Daytona Beach, FL, Feb 18, 2011 – WorkSmart MD, Inc. announced today it will provide Free EMR software to its physician clients that utilize its real viagra online

ef=”http://www.worksmartmdbilling.com/medical-billing-company.html”>medical billing and practice management services.

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On February 17, 2009, President Obama signed the HITECH Act which includes provisions to promote the use of Electronic Medical Records and authorizes incentive payments for providers that demonstrate meaningful use. In 2015, providers are expected to adopt and successfully utilize EMR to avoid financial penalties by Medicare and Medicaid.

“The Government’s Stimulus program is a great way to help physician practices. The problem that we see over and over is that doctors don’t have the time or money to successfully use EMR. As part of our continuing commitment to our clients and helping them improve the financial performance of their practice we will be giving them free EMR in conjunction with our medical billing services” reports M. Jayson Meyer, CEO of WorkSmart MD, Inc.
The web-based software includes integrated billing and allows physicians to submit electronic prescriptions. Additional features include web-based scheduling, free lab integration, and a patient payment portal. WorkSmart MD reports an iPhone app that allows EMR access from anywhere.

“Our model is straight forward and simple. We supply physicians with state-of-the-art, certified, Electronic Medical Records, e-prescribing, all medical billing and clearinghouse services, practice management software and experts to help them maximize its’ potential- all for a cost that equates to sales tax. The net result is 10-15% more cash flow, faster reimbursement, and up to $44,000 in Medicare incentives for the practice.” reports David B. VanderVoort, VP Sales & Marketing.

WorkSmart MD, Inc. is a leading provider of medical billing and EMR services to physicians. Since 2001 WorkSmart MD has helped hundreds of physicians in over 20 specialties improve the financial performance of their practice. WorkSmart MD was founded by entrepreneur M. Jayson Meyer who has been featured on the Oprah Winfrey show, CBS 48 hours, and in the Wall Street Journal.

Contact:
David VanderVoort
Media Liaison
VP Sales & Marketing
WorkSmart MD, Inc.
1540 Cornerstone Blvd – Suite 230
Daytona Beach, FL 32117
877.672.6221 (Phone)
407.650.2555 (Fax)
www.worksmartmd.com
www.worksmartmdbilling.com

December 13, 2010

WorkSmart MD Announces Specialized A/R Recovery Service to Help Physicians Maximize Revenue

The average single physician practice has accounts receivable in excess of $200,000 and aging balance

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s that are approaching 12 months old. According to the Physician Coalition for Health Information Technology (PCHIT) the average physician office collects 84% of what they bill after contractual adjustments are calculated. These numbers indicate a huge gap in medical practice revenue.

“Doctors are working harder than ever in a time of shrinking reimbursements. For private practice physicians to survive they must increase their collection rates. They would rather be looking at NFL play off scenarios than worrying about their A/R. and medical billing” Comments Jason Frederick, VP Business Development for WorkSmart MD.

In June of 2010 sweeping legislation was pending that would have decreased reimbursements by as much as 20% for physicians. At the last minute Congress delayed this decrease and physicians received a temporary reprieve. The future of medical reimbursements remains unclear but what is known for certain is that the Medicare and Medicaid programs are over budget. With new baby boomers entering the Medicare program every year the program can not sustain itself.

“If reimbursements continue to shrink and doctors can’t increase their collection rates they won’t be able to stay in business. For most physicians collecting the first 75% of what they bill insurance companies is easy, it’s the remaining 25% that gets caught in a web of denials and insurance rejections. Our A/R Recovery services are designed to help doctors collect their oldest receivables. Once we have stabilized the practice we can help them implement medical billing procedures to ensure high collection rates.” Reports Jayson Meyer, CEO of WorkSmart MD.

WorkSmart MD, Inc. is a leading provider of medical billing services and EMR software for physicians. Since 2001 WorkSmart MD,Inc. has helped hundreds of physicians in over 20 specialties improve the financial performance of their practice. WorkSmart MD, Inc. was founded by entrepreneur M. Jayson Meyer who has been featured on the Oprah Winfrey show, CBS 48 hours, and in the Wall Street Journal. WorkSmart MD’s A/R recovery services are currently available for medical practices with 1-10 physicians, call 877.672.6221 for more details.

Contact:

David VanderVoort

Media Liason

VP Sales & Marketing

WorkSmart MD, Inc.

1540 Cornerstone Blvd – Suite 230

Daytona Beach, FL 32117

877.672.6221 (Phone)

407.650.2555 (Fax)

www.worksmartmd.com

www.worksmartmdbilling.com

lth Information Technology (CCHIT) and the Drummond Group, Inc. in certifying EMR technologyto meet the criteria set by U.S. Department of Health and Human Services.

InfoGard Laboratories, Inc. was founded in 1993 with a mission to provide accredited IT security assurance services to customers worldwide. Over the years InfoGard has expanded their security services by investing in multiple formal accreditation programs. According to InfoGard they value and maintain independence so they are able to remain objective and serve their customers free from any potential conflicts of interest. Through the formal security evaluation programs of which InfoGard is accredited, and the specialty IT services they offer, InfoGard has been privileged to serve over 200 customers in more than 25 countries

To qualify for the incentive payments offered by the Centers for Medicare & Medicaid Services (CMS) providers must not only adopt, but also demonstrate the meaningful use of, certified EHR systems. ONC authorized the first two ONC-ATCBs in late August, 2010. Additional applications are under review.Rich Text AreaToolbarBold (Ctrl + B)Italic (Ctrl + I)Strikethrough (Alt + Shift + D)Unordered list (Alt + Shift + U)Ordered list (Alt + Shift + O)Blockquote (Alt + Shift + Q)Align Left (Alt + Shift + L)Align Center (Alt + Shift + C)Align Right (Alt + Shift + R)Insert/edit link (Alt + Shift + A)Unlink (Alt + Shift + S)Insert More Tag (Alt + Shift + T)Toggle spellchecker (Alt + Shift + N)▼
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The Office of the National Coordinator for Health Information Technology (ONC) has named a third ONC-Authorized Testing and Certification Body. InfoGard Laboratories, Inc. out of San Luis Obispo, Calif. will join the Certification Commission for Health Information Technology (CCHIT) and the Drummond Group, Inc. in certifying EMR technologyto meet the criteria set by U.S. Department of Health and Human Services.
InfoGard Laboratories, Inc. was founded in 1993 with a mission to provide accredited IT security assurance services to customers worldwide. Over the years InfoGard has expanded their security services by investing in multiple formal accreditation programs. According to InfoGard they value and maintain independence so they are able to remain objective and serve their customers free from any potential conflicts of interest. Through the formal security evaluation programs of which InfoGard is accredited, and the specialty IT services they offer, InfoGard has been privileged to serve over 200 customers in more than 25 countries
To qualify for the incentive payments offered by the Centers for Medicare & Medicaid Services (CMS) providers must not only adopt, but also demonstrate the meaningful use of, certified EHR systems. ONC authorized the first two ONC-ATCBs in late August, 2010. Additional applications are under review.
Path:

re providers. The HITECH Act got everything started for new technology such as the implementation of EMR systems. But the government can’t keep it up by themselves. Help from the private sector will help push this along tremendously.

