As Meaningful Use participation kicks off this year, eligible health care providers and facilities are scrambling to make sure they will qualify for the incentive payments being shelled out by the Medicare and Medicai EHR Incentive Programs ("EHR Incentive Programs") established by the American Recovery and Reinvestment Act as part of HITECH. Yet, key sets of providers and facilities are glaringly missing from the list of those eligible for the EHR Incentive Programs.
The need to incorporate substance abuse, behavioral and mental health treatment professionals and facilities into a cohesive network of treatment along with the rest of an individual's medical treatment has long been recognized nation-wide. However, these crucial health care providers and facilities are not currently eligible standing alone to receive incentive payments for incorporating meaningful use of EHR technology into their practices and facilities.
The Current Payment Structure
As currently provided for by HITECH and ONC's regulations, certain providers and facilities are eligible for incentive payments where they demonstrate "meaningful use" of certified EHR technology. The EHR Incentive Programs exclude:
- Clinical psychologists
- Psychiatric hospitals
- Clinical social workers
- Mental health and substance abuse treatment facilities
For example, a community behavioral health organization ("CBHOs") would not be eligible for incentive payments even though providing the same or additional services that a hospital (eligible for facility incentive payments) might provide. Likewise, while a psychiatrist, primary care physician or nurse practitioner affiliated with a CBHO could potentially receive incentive payments as "eligible professionals", the facility itself along with other health care providers, such as psychologists and clinical social workers providing services there, would not.
Although the availability of funding may have played a large part of this omission, the exclusion of substance abuse and behavioral and mental health from the EHR Incentive Programs runs contrary to the very ideology and goals of the Programs. By far, the populations served by these providers and facilities are in greatest need for the improved efficiency, quality, coordination and integration of health care that EHR technology facilitates.
The Need for Increased Eligiblity: The Behavioral Health Information Technology Act of 2011
Extending the EHR Incentive Programs to these key providers and facilities would provide much needed assistance in the adoption and implementation of EHR technology. It would help substance abuse, mental and behavioral health professionals access recent and up-to-date patient medical histories and would improve the accuracy of diagnoses, the quality of care received by patients and bridge gaps in the provision of mental and substance abuse treatment services. With access to EHR technology, physicians and substance abuse or mental and behavioral health professionals would be better able to coordinate adn integrate mental or behavioral health care into the rest of a patient's medical care, especially for patients admitted through hospital Emergency Departments who may be involved in care at multiple facilities.
Last week, legislation was introduced into the Senate with the aim of rectifying this oversight. The Behavioral Health Information Technology Act of 2011 ("BHITA" for short), S. 539, was sponsored by Senator Sheldon Whitehouse and seeks to expand eligibility for Meaningful Use participation to substance abuse and behavioral and mental health providers and facilities. Sen. Whitehouse stated,
"Mental health care is a critical component of a health care safety net and allowing these providers access to cost-saving, quality-enhancing advances in health information technology will improve the care that millions of Americans receive."
Previous efforts to amend HITECH have unfortunately already failed, as a similar bill, the Health Information Technology Extension for Behavioral Health Services Act, H.R. 5040, died in the House last year. However, the similar BHITA introduced this year into the Senate shows that the need to include these vital providers and facilities continues to be recognized by policymakers.
The BHITA would:
- Extend Medicare and Medicaid eligible professional incentive payments to clinical psychologists and social workers
- Extend Medicare incentive payment eligibility to community mental health centers, private and public psychiatric hospitals, residential/outpatient mental health and substance abuse treatment facilities
- Clarify eligibility for community health centers, psychiatric hospitals, substance abuse and behavioral and mental health professionals, residential/outpatient mental health/substance abuse treatment facilities as Health Information Technology Regional Extension Centers
If passed (and it has only made its way to the Senate Finance Committee so far), the BHITA would be one big step towards treatment of the individual as a whole through better integration and coordination of medical care with substance abuse and mental and behavioral health care. Yet even if passed, additional efforts will likely still be needed to achieve complete efficiency, integration and coordination of care for other populations.
An amendment or similar program for long term care facilities may also be necessary in the future, as individuals in need of long term care comprise yet another population desperately in need of efficient and coordinated systems. Although the Patient Protection and Affordable Care Act provides grants for long term care facilities, the grants are nothing like the aggressive EHR incentive payments and program created by HITECH. To achieve the goals sought after by the EHR Incentive Programs of efficiency, coordination and improved quality of care for patients, these facilities, along with the providers of substance abuse, mental health and behavioral health treatment and services, need to be folded into the EHR development and implementation process.