General Overview
Objectives of Incentive Programs
In 2009, the federal government passed the American Recovery and Reinvestment Act (the “stimulus”). This Act establishes Medicare and Medicaid financial incentives and penalties to promote the meaningful use of electronic health records (EHR). Specifically, the federal government hopes to increase EHR adoption, improve the quality, safety, and efficiency of care while reducing disparities, engage patients and families in their care, promote public and population health, improve care coordination, and promote the privacy and security of EHRs.
CMS spent the first half of 2010 working on the regulations for the incentive programs, and released the final rule on July 28th, 2010. This rule sets the first phase of the incentive/penalty programs. There will be a total of three phases to these programs.
See HHS for more background information regarding meaningful use.
Incentive and Penalties
The incentives and penalties differ between the Medicare and Medicaid incentive programs. One cannot qualify for both programs.
| Program |
Maximum Incentive Payment |
Penalties |
| Medicare |
$44,000 over 5 years per EP |
EPs that are not meaningfully using EHRs by 2015 will have Medicare payment reductions (1% in 2015, increase by 1% every year after, max of 5%) |
| Medicaid |
$63,750 over 6 years per EP |
No penalty with Medicaid providers. |
*EP = eligible professional
Hospitals have different incentive payments and penalties. These amounts above are for individual, eligible professionals only. See Details on Incentives for more information.
Eligibility
The Medicare and Medicaid programs also have different sets of eligible professionals (EPs). Most oncologists will qualify for the Medicare program.
| Program |
Eligible Professionals |
| Medicare |
Physicians (MD or DO), dentists, podiatrists, optometrists, and chiropractors |
| Medicaid |
Physicians, dentists, certified nurse-midwives, NPs, and PAs practicing in an FQHC or Rural Health Center that is so led by a PA |
See Who Qualifies for more information.
Qualifying for the Medicare Program
For EPs, qualifying for the incentives requires a four-step approach:
- Installation of a "certified" EHR.
- "Meaningful use" of the EHR.
- Attestation to CMS of meaningful use.
- Repeat process for next reporting cycle (and next payment).
Medicaid has different qualifications. See How Do I Qualify for more information about both programs.