In article by the ONC it states “at a recent meeting on Advancing EHR Adoption and Meaningful Use sponsored by Health Affairs and Brandeis University’s Health Industry Forum at the National Press Club, payers, providers, and certification and licensing boards came together to announce early plans for supporting rapid adoption and meaningful use of electronic health records.”

• Payers (Aetna, Highmark Blue Cross and Blue Shield, United Health Group, and Wellpoint) announced plans for incentive programs that will work in parallel with the CMS program and utilize the meaningful use objectives.
• Leading provider groups (the Christiana Care Health System, Partners HealthCare, and ThedaCare) announced training and requirements for clinicians.
• And, perhaps most significantly, certification and licensure bodies (the Federation of State Medical Boards and the American Board of Medical Specialties) announced steps for assisting and encouraging physicians in the adoption and meaningful use of electronic health records, with the ultimate goal that their use will become an element of professional certification.

With these incentive plans, we will see the private sector jumping onboard with new health care technology and hopefully see a push toward better healthcare for both government and private sectors. Dr. David Blumenthal, National Coordinator for Health Information Technology, brings this all together saying “with the meaningful use goals as their framework, these representatives of the private sector are formulating a strategy for the transformation of health care in our country through the use of health IT. These are indeed significant and encouraging first steps, occurring a mere three weeks after announcement of the final phase 1 meaningful use rules. We applaud their efforts and we look forward to more payers, providers, and others in both the public and private sectors joining the team to move together towards our common goal.”

There

are many reasons to choose an EHR, the number one reason being the change in reimbursement. Not to mention how complicated the documentation process has become to receive reimbursement from the government and commercial payers.

There are also many other factors driving the EHR market, another example would be the new ICD-10 codes, scheduled to go into effect October 1, 2013. These new codes are going to require all physicians to upgrade their current practice management systems and or require the practicing physician to adopt a certified EHR solution.

To learn more about the future of the EMR market follow this link:

http://www.informationweek.com/news/healthcare/EMR/showArticle.jhtml;jsessionid=DIOS215CQFFWLQE1GHPSKH4ATMY32JVN?articleID=227200057&pgno=1&queryText=&isPrev=

If deciding to go for the Medicare EHR incentive program, e-prescribing is a small part of the core set in showing meaningful use to get the $44,000 in incentive money. More than forty percent of all permissible prescriptions written by the physician have to be transmitted electronically using certified EHR technology. E-prescribing is just a small involvement in reaching meaningful use in an EHR system but a very important measure.

So, which incentive program is better to use? This question is ultimately up to each practice and where they feel they are in implementing either program. Both incentive programs are great to help move forward our healthcare system today.

Morehouse School of Medicine (MSM) was awarded a $19.5 million grant to aid providers with the adoption, implementation, and meaningful use of Electronic Health Record systems. The funding is also intended to help build Georgia’s Health Information Technology workforce.

The U.S. Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 established a health information technology (HIT) extension program, which consists of regional extension centers and a national health information technology research center (HITRC).  The HITECH program named MSM as one of approximately 70 regional extension centers across the U.S.  These centers will provide support for over 100,000 priority primary care providers with an emphasis on implementing electronic health records systems and training health information technology workers in underserved areas.

Under the grant, the National Center for Primary Care (NCPC) of MSM will oversee the Georgia HIT Extension Center (GA-HITREC), which will consist of 18 “adoption centers” that will overlay the 18 public health districts that exist in Georgia.  Managing the project at MSM is Dominic H. Mack, M.D., M.B.A., deputy director at NCPC.  Mack says GA-HITREC will support health care providers to become meaningful users of EHR by providing technical assistance and implementing “best practices.”

Mack explains that GA-HITREC is assembling outreach/education and technical teams to attain the program’s objectives, including expanding the HIT workforce in Georgia. This will be accomplished in collaboration with the Georgia Department of Community Health (DCH) and the statewide health information exchange that’s being created using a community-oriented approach.

A part of MSM’s role is to help providers select an EHR system, then help with the installation and implementation.  “Not only will we ensure that the EHR system has the functionality the providers needs, but that it is being used in a meaningful way by providing training and other support.”

Mack said once they become meaningful users, they become eligible for payments from Medicare and Medicaid which helps pay for EHR hardware and software.  “The federal initiatives actually help providers in two ways: the extension center program funds the technical support needed for the selection and implementation of EHR and the CMS payment incentives puts the money in the provider’s hands to purchase the software and hardware.  Mack said MSM was selected as the sole recipient in Georgia because of its reputation for successful outreach programs for the underserved.  “I believe we were selected because of our established partnerships throughout the state, plus our tradition of serving the under-served population and helping those in need.  I believe that shined through and led to our selection,” he said.  This will help lower, and hopefully eliminate, the disparate gap for technology, health care, and health of the community.”

Mack says one goal, is to develop a national reputation. “Our intent is to provide a high level of quality services to our customers in order to build a national reputation as a reliable HIT resource for providers.  In four to five years I expect we will have a robust Web center and call center, and when physicians need services for HIT, they turn to us.”

Website launched to provide detailed information about EHR incentive programs

June 28, 2010

The Centers for Medicare and Medicare Services (CMS) has launched it’s official website for the Medicare and Medicaid EHR Incentive Programs. This official web site provides up-to-date, detailed information about the Electronic Health Record (EHR) incentive programs

The Medicare and Medicaid EHR incentive programs will provide incentive payments to eligible professionals and eligible hospitals as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology. The programs begin in 2011. These incentive programs are designed to support providers in this period of Health IT transition and instill the use of EHRs in meaningful ways to help our nation to improve the quality, safety and efficiency of patient health care.

Visit the EHR Incentive Programs Website to learn more.

y the Certification Commission for Health Information Technology (CCHIT®) and is a pre-market CCHIT Certified® 2011 Ambulatory EHR additionally certified for Child Health EHR technology. Aprima 2011 also achieved a usability score of 5 out of 5. The Aprima 2011 product’s CCHIT certification is pre-market, pending live use of the application in two practices for 45 days.

Aprima 2011 also preliminarily meets 24 of 24 requirements for Eligible Providers published by the U.S. Department of Health and Human Services (HHS) in the Interim Final Rule. Inspection information is available at http://www.cchit.org/products/ifrstage1/arraeligibleprovider/2123. For the purpose of qualifying products for ARRA incentives, CCHIT anticipates, but has not yet received, accreditation by HHS.

“It is no longer a promise, it is a fact,” said Neil Simon, Aprima Medical Software’s Chief Operating Officer. “We told our customers and prospects that we would deliver a CCHIT Certified 2011 Ambulatory EHR product and we have delivered on that promise. Promise made, promise kept!

