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States won't be checking all those Medicaid EHR incentive criteria

Back in my irreverent youth — okay, as recently as my mid-20s — I had a blast throwing my body around a mosh pit at a Descendents show. Even got my glasses smashed during “Coffee Mug,” which isn’t easy to do because the song is all of 35 seconds long.

Reading recent stories of the back-stabbing, bloody budget battle raging in D.C., a Descendents mosh pit seems more like friendly confines in comparison.

Because Medicare, Medicaid and health care reform are big issues upon which legislators have drawn partisan battle lines, some folks in our health IT sector are worried that HITECH Medicare and Medicaid EHR incentive dollars are at risk, in a sort of “guilt by association” scenario.

Over at InformationWeek, Neil Versel wrote a thorough analysis of how likely those checks could become casualties of budget-gutting movements afoot in the nation’s capital. You might be surprised to learn that seven Congressional bills have suggested pulling the plug on them, but his sources tell him that none has a shot of even making it to the President’s desk for the opportunity of being vetoed.

Yet reports like the one released earlier this week by the U.S. Department of Health and Human Services watchdog Office of Inspector General (OIG) will likely cast the EHR Incentive Program — at least on the Medicaid side, run by each state — as another symbol of government waste for the talking heads on radio and television. The OIG found that, of the 13 states it polled, only Kentucky plans to verify all of the eligibility requirements for health care providers who sign up for incentives before they start doling out the money.

All of the states will verify at least half of the 11 eligibility criteria, and two (Alabama and Alaska) will check 10 of the 11. Why are most states skipping some of the qualifiers? Lack of access to data.

“Depending on the eligibility requirement,” the OIG states in the report’s summary, “States may have none, some, or all of the data they need to conduct a complete verification. Most States do not plan to start collecting all of the necessary data because the effort would be resource intensive and not logistically practical for most States.” All of the states the OIG polled plan to audit providers for eligibility after the fact, the report continued.

It’s a rock-and-a-hard-place situation. While states do receive 90% funding from the federal government to set up Web-based registration systems for Medicaid EHR incentives, there’s still that last 10% they need to dig out from under the couch cushions, while oh by the way they also need to set up other HIT initiatives mandated by HITECH such as statewide health information exchanges. In an economy decimated by prolonged recession, many states are slashing existing infrastructure by necessity; building new systems — even those mandated by federal law — doesn’t come cheap. Or free.

The OIG paints a bleak picture, stating, “The data limitations identified in this report affect States’ ability to proactively ensure the integrity of their EHR incentive payments. Therefore, States should take these limitations into account when planning their program oversight.”

Of course, the authors have no answers or recommendations in the report, either. That’s just another piece of the Medicaid EHR incentive puzzle they’re leaving the states to solve. Imagine being a state HIT coordinator at this point in health IT history. With any luck, their respective state legislatures won’t be cutting the allocation for antacids until this situation resolves itself.

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