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Meaningful Use:
Beyond Stage 1


On February 17, 2009, President Obama signed the American Recovery and Reinvestment Act of 2009. Within the Act is a separate new law called the Health Information Technology for Economic and Clinical Health Act (HITECH Act) which devotes a sizable portion ($19 billion of the $787 billion stimulus) to health information technology, health information exchange, privacy and security. The funds are to be used to reach an aggressive goal of national electronic health exchange by 2014.

The Administration believes the federal money and standards setting provisions in the new law will be the force that breaks the barriers that have kept the electronic health record system adoption at relatively low levels. Part of the law includes a total of $17.2 billion in Medicare reimbursement to doctors and hospitals that show ‘meaningful use’ of a ‘qualifying’ electronic health record (EHR) by 2014. While many organizations are weighing in on what those terms mean, currently there is not a specific definition for meaningful use or parameters around qualifying EHR solutions. Bottomline is working closely with partners in the healthcare space to participate in and monitor discussions around the yet-to-be-defined specifics around the HITECH Act.

The reimbursement schedule contained with the Act has been better outlined. Physicians or other qualified health professionals will receive reimbursement over 5 years. It is reported that hospitals’ reimbursements will start at $2 million and could reach $11 million depending on discharges and additional metrics. One thing is clear; the reimbursement schedule is designed to provide an incentive to implement quickly. Physicians receive a larger first year payment if implementation occurs in 2011 or 2012 and lesser amounts if they implement later. Also, all payments stop after 2016; thus, to maximize reimbursement implementation needs to occur by 2011 since the Act provides for 5 years of payments.

Alternatively, for physicians and hospitals that do not demonstrate a meaningful use of a qualified EHR solution there is a punitive language in the law. For them, reimbursement for Medicare payments is reduced 1% starting in 2015 with an increasing percentage point each year thereafter with a jump to 5% in 2018 if less than 75% of physicians are using EHRs.

So what does it all mean?

Given the strong incentives to implement as soon as practical along with the current ‘unknowns’ surrounding the language in the law, Bottomline is well positioned to provide hospitals with options now to be ready for 2011. First, Bottomline MedEx forms automation solution is a critical first step in the migration from paper to electronic health records. Having your arms around your clinical forms is a critical first step in the evolution from paper to electronic records. Given the uncertainty with the HITECH Act as well as the implementation incentives starting in 2011, getting your data into an electronic format AND creating the processes that support that environment is a step you can take now. For clients who are well down the path, Bottomline offers solutions such as Patient Signature Capture and Image Integration that help electronically capture the last remnants of paper or interface the outlier or specialized clinical systems.

Another clear advantage of implementing a forms automation solution now is cost. Bottomline’s forms automation solution typically provides year 1 return on investment meaning you can use your savings to finance your EHR implementation when it is time to implement. Moving from paper to electronic records now and using the savings to fund EHR implementation that provides significant reimbursement later is a decision that is a win-win.

Clearly, forms automation is a wise pre-requisite to EHR and something that can immediately ready you for the benefits of the HITECH Act. The follow-on question, of course, is what EHR solutions will meet the criteria of ‘meaningful use’ and 'qualifying' solution. Since those terms are yet to be defined, obviously, nobody can say for sure. Currently, Bottomline offers an EHR solution, QuickRecord, which has been around for several years and is distributed throughout our customer base. It is not possible to say that QuickRecord or any new Bottomline solution will meet all the forthcoming criteria set forth in the HITECH Act. However, we do know implementing a forms solution now will assist new and existing clients to meet the requirements, once defined. Then as the HITECH Act requirements are better defined Bottomline will be working to determine how to best help prospects and clients ready themselves for those requirements through all of our forms management, document process automation, and EHR solutions.

For more information on how Bottomline can help you get ready for the provisions in the stimulus contact Bottomline at 800.472.1321 or



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