In recognition of the broad need for EHRs in the pediatric and family care practice segments of the market, the company submitted Aprima 2011 for the additional certification by CCHIT for Child Health EHR technology.

“While our clients represent more than 40 specialties nationwide, the pediatric and family care practices tend to be smaller and have historically felt priced out of the EHR market,” stated Michael Nissenbaum, Aprima Medical Software’s President and CEO. “We made the additional modifications for these providers, thus earning the Certification Commission’s additionally certified for Child Health EHR technology label. Our customers have embraced our template-free, content-rich application, and now influential bodies like the Regional Extension Centers (RECs) can look to Aprima 2011 as the electronic health record solution of choice that is certified to address the needs of their communities from infant to aged.”

“The next step for Aprima 2011 development is to complete work on additional features and functions beyond the Meaningful Use requirements,” explained Simon. “These enhancements will enable Aprima 2011 to leapfrog the market.” Aprima will demonstrate these features, along with all the Meaningful Use functionality, at its 2010 Aprima National User Conference in Dallas, August 6 – 8.

“These certifications are the continuation of our commitment to our clientele to consistently meet all national standards,” said Nissenbaum. “We have met all available years of the Certification Commission’s certifying criteria (2006, 2007, 2008, and now 2011). Our prospects and clients can be assured that this will continue in the future.”

The CCHIT Certified® 2011 certification program, opening on April 7, 2010, is one of two distinct, but complementary, programs of certification offered by CCHIT, the second is the Preliminary ARRA IFR Stage 1. Health IT companies may be certified in one or both programs.

In the CCHIT Certified 2011 program, products are rigorously inspected against integrated EHR functionality, interoperability, and security criteria independently developed by the Commission’s broadly representative, expert work groups, using the Commission’s published testing methods. This program is intended to serve health care providers looking for maximal assurance that a product will meet their complex needs.

The Preliminary ARRA IFR Stage 1 program tests complete EHRs or EHR modules against criteria and standards published by the US Department of Health and Human Services (HHS) in the Interim Final Rule (IFR) on “Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology” on January 13, 2010, and effective on February 12, 2010.

This program, based on the federal standards for certified EHR technology to support the Stage 1 incentives under the American Recovery and Reinvestment Act of 2009 (ARRA), is designed to demonstrate that a vendor’s product is extremely well prepared to be certified once the Office of the National Coordinator (ONC) accredited testing and certification becomes available. When that occurs, CCHIT will replace the Preliminary ARRA program with a final, ONC-accredited ARRA certification program. Aprima 2011 will apply for that certification once the accredited certifying organization’s procedures are in place. CCHIT does not offer a guarantee that it will be accredited.

All testing for Preliminary ARRA IFR Stage 1 or final ARRA Stage 1 is conducted separately from the CCHIT Certified testing.

For over a year the question of EHR Certification has been a mystery. Many physicians have been on “hold” as they await to find out what it means to be a certified EHR software system.

The que

stion of Certification of Electronic Health Records (EHRs) has caused confusion among many physicians, clinics and hospitals. Under the American Recovery and Reinvestment Act of 2009 (ARRA), a new approach to certification has been implemented by the ONC.

Is CCHIT a thing of the past?

The traditional way that EHRs became certified was through CCHIT, which was the sole designated certifying source up until now. CCHIT created its own criteria for designating what functionality an EHR should have in order to be functional and robust.

The Office of the National Coordinator for Health IT (ONC) took a fresh look. The ONC developed Meaningful Use criteria, which defines what a physician must do in order to qualify for HITECH Act Stimulus funds. Driven by these Meaningful Use criteria, new HHS Certification criteria have been proposed. 2 weeks ago ONC announced their “Temporary Certification” program which allows vendors with appropriate experience to apply as intermediaries to test modular functionality of EHR systems. This temporary certification is the key to HITECH Act Stimulus funds. The ONC reports that as of June 20th 2010 NO VENDORS are certified.

Given this new environment, CCHIT has responded by offering “preliminary” HHS certification, as a separate channel from its legacy certification. Even though CCHIT certification is not sufficient to access ARRA Meaningful Use money (only HHS Certification is), CCHIT has continued to make a case for its legacy program. To quote the CCHIT web site, “The Preliminary ARRA IFR Stage 1 program is simpler and more flexible, although it does not provide as much buyer assurance as the CCHIT Certified 2011 program.” This position certainly adds to a muddying of the waters, and confuses physicians and hospitals when it comes to adopting EHRs – the result is that potential EHR adopters may hold back and let matters become clearer.

To help shed light on the differences between what CCHIT claims is “important” in its legacy certification program and the new HHS Certification criteria, a side-by-side comparison is a useful exercise.

The CCHIT Certified 2011 Ambulatory EHR Criteria contains 286 items, grouped into a variety of categories. Compared to the HHS criteria, the CCHIT criteria are much more granular, and focus in much more detail exactly how records should be organized in an EHR. Many of these items are good ideas, and are not specifically tested by the HHS criteria.

Many entire domains of CCHIT criteria are specific to locally-installed client server systems and the networks they must run upon – numerous documentation items, data backup items, installation and technical support for local deployment and product upgrades, and security specifications for nodes in a network. The assumption is that the EHR “universe” is a local network, which must be isolated from the “outside world” for the purpose of security. None of these specifications are relevant to web-based EHRs, which do not use local networks, which build security and privacy into their products in order to function properly on the Internet, and which do not need “local installation and support,” data backup, or upgrade worries. Of course, assurance of business continuity, data safety and security, and customer support are all important for web-based EHRs (just like they are for everyone) – but the CCHIT specifications do not address the needs of EHRs that are natively web-based.

Are there elements of the simpler HHS Certification that are not included in CCHIT’s exhaustive criteria-set? Yes – this is important to recognize.

The areas of HHS Certification that are not addressed by CCHIT certification are mainly around interoperability: (1) reporting PRQI measures electronically, (2) submission to and retrieval from Immunization Registries, (2) public health surveillance e-reporting, and (4) Computerized Physician Order Entry (CPOE) capture.

The vision of the ONC is to build an interoperable national health IT infrastructure, and much of the emphasis there is around interoperability (as opposed to the traditional all-encompassing enterprise legacy approach that has driven CCHIT). Taking CPOE as an example, the Stage 1 HHS Certification is simply to capture physician orders – in an ambulatory setting, there are 4 such orders to be captured: (1) medications/prescriptions, (2) laboratory test orders, (3) imaging/x-ray ordering, and (4) referrals to outside providers. Stage 2 HHS Certification asks that these CPOE items actually connect with outside systems, and Stage 3 HHS Certification is expected to demonstrate outcomes (bending the curve). None of this is addressed by CCHIT certification.

A good way to look at all of this is as follows: CCHIT has had a legacy certification approach, which mainly looks at the details of how an EHR is put together, and how it functions in a closed, local network environment. The relevance of this going-forward is questionable – both HHS Certification, as well as the emergence of web-based EHR technologies, outstrip the vision of the traditional CCHIT approach.

