Then fall 2008 happened: Wall Street collapsed. Barack
Obama was elected president. And Democrats seized a major-
ity in Congress. “Because health care is almost 20 percent of
the U.S. economy, both the new Congress and the new presi-
dent decided it was an area where we should be investing
federal tax dollars to stimulate the economy,” Roberts contin-
ues. “So, the economic stimulus legislation was passed, and
it included in it incentive payments for doctors and hospitals
that purchase certified IT products and can prove they are
effectively using those products.”
On Feb. 17, 2009, President Obama signed into law the
American Recovery and Reinvestment Act. Title XIII of ARRA,
called the Health IT for Economic and Clinical Health — or
HITECH — Act, allocated $19.2 billion toward health IT that
will be used to incentivize the adoption and use of EHRs by
health care organizations that bill for Medicare and Medicaid.
“Depending on the program — Medicare or Medicaid
— they have either a five- or six-year window to earn these
incentives,” explains HIMSS Executive Vice President Carla
Smith, CNM, FHIMSS. “At the end of that window there’s
a penalty program that will go into effect, and those clini-
cians and hospitals across the nation that bill Medicare and
Medicaid and cannot demonstrate effective use of IT will
receive less federal money per transaction. It’s a carrot-stick
approach.”
The remarkable thing about the HITECH Act isn’t that
it incentivizes EHR adoption; it’s that it incentivizes EHR
usage. In fact, the legislation specifically requires hospitals
and physicians to demonstrate “meaningful use” of EHRs to
qualify for incentives.w
“The term ‘meaningful use’ isn’t about implementing a
piece of software,” Smith says. “It’s about meaningfully using
it to help people stay healthy and manage the costs of care.”
The purpose was simple. The particulars, however, prom-
ised to be complicated. After Congress passed ARRA in
2009, the HITECH Act was inherited by the Centers for Medi-
care and Medicaid Services (CMS), which is charged with
turning the legislation into regulation. To accomplish that, it
will roll out a detailed definition of “meaningful use” in three
stages through 2015. So far, only Stage 1 is complete: CMS
issued a notice of proposed rulemaking (NPRM) for Stage 1
in December 2009, commencing a 60-day period of public
comment that concluded in March 2010. The final rule for
Stage 1 was published last July.
