Priority is given to primary care providers (PPCPs) who practice in groups of fewer than 10 physicians — specifically:

 MDs or DOs who are family physicians

 General internists

 Pediatricians or obstetrician/gynecologists (board certification not required)

 Nurse practitioners, nurse midwives, and physician assistants with prescriptive privileges

Priority also goes to PPCPs who provide primary care services in public or critical access hospitals:

 Federally Qualified Health Centers (FQHCs)

 Rural health clinics

 Other settings for predominantly uninsured, underinsured, or medically underserved populations

Direct technical assistance will be capped at the 10-provider level for groups with more than 10 physicians or providers.

Under Medicare, "eligible professionals" include: MDs, DOs, Dental Surgeons, Doctors of Dental Medicine, Optometrists, Podiatrists, and Chiropractors.

Under Medicaid, "eligible professionals" include: Physicians, Pediatricians, Dentists, Certified Nurse Midwives, Nurse Practitioners, and Physician Assistants operating at an FQHC led by a Physician Assistant.

The first Medicaid payments will most likely be in the summer of 2011. The first year that is considered to determine "meaningful use" is 2011. Payments are calculated using the claims received by Medicare by the end of February of 2011. The provider needs to sign up for the incentive program, meet meaningful use for 90 days for Medicare reimbursement, then sign the attestation form that he/she has met the requirements. Therefore, the first payment could be received as early as May, 2011. Payment will be made as one payment for each year of eligibility.

To further encourage early adoption, practices that adopt EHR in 2011 or 2012 only have to meet Stage 1 requirements for "meaningful use," which can be done very quickly at this level. Documentation of Stage 1 "meaningful use" is very general. In most instances it just requires a provider to attest to the percentage of patients that the practice treats using the stated standard.

Services from the Regional Partners are:

 Implementation and project management

 Practice and workflow redesign

 Functional interoperability and health information exchange; vendor selection

 Privacy and security best practices;

 Assistance in achieving "meaningful use"

There are three elements of meaningful use:

1. Use of a certified electronic health record (EHR) in a meaningful way (e.g., e-prescribing).

2. The technology is connected in a way that provides electronic exchange of health information to improve the quality of care.

3. Clinical quality measures are submitted to the Centers for Medicaid and Medicare Services (CMS).

Regional partners are the technical assistance arm for the adoption of electronic health records in Ohio. They work with healthcare providers in their individual regions to:

• Assist in the workflow assessment that is necessary to successfully convert to electronic records;
• Help select and successfully implement EHR systems; and
• Work with practices to achieve "meaningful use" of certified EHR technology.

To accomplish these goals, the Regional Partners offer education, outreach, technical assistance, discounted certified EHR offerings and a health IT loan program.

There are seven Regional Partners to Ohio Health Information Partnership throughout the state.The Ohio Health Information Partnership and HealthBridge are the two entities identified in Ohio as Regional Extension Centers. HealthBridge covers southwest Ohio, southeastern Indiana, and northern Kentucky.

The Ohio Health Information Partnership's Regional Partners will provide services to the practices wishing to convert to EHR or achieve "meaningful use" in all areas, except the 11 counties surrounding Cincinnati and Springfield. These areas will be serviced by HealthBridge.

The Ohio Health Information Partnership's goal is to assist 6,000 physicians in Ohio, to adopt and "meaningfully use" an EHR by 2012. Nationally, the goal is to have 100,000 physicians adopt an EHR within the next few years. By the end of the decade, the US Department of Health and Human Services would like to have at least 75 percent of all physicians adopt an EHR.

The Ohio Health Information Partnership is a nonprofit entity that is working to facilitate the adoption and use of health information technology (HIT) throughout Ohio. Ohio Health Information Partnership, along with its seven regional partners, is helping physicians and other providers to adopt Electronic Health Records (EHRs) and draw down federal incentive dollars while doing so. The Ohio Health Information Partnership's overall goal is to improve the quality and value of health care by allowing authorized providers access to a patient's health information regardless of the care setting. The partnership also is charged with the creation and implementation of a statewide Health Information Exchange (HIE). Founders include the:

• Ohio State Medical Association
• Ohio Osteopathic Association
• Ohio Hospital Association
• BioOhio
• State of Ohio

The leaders of this nonprofit organization serve as the Executive Committee on the 15-member Ohio Health Information Partnership Board, also made up of information technology, medical, hospital, behavioral health and health insurance leaders. Ohio is one of six state-designated entities that also is a Regional Extension Center (REC) awardee, so its governance involves experts who have a local, grass-roots interest in the integration of EHRs into an HIE infrastructure.

Federal legislation passed in 2009 (American Recovery and Reinvestment Act or ARRA) created five major sources of funding to encourage the adoption of EHRs. This includes:

• Grants for health information exchanges (HIEs)
• Medicare/Medicaid incentives for physicians and hospitals to adopt EHRs
• Grants for regional extension centers (RECs) to assist in that adoption
• Grants for IT workforce development
• Grants to communities that have achieved wide-scale use of health information to assist them in disseminating their best practices.