HHS Certification, admittedly simpler (30 criteria vs. 286), is what counts when it comes to ARRA Meaningful Use incentive payments. It also includes kinds of functions that had not been addressed previously – mainly, interoperability with other outside systems.

Hospitals, physician groups, and organizations functioning as Regional Extension Centers should recognize this – it is HHS Certification (not CCHIT certification) that drives what should be included in an EHR system. The vision of the ONC to create an affordable, interoperable, and ubiquitous national health IT infrastructure is based on HHS Certification, and this is the approach that should be supported.

West Virginia has received $6 million in federal stimulus funds to establish a regional health information technology extension center.

The center has been designated as the statewide organization

to provide education, training and support services to help the state’s primary-care providers implement and meaningfully use health information technology for the purpose of improving patient outcomes.

“It should be active this summer,” said an aide to West Virginia Gov. Joe Manchin, who along with other local and state officials announced on June 8 the effort to help primary-care doctors adopt electronic health.

The American Recovery and Reinvestment Act of 2009, also known as the stimulus law, mandates that providers meaningfully use an electronic health-record system to qualify for up to an estimated $27.3 billion in federal reimbursements.

To help physicians become eligible for these incentive payments, the center will, among other initiatives, provide assistance in the selection and purchasing of electronic health-record systems, project management and implementation services, and guidance on privacy and security matters.

“West Virginia remains a national leader in the adoption of health information technology, and this statewide health information-technology extension center will be another key component of our ongoing efforts to use technology to improve the health of our citizens,” Manchin said in a written statement. “This project is the latest example of how West Virginia is working to modernize its healthcare delivery system in order to improve overall healthcare, enhance efficiencies and facilitate greater information-sharing between physicians and patients,” he said.

hysicians in the state qualify for healthcare IT stimulus funds. EHR vendors chosen by ZaneNet include Medical Informatics Engineering (MIE) and Sevocity, and the PHR vendor is NoMoreClipboard.com. ZaneNet has selected Resource Partners, LLC to provide practice management services.
“We have successfully deployed Sevocity, NoMoreClipboard and MIE applications with area practices, hospitals and other care providers,” says ZaneNet Director of Technology Luigi LeBlanc. “Each of these organizations has proven strength in interoperability and they have successfully collaborated with us and our healthcare clients. We are confident that Maryland physicians can achieve meaningful use efficiently and without breaking the bank by working with the ZaneNet Connect platform and the vendors we have selected.”
The Chesapeake Regional Information System for our Patients (CRISP) was awarded $5.5 million by the Office of the National Coordinator to become Maryland’s Regional Extension Center. CRISP is entering into contracts with MSOs to provide direct assistance to 1600 Maryland physicians. Each MSO will help physicians select and purchase an EHR and achieve meaningful use in order to receive reimbursements of $44,000 or more.

“We have selected Software as a Service or SaaS EHR solutions that will help Maryland practices demonstrate meaningful use without having to make significant up-front investments in expensive client-server systems,” added LeBlanc. “Sevocity and MIE focus on affordable, web-based EHR applications that integrate into our ZaneNet Connect platform, and NoMoreClipboard will help physicians satisfy patient and family engagement meaningful use requirements.”
ZaneNet personnel will collaborate with Resource Partners to help client practices qualify for incentive payments, improve revenue cycle management and enhance capacity to provide multi-disciplinary coordinated care. Service packages include Clinical and Technical Practice Assessment, EHR Implementation and Training, Medical Billing, Credentialing, Revenue Cycle and Document Management, Chronic Disease and Medical Home management services.
ZaneNet Connect provides a unified platform for providing secure access to a wide range of mission critical applications and connectivity to the statewide HIE. In addition to negotiating reasonable, subscription-based pricing for EHR and PHR applications, ZaneNet will manage the privacy and confidentiality aspects of selected systems, and offers back office, revenue cycle, and technical implementation support for practice network, wireless, workstation, LAN and WAN configuration needs.

on+Systems%2C+Inc.&index=1&md5=ff7a21bdc029b5f79c1da38c6d93c1b2″ target=”_blank”>NextGen Healthcare Information Systems, Inc., a wholly owned subsidiary of Quality Systems, Inc. (NASDAQ: QSII), and leading provider of healthcare information systems and connectivity solutions, today announced it has been named a preferred vendor of electronic health records by New York eHealth Collaborative (NYeC) and a selected vendor for NYC Regional Electronic Adoption Center for Health (NYC REACH), the federally designated Regional Extension Centers for New York State and New York City, respectively.

“NextGen Healthcare has proven success stories working with clients to execute quality-focused initiatives and is committed to enabling the same success in providers working toward Meaningful Use”

NextGen Healthcare’s Ambulatory EHR version 5.6 will be part of a select group of products recommended by NYeC and NYC REACH to physician practices, community health centers and critical access hospitals as they work to demonstrate Meaningful Use and secure incentive payments under the American Recovery and Reinvestment Act. The regional extension centers will offer support services to these providers, guiding them through achievement of Meaningful Use with selected EHRs, including NextGen®. In addition, NYeC has negotiated discounted prices for selected health IT products and services and will provide subsidized EHR adoption assistance.

“NextGen Healthcare has proven success stories working with clients to execute quality-focused initiatives and is committed to enabling the same success in providers working toward Meaningful Use,” said Scott Irwin, Director of Regional Extension Center Support at NextGen Healthcare. “We are thrilled to partner with the New York RECs in this effort and look forward to sharing our educational, outreach and technical resources with additional RECs across the country as they help providers become meaningful users.”

NextGen Healthcare serves more than 50,000 physician users today. Through the NextGen Path to Meaningful Use, the company details how these clients and their RECs can use NextGen® Ambulatory EHR to help meet the ePrescribing, interoperability, and quality reporting measures of Meaningful Use. The company also offers a Grants Resources Center to help clients identify and apply for grant opportunities made possible by health reform, and employs a team of experienced, qualified physicians to consult on implementation and optimal use of EHRs. Exclusive NextGen solution certification is available to help HIT consultants and RECs learn how to best lead providers to become “meaningful users” using NextGen® products and services.

For more information about NextGen Healthcare’s support for the mission of Regional Extension Centers, visit http://www.nextgen.com/Stimulus/rec/rec.aspx or read an open letter to RECs from NextGen Healthcare president Scott Decker.

About NextGen Healthcare

NextGen Healthcare Information Systems, Inc., a wholly owned subsidiary of Quality Systems, Inc. (NASDAQ: QSII), provides integrated clinical, financial and connectivity solutions for ambulatory, inpatient and dental provider organizations. For more information please visit www.nextgen.com and www.qsii.com. Follow NextGen Healthcare on Twitter at www.twitter.com/nextgen or Facebook at http://www.facebook.com/NextGenHealthcare.

