and efficiency of healthcare services; reducing healthcare disparities; engaging patients and their families; improving the coordination of care; improving population and public health; and ensuring the privacy and security of personal medical information" (Robeznieks, 7/13). 

The Boston Globe: The unveiling of the regulations was presided over by Donald Berwick, the newly appointed director of the Medicare agency, which will distribute the stimulus funds. "Berwick opened his brief speech with forward-looking remarks, reminding the audience of President Obama's goal to have electronic health care records available to all Americans by 2014. 'What we have at stake is the future of health care itself,' said Berwick. 'The benefits of a modernized health information technology help everyone. It's a win-win, right across the board'" (Vallejo, 7/13).

NPR: Berwick himself is a fan of electronic records. He also said, "I never had to go hunting for a missing piece of paper with a lab test written on it that I needed. … All the results were there, right there, as soon as the lab that produced the result." NPR adds, "And if he sent a child to see a specialist, there was 'no phone tag after that, wondering what happened. The specialist notes were there for me, and the family, just as soon as the specialist prepared those notes'" (Rovner, 7/13).