Medicare and Medicaid electronic health record (EHR) incentive payments are estimated to have reached $9.245 billion to 177,100 physicians and hospitals through November since the program's inception and are anticipated to reach $10 billion by the end of the year (Healthcare IT News went to press before the Centers for Medicare and Medicaid Services (CMS) posted final figures in late December).
During November, CMS estimated that it paid out 8,250 Medicare-eligible physicians $150 million; 4,000 Medicaid physicians $73 million; and hospitals under either of the two programs $645 million, for a grand total of $868 million, according to Robert Anthony, a specialist in CMS' Office of eHealth Standards and Services.
"We saw a large number of hospitals come in November - 525 hospitals were paid by either Medicare or Medicaid," he said at the Dec. 5 meeting of the advisory Health IT Policy Committee.
Many providers, hospitals in particular, will attest and get paid in the final months of this year and early months of next year so they can be counted for 2012.
"The incentive payments were almost $1 billion more in November. We are on track for the end of December to hit the $10 billion mark for EHR incentives," Anthony noted.
In October, the totals were $8.4 billion paid since the program's start to 164,593 Medicare and Medicaid providers.
Each month, the percent of provider involvement in meaningful use steadily rises. As of October, 26 percent, or one out of every four Medicare eligible providers, are meaningful users of EHRs, Anthony said. Additionally, one out of every three Medicare and Medicaid eligible providers has made a financial commitment to an EHR, he said. And over 65 percent of eligible hospitals have received an EHR incentive payment.
In data supplied by the regional health IT extension centers, they found as they assist physician practices in adopting and using EHRs that they struggle most notably with the clinical summary, medication reconciliation, the security review, patient reminders and the summary care record.
"We see that this information jives very closely with what we're seeing in attestation as well," Anthony said.
Practices also find challenges as they try to become meaningful users of EHRs including, by rank, provider engagement (25 percent); administrative issues (22 percent); vendor selection (6 percent); workflow adoption (14 percent; and financial at 10 percent. On vendor issues, the biggest area is the delay in implementation or installation of EHRs.
"Meaningful use measures are not the lead challenge for most providers, except for very small providers," he said.
Neil Calman, MD, policy committee member and president and CEO of the Institute for Family Health, was gratified that meaningful use measures did not lead the challenges for physicians.
"I think that speaks a lot to how on target we are at bringing meaningful use into the spectrum of what's good for the public. Now we have the data about how right on this initiative is," he said. In mission-driven organizations where the patient is the focus, people don't see meaningful use measure as off target but rather part and parcel with the work, Calman added.
Paul Tang, MD, policy committee vice chair and chief innovation and technology officer at the Palo Alto Medical Foundation, said he was encouraged that the financial issue, which used to be the number one barrier, is no longer the top challenge for physicians. Now, it's making sure that more standards are there without deterring providers. "We don't want standards to be an excuse for not moving forward," he said.
From the meaningful use attestation data, providers reported that few patients know at this point that they can request an electronic copy of their health information, Anthony said. When they have asked, however, physicians are providing their information at a very high rate, though a large number of physicians are putting off the objectives for electronic access to information and patient education resources.
Providers generally hold the same popular and least popular menu objectives for meaningful use each month, he said. Besides the required measures, the most popular menu objectives for physicians are drug formulary, immunization registries and generating patient lists. For hospitals, it's advance directives, drug formulary and clinical lab test results. The least popular menu measures for physicians are the transitions of care summaries and patient reminders; for hospitals, it's the transitions of care summaries and reportable lab results.
As of November, 117,284 have attested successfully and 230 unsuccessfully at first and later 214 resubmitted successfully, Anthony said. Among hospitals, all 2,558 that attested did so successfully.