About New York eHealth Collaborative

The New York eHealth Collaborative (NYeC) is the federally designated Regional Extension Center for all areas of New York State except New York City. Founded by health care leaders across the state, with leadership and support from the New York State Department of Health, NYeC is a public-private partnership that serves as a focal point for health care stakeholders to build consensus on state health IT policy priorities, and collaborate on state and regional health IT implementation efforts. More information about the NYeC Regional Extension Center at is available at www.nyecred.org, for information on NYeC visit www.nyehealth.org.

About NYC REACH

The NYC Regional Electronic Adoption Center for Health (NYC REACH) is the federally designated regional extension center serving physicians in New York City. It was launched by the NYC Health Department’s Primary Care Information Project (PCIP), in partnership with the Fund for Public Health in New York (FPHNY). REACH will encourage health IT adoption in physician offices and community health centers to coordinate care and improve health outcomes, specifically through the use of prevention oriented electronic health records (EHRs). More information can be found at www.nycreach.org.

erform a set of well-defined functions. To this end, standards, implementation specifications, and certification criteria for health IT are being established by the Office of the National Coordinator (ONC.)

Like CMS, ONC has also engaged public comment through formal rule making to inform these standards and criteria.  In January 2010, ONC published an interim final rule on the standards and certification criteria.  They have also published a proposed rule on the processes the National Coordinator would take to authorize organizations to perform the certification of health information technology. ONC accepted public comments and are currently working on finalizing both rules for release in late spring/early summer 2010.

How Certification is related to the EHR Incentive Programs
The EHR Incentive Programs require the use of certified EHR technology, as established by these new set of standards.  Existing EHR technology needs to be certified to meet these new criteria in order to qualify for the incentive payments.

NOTE: Currently, there are no certified EHR products that meet the certification requirements for this program in order to receive an incentive.

Timing of Certified EHR Technology for the EHR Incentive Program

Once released, certification bodies will be established to test and certify EHR technology for the EHR incentive programs. In addition, vendors will definitively know the standards and criteria for certified EHR technology, and they can make adjustments to their products to include the required specifications if their products do not already include them. Upon the “opening” of the certifying bodies, vendors can submit their EHR products to be tested and certified. Hospitals and practices who have developed their own EHR systems can also seek to have their existing systems tested and certified. Complete EHRs may be certified as well as EHR modules that meet at least one of the certification criterions.  Once a product is certified, it will be published on the ONC web site. This is expected to start in fall 2010.

REMEMBER: You do not have to have your certified EHR in place by the launch of the program in order to participate.

Resources to Help in Adoption and Use of EHRs

ONC has provided grants to local entities, called Regional Extension Centers, to provide technical assistance for small-sized physician practices public and critical access hospitals, community health centers, and other settings that predominantly serve uninsured, underinsured, and medically under-served populations in both adopting certified EHR technology and meeting the upcoming definition of meaningful use to qualify for the incentive payments. Information to find a local Regional Extension Center can be found in the Links Outside CMS section below. Other programs to help providers include the State Health Information Exchange Cooperative Agreement program, the Beacon Community Program , and the National Health Information Technology Research Center, where communities of practice are being established to help providers share information, best practices and resources. Information can be found in the related Links Outside CMS section below.

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amily: geneva,arial,helvetica; font-size: x-small;”>By Marianne Kolbasuk McGee, InformationWeek

Dr. David Blumenthal,
national coordinator for health IT

The U.S. Dept. of Health and Human Services this month is finalizing the much-anticipated requirements for what constitutes the “meaningful use” of electronic health records. Those requirements will let healthcare providers know what they must do to qualify for the more than $20 billion in incentive funds set aside as part of the Health Information Technology for Economic and Clinical Health (HITECH) Act. It’s expected that many healthcare providers who haven’t deployed EHRs yet, will do so after the meaningful use requirements are released.

InformationWeek editor at large Marianne Kolbasuk McGee recently spoke to the nation’s health IT coordinator, Dr. David Blumenthal, about what’s at stake as healthcare providers, especially smaller ones, start deploying and using EHRs.

InformationWeek: Why is it important to hospitals for doctor practices to get on board with health IT and meaningful use?

Blumenthal: In future stages of meaningful use our goal is to make sure that information follows patients. Organizations that participate in the care of patients must support the gathering of information in ways that meet the full needs of patients regardless of where they get their care. So if you’re a hospital in a city and a patient gets specialty care in a network of physicians or at a hospital other than yours, I expect the criteria for meaningful use to take into account the ability of hospitals to move information to those other specialty providers whether or not they’re affiliated.

InformationWeek: Will rewards or penalties be tied to the ability to exchange medical information?

Blumenthal: From a policy standpoint, an aspirational standpoint, the Department of Health and Human Services—and I think the Congress—is very clear on where we want to go, and that’s to have information follow patients. That’s to have information that’s generated in any part of the health system to be available to every other part of the health system that takes care of that single patient. We don’t want information to be stopped at the border of a health system, a commercial boundary, or a geographic or political boundary. Ultimately we don’t even want it to stop at national boundaries. We want this to be about patients, not about the technical or business concerns of providers.

InformationWeek: What are the biggest risks to doctors who don’t get on board besides the financial penalties that will eventually kick in?

Blumenthal: First of all, any doctor who wants to sell his or her practice or who wants to recruit a partner to give new life to the practice or to expand it will have a lot of trouble recruiting a young physician—someone under the age of 45—if they don’t have an electronic health record or don’t plan to acquire one. This new generation of physicians isn’t going to tolerate a paper world.

InformationWeek: So the excuse that you’re a doctor who’ll be retiring in a few years isn’t a valid reason not to implement EHRs?

Blumenthal: If you’re a 50- to 60-year-old physician, you’re in the prime of your professional career and your patient panel is expanding. You probably want to bring on a new partner—maybe two or three—so you’ll be recruiting. There’s a physician shortage, so what’s going to make your practice competitive?

InformationWeek: Will the move to health IT and meaningful use lead to consolidation of the healthcare marketplace?

Blumenthal: That’s one possibility. And there has been a tendency among physicians to go into employed situations over the last decade. But I want to make it clear that it’s not our purpose or goal to undermine solo or small group practices. The acquisition of electronic health records can make those practices more sustainable over time and enable them to maintain their independence if they wish. It may be a little harder for them to get over the hump of acquisition than if they were part of a group or large organization, but they can share data with a larger organization through an electronic health record and maintain their independence using electronic means better than they could in the paper world.

InformationWeek: The HITECH act was signed into law about a year before the nation’s healthcare reform legislation finally passed. Anything you now think is missing from the HITECH legislation that needs to be addressed?

Blumenthal: We will certainly learn in which ways electronic health information systems can better support health reform over time, but I think now we have a huge, very innovative mandate. If we can just do what the Congress asked us to do under HITECH, we’ll have gone a long way toward making health reform more successful. I’m just hoping we can fulfill the expectations of Congress and the administration within the current HITECH authorities rather than looking forward to new pastures to graze in.

