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Hawaii is among the few states to not take advantage of a federal incentive program estimated to distribute as much as $80 million to Medicaid providers for the establishment of electronic health records.
The Medicaid Electronic Health Record Incentive program offers individual medical professionals up to $63,750 over six years if they demonstrate their use of electronic medical records improves quality and reduces errors, according to the federal Centers for Medicare and Medicaid Services (CMS). Community health centers and hospitals with a significant Medicaid population can receive incentives starting at $2 million.
Hawaii is one of a half-dozen states — Idaho, Illinois, Kansas, Minnesota and Colorado — that haven’t launched Medicaid EHR programs, CMS said. Guam, the Marshall Islands and the District of Columbia also have yet to participate in the program. Doctors in other states began collecting the federal dollars as early as last year. The earliest Hawaii doctors could start getting money is 2013, according to the state.
"I don’t know why we’re not grabbing them (the federal dollars) sooner because there’s a multiplier effect," said Richard Bettini, CEO of the Waianae Coast Comprehensive Health Center. "In purely economic terms it seems to me we’ve got to get these dollars flowing. It seems that this ought to be a higher priority."
ABOUT THE PROGRAM
Who is an eligible professional under the Medicaid EHR Incentive Program?
>> Physicians (primarily doctors of medicine and doctors of osteopathy)
>> Nurse practitioners
>> Certified nurse-midwives
>> Dentists
>> Physician assistants who furnish services in a federally qualified health center or rural health clinic that is led by a physician assistant
To qualify for an incentive payment under the Medicaid EHR Incentive Program, an eligible professional must meet one of the following criteria:
>> Have a minimum 30 percent Medicaid patient volume.
>> Have a minimum 20 percent Medicaid patient volume and be a pediatrician
>> Practice predominantly in a federally qualified health center or rural health center and have a minimum 30 percent patient volume attributable to needy individuals
What is an eligible hospital under the Medicaid EHR Incentive Program?
>> Acute care hospitals with at least 10 percent Medicaid patient volume
>> Children’s hospitals (no Medicaid patient volume requirements)
Source: Centers for Medicare and Medicaid Services
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In Hawaii there are roughly 6,500 Medicaid fee-for-service providers, including physicians, community health centers and hospitals.
In addition to not getting incentive payments, Medicaid providers that haven’t successfully participated in the electronic records program will see their government reimbursements reduced beginning in 2015, a CMS spokesman said.
Hawaii hasn’t applied for the program nor developed a plan, which must first be approved by CMS for local providers to participate and cash in on the federal funds.
"It is true that we are (among the) last in the nation," said Beth Giesting, the state’s health care transformation coordinator. "That really is too bad because health information technology is one of the fundamentals for making all of the transformation that we want."
The Legislature appropriated money to the state last year to implement the program, but the problem has been staffing resources, Giesting said. DHS lost nearly half its Med-Quest staff in 2009 due to budget cutbacks. Med-Quest is Hawaii’s Medicaid program.
"The Med-Quest folks have a lot of things they’ve got to do, and if they don’t do them, they’d be penalized," Giesting said. "Unfortunately, when they have to prioritize things, something like this, which is incredibly important, is not quite as important because there’s no penalty attached to it."
The state Department of Human Services is "actively pursuing" the federal incentive program and recently received approval from CMS to issue a request for proposal to hire a consultant to develop the State Medicaid Health Information Technology Plan, a needed step before getting the federal money, said spokeswoman Kayla Rosenfeld.
"It’s better now than never," Giesting said. "It is a lot of money for a very important purpose."
Hawaii has done what was needed to get federal dollars to pay for setting up electronic records for Medicare patients. Through February, 169 Hawaii Medicare providers, including doctors and hospitals, have received more than $11.5 million in EHR program incentives, according to CMS.
Among the benefits of providers using electronic records is greater efficiency through e-prescribing and the instant exchange of health information to improve the quality of care and clinical research.
The program is voluntarily offered by individual states and territories. The federal government pays 100 percent of the money distributed to providers and nearly all of the cost of administering the program.
"The DHS fully appreciates the advantages of EHR and the benefits it will bring to providers and their patients," Rosenfeld said. "We continue to move forward on this initiative and are fully committed to participating in the voluntary Medicaid EHR Incentive Program."
DHS plans to launch the program by the end of 2012. Eligible Medicaid providers have until 2016 to enroll in the program before losing federal incentives.
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