This post first appeared in the Practice Fusion Blog.

Responding to public feedback on a working group’s proposal made last month, the federal HIT Policy Committee has released updated recommendations for defining what is meant by the term “meaningful use” of electronic medical records.

The new recommendations include modifications to the criteria for computerized order entry and a more aggressive implementation time frame for implementing personal health records.

The recommendations now go to the Office of the National Coordinator for Health Information Technology and other branches of HHS, who will use them in developing rules to implement the incentive programs.

The final product should be released beforeyear end.

HITECH legislation states that providers must demonstrate meaningful use of an EMR in order to qualify for bonus payouts under Medicare and Medicaid beginning in 2011.

In an important change designed to ease pressure on providers, the Policy Committee has recommended that its 2011 criteria should apply not just to 2011, but to whatever year a particular provider decides to implement his or her EHR.

Thus if a practitioner decides to go live with an EHR in, say, 2013, he or she will be required to meet 2011 criteria for meaningful use in order to qualify for bonus funding.

The Policy Committee has retained the guideline matrix originally proposed by its working group, while making several modifications to it, most notably with respect to the adoption of CPOE.

Here, the working group’s proposed requirement that providers must use CPOE for “all” orders in 2011 has been diluted to state that 10% of orders “of any type” must be entered by an authorized provider in order to qualify. This will allow pilot CPOE projects and phased implementations to meet the requirement.

The revised criteria also require providers to:
* Implement one clinical decision support rule relevant to a specialty or a high clinical priority;
* Submit claims to payers electronically;
* Check insurance eligibility electronically when possible;
* Provide patients with timely electronic access to their health information;
* Provide patients, upon request, with an electronic copy of their discharge instructions and procedures at the time of discharge; and
* Be able to exchange health information where possible in 2011, and participate in a national health information exchange by 2015. (more…)

The Centers for Medicare and Medicaid Services announced last Wednesday that it was changing its payment rates to providers in 2010.

The new rates will increase payouts to beleaguered primary care practitioners while snubbing radiologists and cardiologists, among others.

Among the perks for PCPs, CMS has proposed a bump in payments for the Initial Preventive Physical Exam, a.k.a. the “Welcome to Medicare” visit to reflect the true complexity of the service.

CMS also proposed to change the way Medicare recognizes professional liability expenses such that Medicare’s support for these costs is redirected to providers experiencing the highest malpractice premiums.

Beyond that, the news was gloomier than Boston’s weather this June. 

CMS is, for example, proposing to remove physician-administered drugs from the definition of “physician services” and to stop paying for consultation codes, which are typically billed by specialists at a rate higher than procedurally similar evaluation and management (E/M) services. 

Overall, the changes would increase payments to GPs, family physicians, internists, and geriatric specialists by 6-8%, according to a CMS press release. The biggest losers will be radiologists, especially interventional radiologists who should see cuts of at least 20% for most imaging tests.

Payments to cardiologists would be cut about 11% overall, with cuts of up to 42% for reading an echocardiogram and 24% for performing cardiac catheterization.

Cuts “like this threaten the successes we have had over the years with reducing heart disease,” ACC president Alfred Bove warned the Wall Street Journal.

Meanwhile Ted Epperly, president of the American Academy of Family Physicians, said the CMS proposal would drive more medical students into primary care, and hailed the pay raise for his constituency as “long overdue.”