InformationWeek: In terms of mass adoption of health IT, how will it help the so-called Accountable Care Organizations? (ACOs are organizations where a doctors and hospitals manage all of a patient’s care and share in the savings from providing better care.)

Blumenthal: The Accountable Care Organizations are organizations intended to hold themselves accountable to performance standards and can perform at a higher level. How do you hold yourself accountable? Through measuring what you do, looking at what you do, understanding what you do. How are you going to measure what you do without timely, accurate, comprehensive information? Where are you going to get that information in a paper world? Paper chart reviews are just not adequate. They’re not accurate enough. They’re not robust enough. They’re not timely enough, and they’re too expensive. So I think the ACO mission and agenda almost presumes the availability of electronic health information.

InformationWeek: So, if you’re not using EHRS and other high-tech tools, you really can’t be part of an ACO?

Blumenthal: It’s possible to do with extraordinary effort. There are some organizations in the paper world that perform better than others. And with great effort and considerable cost, it’s possible to document that. But the documentation has never been complete. It almost always has relied on claims data and was never adequate to really maximize the potential of those organizations and give healthcare providers with real-time feedback on their performance—the moment-by-moment kind of feedback you can get with an electronic health environment.

InformationWeek: Patients and consumers get uneasy sometimes when you talk about digitizing their health information. They worry about privacy and security. Are there plans to address this?

Blumenthal: The HITECH act enacted a whole series of provisions to tighten the privacy and security laws under HIPAA. And the Office of Civil Rights has already issued an interim final rule on breach notification that requires the notification of patients or other individuals whose data is breached. There’s also a series of much harsher penalties for breaches due to negligence. There are a series of restrictions on the use of patient information for the marketing of products, for fundraising, or for other uses they haven’t given permission for. These will begin to give the public some insight into what we’re doing.

Beyond that we’ve begun working with the administration’s cybersecurity czar to make healthcare a model program to tighten security of information in general. We’re looking top to bottom at the security standards and technologies available to providers to protect health information.

InformationWeek: Some large medical organizations say a big concern about the proposed meaningful use rules is the “all-or-nothing” approach to rewards, which could hurt healthcare providers who attempt to meet all two-dozen or so requirements but come short on the last few. What do you think about a more scaling type of reward system?

Blumenthal: We’ve heard that concern and are looking closely at it. There were quite a number of concerns, not only about the number of requirements, but also about the threshold levels. So I suspect if some of the thresholds weren’t as demanding, then maybe the concern about number of requirements might not have been so great. There are a lot of things to balance, and we’re working on them.

InformationWeek: As you’ve traveled around the country and talked to healthcare providers, what are the top hurdles they’re most worried about in deploying these systems?

Blumenthal: The concerns are the cost of acquiring the records, the technical challenge of putting them into place, and possible lost of productivity at first. They also raise questions about whether these systems will be compatible with their practice, their style, and their ability to do their work. That’s mostly what’s on people’s minds.

InformationWeek: Now that the grants have been awarded for these programs, how will Beacon Communities and Regional Extension Centers help providers?

Blumenthal: Beacon Communities and Regional Extension Centers haven’t been on the ground long enough to become household words in most communities. So many physicians aren’t widely aware of the services they’re providing. I hope that will change quickly. Some Regional Extension Centers are functioning, and some are still getting organized.

InformationWeek: In terms of getting the word out to providers about any of these efforts, is there anything you’d like to add?

Blumenthal: We’re optimistic, we’re moving forward, and we’re deploying a whole series of new programs. We still have 16 months before providers have to demonstrate meaningful use. Under the notice of proposed rulemaking, it’s not until Oct. 2011 when folks have to start documenting their meaningful use. We still have substantial time to provide assistance to people who want to get started.

d certify electronic health record (EHR) technology.

Use of certified EHR technology is a core requirement for eligible health care providers to qualify for payments under the Medicare and Medicaid EHR incentive programs administered by the Centers for Medicare & Medicaid Services.

For more information on the temporary certification program, visit: http://healthit.hhs.gov/certification.

The Health Information Technology for Economic and Clinical Health (HITECH) Act provides HHS with the authority to establish programs to improve health care quality, safety, and efficiency through the promotion of health information technology (HIT), including electronic health records (EHRs) and private and secure electronic health information exchange.

The HITECH legislation directs the Office of the National Coordinator for Health Information Technology (ONC) to support and promote meaningful use of certified electronic health record (EHR) technology nationwide through the adoption of standards, implementation specifications, and certification criteria as well as the establishment of certification programs for HIT, such as EHR  technology..

About the Temporary Certification Program and ONC-ATCBs
To provide assurance to eligible professionals, eligible hospitals and critical access hospitals (CAHs) that the EHR technology they adopt will assist their achievement of meaningful use, the Department of Health and Human Services (HHS) issued a final rule to establish a temporary certification program for EHR technology on June 18, 2010. The rule outlines how organizations can become ONC-Authorized Testing and Certification Bodies (ONC-ATCBs). Authorized by the National Coordinator, ONC-ATCB are required to test and certify that certain types of her technology (Complete EHRs and EHR Modules) are compliant with the standards, implementation specifications, and certification criteria adopted by the HHS Secretary and meet the definition of “certified EHR technology”.

About the Standards, Implementation Specifications, and Certification Criteria
On January 13, 2010, the Secretary published in the Federal Register an interim final rule that adopted standards, implementation specifications, and certification criteria for HIT. A final rule, which will realign with the Medicare and Medicaid EHR Incentive Programs final rule, is expected to be released in the near future.

What Certification Means for Health Care Providers
EHR technology, certified by an ONC-ATCB must be used in order to qualify for incentive payments. The temporary certification program provides assurance that the EHR technology health care providers adopt is technically capable of supporting their efforts to achieve meaningful use.

What Certification Means for Developers of EHR Technology
The temporary certification program provides a way for developers of EHR technology to have their HIT tested and certified so that it can be subsequently adopted by eligible professionals, eligible hospitals and CAHs who seek to achieve meaningful use.

Management School Wins Grant to Find Best Ways to Digitize Patient Data

Last year’s economic stimulus package paved the way for the creation of an electronic medical records (EMR) database. Now, the UT Dallas School of Management is going to play a significant role in helping doctors capture and store that information.

The federal government awarded an $8.48 million grant for the creation of a Regional Extension Center (REC) by a partnership formed between UT Dallas and The University of Texas Southwestern Medical School and the Dallas-Fort Worth Hospital Council and Research Foundation. The North Texas REC, which includes 43 counties in and around the Dallas-Fort Worth area, will offer technical assistance and guidance to healthcare providers and accelerate their efforts to implement EMRs.

“EMRs involve the electronic storage of all medical records at a particular site,” explained John F. McCracken, clinical professor of healthcare management at the School of Management and founding director of its Alliance for Medical Management. “It includes all the notes, everything a doctor creates for a patient.”

