HITECH stimulus for physicians.

n response to the economic circumstances occurring in late 2008, on February 17, 2009 President Barack Obama signed in to law the American Recovery and Reinvestment Act of 2009 (ARRA). This act, often referred to as “The Stimulus Act,” appropriated federal expenditures to a variety of projects throughout the economy,with a large portion of the funding being allocated toward infrastructure development (such as road construction). A portion of the funding appropriated under the Act provides health care information technology (HIT) incentives and expands privacy legislation. Title XIII (Section 13001) of that legislation is termed the Health Information Technology for Economic and Clinical Health Act (HITECH) and funds $17.2 billion for incentives and $2 billion for grants. HITECH may be more of a lesson in delayed gratification than a stimulus bill. Incentive payments to physicians participating in Medicare do not start until January of 2011 for meaningful use of certified information systems. Table 1 (page 355) lists the Medicare Part B maximum yearly payments. In 2015, the law directs 1% reductions in the Medicare fee schedule followed by an additional 1% reduction in each of the next two years—2016 and 2017—for physicians who have not satisfied the requirements to qualify. When announcing the HITECH legislation, President Obama promoted an electronic health record (EHR) for all US citizens by 2014. The rationale behind having an EHR is the expectation that it will improve the quality of health care and population health while simultaneously delivering care more efficiently. EHRs have been able to deliver some operational efficiencies inside an integrated delivery network such as Kaiser Permanente but the effect of widespread adoption is unknown. A simplified but useful formula for incentive payment requirements is $ = EMR + HIE + QR. An EMR is an electronic medical record that includes electronic prescribing, HIE is a health information exchange which shares medical records, and QR is quality reporting. Most physicians are familiar with the concept of an office EMR and the reporting of National Quality Forum metrics through the Centers for Medicare and Medicaid Services Physician Quality Reporting Initiative. The key to payment depends upon the final definitions of meaningful use and certified. These definitions will be issued by the Secretary of the Department of Health and Human