A hospital which is a “meaningful EHR user” (as determined by the Secretary of the Department of Health and Human Services) would be entitled to incentive payments from the Medicare program over a four-year period. The hospital would receive the full incentive payment during the first year; 75 percent during the second; 50 percent during the third; and 25 percent during the fourth year. However, if the hospital does not quality for the incentive until 2013 or later, then the payment is reduced. The first year incentive payment would be calculated as a base amount of $2 million, plus $200 per discharge for each discharge between 1,150 and 23,000, multiplied by the hospital’s Medicare share. The Medicare share is the number of inpatient days paid under Part A or attributable to Medicare Advantage enrollees, divided by the product of total inpatient days, multipled by the proportion of total charges not attributable to charity care divided by total charges. Starting in fiscal year 2016, hospitals that are not meaningful EHR users will see their market basket adjustments decreased by 33 1/3 percent for 2016, 66 2/3 percent for 2017 and 100 percent thereafter, with allowance for hardship exceptions.
H.R. 1 also provides for reimbursement under the Medicaid program for costs incurred in acquiring certified EHR technology, and support services including maintenance and training. Hospitals eligible for the Medicaid incentive include children’s hospitals and hospitals that have a Medicaid patient volume of at least 10 percent.
The Senate has divided the responsibility for the stimulus package between the Appropriations Committee (advancing S. 336) and the Finance Committee (advancing S. 330). The incentives for adoption of health information technology are contained in the Finance Committee bill. The Medicare incentive is the same as under the House bill (except that the per discharge amount would be $200 for discharges between 1,150 and 9,200; $100 for discharges between 9,201 and 13,800; and $66.67 for discharges between 13,801 through 23,000). The market basket decreases for hospitals that are not meaningful EHR users is pushed up to 2015 in the Senate bill. S. 330 also contains a Medicaid incentive provision similar to H.R. 1.
Ms. King (pking@schosp.org) is assistant general counsel for Swedish Covenant Hospital in Chicago.
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