For that information to be shared between doctors, health information exchange sites must be created. Those sites will allow patient information to be stored in a single place. Advocates of EMRs say sites save time and money by preventing duplication of tests, enhance safety by preventing prescription of medicines that might interact with current medications, and provide instant access to a patient’s important information.

“It only becomes an EMR when you are able to share [that information] between sites,” McCracken said. “Hopefully, within five or 10 years, all Texas doctors will be on a health information exchange.”

The Bigger Picture

The U.S. now has 60 RECs, and the North Texas REC is one of four in the state. McCracken said

the four Texas RECs will work closely together to “present as much of a unified face as possible to both vendors and the medical community.”

“Essentially, we are creating a common source for physicians in Texas to use,” he said. “This is a learning process, because this hasn’t been done before. But the government wants to see significant progress in the first two years. They want us to show that we have accessed 25 percent of the primary care physicians in our region by that time.”

The initial step is to reach out to physicians, McCracken said.

“Our target is to get 15,030 doctors to meaningful use in two years,” Mike Alverson, executive director of the North Texas REC, said. “It’s a very short time frame.”

“We want to become a trusted adviser to physicians,” McCracken said. “Secondly, we’re going to find and develop the technological talent to pull this off. We have to have the personnel in place that can make it happen.”

Finally, he said, the North Texas REC will help doctors learn to reinvent the workflow as they migrate from a paper-based system to an electronic one. Acknowledging that the transition will not happen overnight, McCracken said that UT Dallas has the expertise to further help physicians make the change.

“The School of Management has a well-established program for physicians,” McCracken said. “Training and development is what we do. We offer an M.S. in Healthcare Management, and our faculty knows about healthcare.”

Getting Up to Standards

The government has outlined specific guidelines for doctors to achieve what it considers “meaningful use” of EMRs, McCracken said. The portion of the 2009 stimulus package known as the Health Information Technology for Economic and Clinical Health (HITECH) Act allows non-hospital-based physicians who accept Medicare patients and who achieve “meaningful use” of a certified EMR technology to earn up to $44,000 in incentives from 2011 to 2016. Those with at least 30 percent Medicaid patients could receive up to $63,750 over six years, beginning in 2011.

Alverson said he believes that interest from the medical community will help drive the mission forward. “I feel there’s a real momentum that’s building,” he said, “and I expect in the next 24 to 36 months, there’s going to be an absolute tsunami of interest in this.”

For nearly four years, the Certification Commission for Health Information Technology (CCHIT) has been the lone entity recognized by the federal government to certify electronic health record systems. Since being named a recognized certifying body by Health and Human Services (HHS) in 2006, CCHIT has awarded certifications to nearly 200 EHR software products based on CCHIT’s standards of functionality, interoperability, usability and security.

However, CCHIT’s role in the EHR market is changing. The Office of the National Coordinator of Health IT (ONC) and the Center for Medicare & Medicaid Services (CMS) announced in early March 2010 that they would name more than one organization to certify EHR software, countering previous claims that CCHIT would become the sole certifying body. The certification requirements are in accordance with 2009’s Health Information Technology for Economic and Clinical Health (HITECH) Act.

As this news swirled around, one doctor called Software Advice and asked: “Is CCHIT dead?”

Dead? No. But it appears that the organization’s influence is waning.

In the spirit of point counterpoint, here are three reasons why CCHIT could become less relevant in the EHR industry:

• Competition with other certifying entities;
• Influence of regional extension centers; and,
• Diminishing need for certification.

And here are three reasons why CCHIT could continue to remain relevant:

• Institutional knowledge;
• CCHIT products are a bridge to HITECH incentives; and,
• Need for alternatives to government certification.

Why CCHIT Will Become Less Relevant
CCHIT became a recognized certifying body (RCB) in 2006 so that hospitals could donate IT systems, equipment and training to physicians and other healthcare providers without fear of violating anti-kickback laws. If the equipment donated by the hospitals was approved by an RCB, then it was perfectly legal. CCHIT was the only organization, and still is, to earn the RCB designation.

Fast forward to 2010 and you’ll see how CCHIT has outgrown this role. Even though we think that CCHIT has considerable staying power in the EHR software market, the organization’s fight to remain relevant includes numerous obstacles as the U.S. healthcare system enters the “HITECH era.”

Competition with other certifying bodies. In a recommendation released in August 2009, the Health IT Policy Committee, an advisory group to the National Coordinator for Health IT, said that it would be in the best interest of the healthcare industry to have multiple entities certifying EHR software.

This recommendation by the Health IT Policy Committee effectively ends CCHIT’s “monopoly” on certifying EHR software. Other groups, such as The Drummond Group, are beginning to step into the certification space. This company “has tested over a thousand international software products used in vertical industries such as automotive, consumer product goods, healthcare, energy, financial services, government, petroleum, pharmaceutical and retail.” While The Drummond Group hasn’t specifically certified EHR software before, they obviously feel comfortable enough with the government’s certification requirements to move forward with their application.

Private entitites aren’t the only groups involved in certifying EHRs. The National Institute of Standards and Technology, a government entity, is collaborating “with health IT stakeholders such as vendors, implementers, standards organizations and certification bodies to establish a testing infrastructure.” Essentially, the institute will monitor the organizations that become official certifying bodies and ensure they’re held to national data standards.

In short, there is now competition and oversight in a space where previously there was none. This alone reduces CCHIT’s influence and relevance. Organizations that become RCBs will have the opportunity to attack CCHIT’s perceived weak spots, such as evaluating more specialty-specific EHR software and offering certification programs with less stringent requirements.

RECs may not choose CCHIT-certified products. The HITECH Act established approximately 60 regional education centers (REC) whose goal is to “offer technical assistance, guidance, and information to support and accelerate health care providers’ efforts to become meaningful users of Electronic Health Records.” Spread throughout the country, RECs are tasked with getting approximately 100,000 phy

sicians up to speed as meaningful users of EHR software over the next two years.

The RECs not only will help physicians implement EHR software but also will choose “preferred” EHR vendors to work with. For example, the NYEC Regional Extension Center, which serves New York state except for New York City, recently chose eClinicalWorks, Eclipsys, Greenway, NextGen and Sage as “preferred vendors.”

How does this affect CCHIT? Each REC can choose their own preferred EHR software vendors, CCHIT-certified or not. If RECs choose to promote vendors that don’t offer CCHIT-certified EHR software, then CCHIT is effectively cut out of that region’s REC physician pool. The more software vendors RECs choose that are not CCHIT-certified, the less influence the commission will have. Conversely, if RECs choose CCHIT-certified software or make CCHIT certification part of their preferred vendor selection process, the commission stands to actually increase their influence in the EHR arena.

Certification may become less important to new vendors. The list of EHR software providers that are currently CCHIT-certified leans heavily towards larger, more established software vendors. While some may take this as an indication of CCHIT bias towards larger vendors, others may argue that smaller or less established vendors may not choose to have their products CCHIT-certified because of the cost involved.

