EHR Incentive Program Bonus for Anesthesiologists:  Q & A

By: Bellinger P. Moody, RHIA, CPC, CCP, CPC-I
Executive Vice President of Compliance

February 4, 2011

Under the initial provisions of the new Electronic Health Records (EHR) Incentive Program brought about by the American Recovery & Reinvestment Act (ARRA), “eligible professionals (EPs)” – physicians only – are eligible to receive incentive payments for the “meaningful use” of EHRs.  The total incentive payments are $44,000 per physician – if they meet meaningful use requirements beginning in 2011 or 2012.  Also stated in the Act are provisions for penalties beginning in 2015 – if the physician has not yet begun meaningfully using and EHR.

There are two categories of professional under the EHR Program:  (1) “eligible professionals” (EPs); and (2) hospital-based eligible professionals (HBEPs).   According to a December 22, 2010 posting on the ASA website: 
“ Under the [EHR Incentive] Program . . . . . . hospital-based eligible professionals [e.g. Anesthesiologists, Radiologists, Pathologists] – despite the name – are actually not eligible to receive the incentive payments (and are exempt from future penalties) because the thinking was that they would use their hospital’s EHR.  To be deemed a hospital based eligible professional, one needs to provide 90% or more of their covered services in an inpatient or emergency room setting . . . . . The majority of anesthesiologists do not provide 90% or more of their covered services in the inpatient or ER setting unless one exclusively does cardiac, transplant or critical care work, which is rare.  The majority of the codes submitted by anesthesiologists are for work done in the outpatient, ASC or Office-based setting and therefore, by definition, most anesthesiologists will be deemed “eligible professionals” and thus technically eligible to receive the incentive payments.”

So, the question then becomes:

Can anesthesiologists receive the $44K EHR Incentive Bonus Payment from Medicare?
The answer to this question is contingent upon CMS’s response to a joint letter written to CMS, from the ASA (American Society of Anesthesiologists), the ACR (American College of Radiology) and the CAP (College of American Pathologists).  The letter (attached above) – dated December 15, 2010 and addressed to Department of Health and Human Services Secretary, Kathleen Sebelius – asks for a meeting to discuss more appropriate meaningful use requirements that would allow anesthesiologists, radiologists and pathologists to participate in the incentive program.

Can you show meaningful use of an EHR without having purchased it?

Some advisors in the anesthesia community may have given a lot of practices the wrong information as to whether anesthesiologists have to have paid for the EHR versus the hospital.  The more important questions are:  (1) Is the EHR certified; and (2) Can you show meaningful use of the EHR without having purchased it?

You can show meaningful use of an EHR without having purchased it.  The EHR must be certified for the user to be eligible for the incentive payment and the user must meet the meaningful use requirements.   What are the meaningful use requirements?  These are 25 Stage-1 measures, of which the first 15 (core) measures must be satisfied along with 5 of the 10 remaining (non-core) measures.  However, many of these measures do not apply to the scope of practice in anesthesia and don’t fit typical anesthesia practice patterns.  For example, one of the measures is whether the physician has “provided the patients with an electronic copy of their health information (including diagnostics test results, problem list, medication lists, medication allergies upon request”.   Most of these measures appear to focus solely on the clinical and administrative needs of primary care or office-based providers.  This is one of the primary reasons that the three specialties (ASA, ACR and CAP) have asked for a meeting to discuss more appropriate meaningful use requirements that would allow anesthesiologists, radiologists and pathologists to participate in the incentive program.
The next questions become:

Should anesthesiologists register for the incentive payment?  Can my billing office register me?

Ultimately, the answer to the first question lies with CMS’s response to the December 15th letter to CMS.  However, if CMS does make revisions and you have not registered, you will be behind the curve and you may miss your opportunity for the bonus.

However, if you are using an EHR in your facility or will be using one by February 29, 2012 – whether you purchased it or not – I recommend that you get registered in the program to be eligible for the largest payout of the bonus program (Calendar year 2011).  The bonus payment per physician for calendar year 2011 is $18K per physician – but you must: (1) be using a certified EHR; (2) have registered; and (3) have attested to meaningful use by February 29, 2012.

Your billing agent, office staff or practice manager may act as a proxy and can register you.  However, they will need your NPI number and your user name and password that was established when you first obtained your NPI number in order to register you.  Currently, as it stands, there is no group registration.  Each individual physician must be registered. 

Medac’s provider enrollment department will register all providers that are, or will be, using a certified EHR by 2012, and are interested in participating in the bonus program (both anesthesiologists and pain physicians).  Please contact your Medac Practice/Account Management Representative if you would like Medac to register the physicians in your group.

The information presented herein reflects general information that is current as of the date it was first published.  In light of changes that may occur in the health care regulatory and compliance environments, the author's presentation of this information might become outdated.  Please check with your individual legal and/or compliance advisor(s) prior to taking any significant actions based upon the information and advice presented.