The funding in the REC grant goes directly to the Ohio Health Information Partnership, then on to the regional partners and its sub-contractors for providing education and assistance in EHR adoption. The REC grant does not include the stimulus dollars for the physicians, hospitals, and other health care providers who purchase and implement EHR systems in a meaningful way. This funding is provided through Medicare and Medicaid.

Health Information Exchanges are IT networks that provide connectivity between and among health care providers – hospitals and providers, hospitals and hospitals, providers and public health agencies, and providers and providers. The Ohio Health Information Partnership received federal and state funding to create the IT architecture for Ohio that will allow local networks to communicate with each other as well as with individual providers and hospitals.

"Eligible professionals" who treat either Medicare or Medicaid patients may be eligible for incentive payments over the next five years if they adopt an electronic health record (EHR) system and use it in a meaningful manner.

To qualify for Medicaid incentives, a certain percentage of the practice must be Medicaid (as measured in a 90 day period).

For pediatric practices, 20 percent of the patient volume must be Medicaid. Pediatricians with 20 to 30 percent of their patient volume as Medicaid can earn 2/3 of the total Medicaid incentives for EHR adoption (approximately $42,700 maximum). If the patient volume is 30 percent, the pediatrician is eligible for the full incentive reimbursement.

For non-pediatric practices, 30 percent of the patient volume must be Medicaid (either managed care or fee for service). For Medicare incentives, there is no requirement that a minimum percentage of the practice be Medicare.

The Ohio Health Information Partnership has two basic functions in Ohio:

• Coordinate the efforts of regional extension center partners (also known as RECs) to encourage the adoption of health information technology by physicians and other health care providers in Ohio
• Develop a statewide health information exchange (HIE) for Ohio

In addition, the Ohio Health Information Partnership will assist in the development of the workforce grants and directly help to implement the physician EHR incentive program. Medicare and Medicaid will provide the incentive funding to providers for the "meaningful use" of an EHR. The Ohio Health Information Partnership is the direct recipient of two of the five grants listed above created under ARRA – an HIE and REC grant.

The purpose of this initiative is to encourage early adoption of an EHR, so incentive payments are higher in the first few years of the program. For example, Medicare will pay up to $44,000 over five years to providers that adopt and meaningfully use an EHR in 2011 or 2012 – $18,000 the first year, $12,000 for the second, $8,000 for the third, $4,000 for the fourth, and $2,000 for the fifth year. Every provider in a practice who is eligible will receive separate incentive payments.

No Medicare incentives are given for adoption in 2015 or later. In fact, starting in 2015, practices that have not adopted an EHR and demonstrated "meaningful use" will start receiving decreased reimbursement from Medicare.

Medicaid incentives are paid at a higher rate than Medicare, but the same maximum rate ($63,750) applies no matter which year you meet "meaningful use" from 2011 to 2016. There is an additional year of eligibility (2016) for EHR adoption for Medicaid.

Medicaid will pay incentives in the first year to "adopt, implement, or upgrade certified EHR technology. The actual procedure for drawing down Medicaid EHR incentives is being developed by the state of Ohio's Medicaid program, which oversees the Medicaid incentive payments. There are no reimbursement penalties for failure to adopt an EHR system under Medicaid.

Payments are calculated using 75 percent of Medicare fee-for-service billing for the preceding year, up to the maximum permitted. To receive maximum reimbursement for the first year, a practice would need to have $24,000 in Medicare allowed charges for the preceding year. Charges do NOT include Medicare Advantage billings except in situations where the practitioner is part of a Medicare Advantage HMO. If the practice has more than one site, 50 percent or more of the patient encounters must occur at a location or locations that have certified EHR technology to draw down incentive payments in that year.

Practices that wish to receive Medicare incentive payments at the earliest possible date are only required to have to meaningfully used the EHR for 90 consecutive days in 2011. The 2011 period needs to be followed up with a full year of EHR use in 2012.

For Medicaid incentives, payment is calculated on the actual cost of the EHR system, including the cost of training and support. The reimbursable amount of Medicaid incentives is 85 percent of the cost, with a maximum for the first year being $21,250 (85% of $25,000). If the physician or practitioner has received outside assistance in purchasing an EHR, Medicaid will still allow $29,000 in subsidy before the incentive payment is decreased.

If the physician or provider has at least 50 percent of his or her practice in a Health Professional Shortage Area (HPSA), then the physician or provider is eligible for an additional 10 percent incentive payment over his or her Medicare incentive. This is automatically calculated and does not require the provider to apply separately for the increased payment.

Yes, hospital-based physicians (e.g., radiology, pathology, anesthesiology, ER) are excluded if more than 90 percent of the patients seen are hospital-based and the provider uses the hospital's facilities and equipment.

Services are considered hospital-based if the place of service code is inpatient or emergency department. Hospital-based does NOT include ambulatory patients, even if the practice is hospital-owned.