Whether or not new competition drives down CCHIT’s certification fees remains to be seen. If their certification costs remain high, it’s plausible that more EHR vendors without interest in CCHIT certification will emerge. The emergence of cloud computing and Software as a Service (SaaS) applications is bringing software development and maintenance costs down. A lower barrier of entry to the market means more niche vendors will emerge, filling in gaps that CCHIT-certified software doesn’t fill.

Why CCHIT Will Become More Relevant
CCHIT has been entrenched in the EHR certification game for too long to just disappear. In fact, there’s an argument that CCHIT stands a good chance of becoming a permanent certifying body in the EHR software industry. Here are a few reasons why CCHIT will continue to remain relevant to providers searching for EHR software.

Experience counts. In the world of EHR certification, CCHIT is currently “it.” They’ve been carrying the torch of EHR certification since the organization was created in 2004. No other U.S. organization has been more thoroughly involved in testing and certifying EHR software than CCHIT. They’ve certified nearly 200 products since 2006.

With experience like that, it’s unlikely that CCHIT will be left out in the cold once Health & Human Services chooses certification bodies. CCHIT already has applied to become an official certification body under the program and created a preliminary EHR certification program designed to meet the proposed HITECH standards. Even if CCHIT isn’t the best choice to become an official certifying body, it’s tough to argue against including them as at least one of the options.

The bottom line: No other organization is as prepared as CCHIT is to begin certifying EHR software for the government.

CCHIT products are the “best bet.” Many providers and hospitals are waiting on the certification requirements of the HITECH Act to become final before they choose an EHR software system. At the same time, a provider needs to demonstrate meaningful use for 90 consecutive business days in the year 2011 to earn up to $18,000 in incentive payments for the 2011 calendar year.

So, providers need to have an EHR up and running relatively quickly but they’re still not sure what EHR systems are going to be certified. What can they do? Currently, CCHIT offers a Preliminary 2011 ARRA certification in addition to its it’s full 2011 EHR certification. CCHIT’s ARRA certification is “simpler and more flexible” than the normal CCHIT certification and is “designed to demonstrate that a developer’s technology is well-prepared to be certified once ONC-accredited testing and certification becomes available.”

It’s likely that in this time of uncertainty, many providers and even RECs are turning to CCHIT-certified products to guide them.

Alternatives to government certification are needed. The HITECH Act’s success is not guaranteed. And in the event that the government-sponsored EHR certification program doesn’t succeed or loses relevance, the market will need to fill a void. Some authority on EHR software will be needed and CCHIT is one of the best positioned organizations to become that authority.

Even if the HITECH Act is a rousing success, the EHR market will still have a need for an organization akin to what CCHIT and others do now – evaluate the functionality of EHR systems.

A Towers Watson analysis of the new health care reform law released last week shows that the “Cadillac plan” excises tax will likely impact more than 60 percent of large employers by the provision's 2018 effective date. The provision was intended originally to penalize employers with rich health benefits plans, but the end result clearly will go much farther even if only an 8 percent average annual cost increase (typical for much of the past decade) is factored in. The companies that are top performers in managing their health benefits strategies may forestall the tax until 2023 or beyond, Towers Watson suggests. The analysis underscores the problems ahead if current health care cost trends are not adequately addressed.

Federal

Congress seems to have finally turned the corner on advancing legislation that more permanently deals with several key health issues rather than following the month-to-month path it has been on since January. Late last week the Senate Finance and House Ways & Means Committees released a legislative package on Jobs, Loopholes and Extenders that appears to have sufficient support to actually achieve enactment in the coming weeks. It contains two key health items that are currently addressed by temporary fixes set to expire at the end of May:

• The package contains a much-needed physician rate fix for Medicare that would suspend scheduled reimbursement cuts in the coming years. This suspension would last for three and a half years, which means that Medicare doctors would not have to worry about a major reimbursement cut until 2014. For the rest of 2010 and 2011, doctors would enjoy a modest increase. For 2012 and 2013, the annual “update” would be based on a two-bucket formula but could not result in a decrease. If nothing changes, the current formula (deep cuts) returns in 2014. This “fix” costs about $63.1 billion over 10 years and will be added to the deficit, since it is exempt from the new Pay-Go requirements.
• The proposal extends the current 65 percent government subsidy of COBRA benefits for seven months to the end of 2010, for individuals laid off through December 31, 2010, at a cost of $7.8 billion over 10 years. This cost also will be added to the deficit.

States

ARIZONA: On May 18, voters approved the long debated one-cent increase in the state sales tax by a margin of 64 percent to 34 percent. The temporary tax is a three-year measure that is expected to generate approximately $900 million a year in additional revenue. The vote will stave off proposed reductions in funding for education, public safety and health care. The sales tax increase has been a lightning rod issue for Governor Jan Brewer, who has bucked the Republican-dominated legislature since last summer with her efforts to generate support for adding a revenue stream rather than making deep cuts in services.

KANSAS: Lawmakers finished the 2010 legislative session recently, ending a two-week veto session that wrapped up one day short of the 90-day statutory limit. It was a particularly intense year for the health insurance industry. Bills that passed included mandates for oral chemotherapy and autism treatment coverage (for state employee plans only), a prohibition of dental contracts that require the use of fee schedule rates for non-covered services and some restrictions on genetic testing. The legislature also passed a non-binding resolution reserving the state's right to freedom from federally imposed health insurance coverage mandates.

Bills that died included a tele-medicine mandate, a prohibition on abortion benefits in health insurance policies, creation of an employer database and/or exchange, ballot initiatives relating to federal health care reform, a prohibition on hospital charges to self-pay patients for more than 25 percent over its highest volume private payer, a ban on Most Favored Nation clauses, a mandatory contribution by small employers to individual plans purchased by employees, and required exclusions for coverage of tobacco-induced medical conditions.

LOUISIANA: The Legislature continues to debate many problematic bills, including a contentious proposal that would place requirements for “network adequacy” on health plans and the payment of billed charges to non-participating providers.

MASSACHUSETTS: A day after the state's four major health insurers said they lost $116 million in the first quarter of the year because of an ongoing dispute with Gov. Patrick on small business premiums, legislation pitched as “cost containment” for small businesses and individuals passed the Senate 33-4, with no provisions addressing premium cost drivers. The bill creates a presumptive disapproval of rate increases more than 1.5 times the prior calendar year's consumer price index increase for medical care services. It creates a mechanism to avoid presumptive disapproval if a plan agrees to an 88 percent medical loss ratio (MLR) in the first year and 90 percent in the second, with a 1 percent margin added in for profit and surplus. Refunds must be distr

ibuted if these targets are not met. The bill would require small group carriers to file all changes to base rates, rating factors and administrative costs with the Division of Insurance (DOI) and the Attorney General (AG) at least 90 days before their effective date and would set up the High Risk Reinsurance Trust Fund. The insurance commissioner would have the authority to determine the amount of the insurer assessments and authorize expenditures from the fund to reimburse carriers for costs that carriers incur in claims.

The bill would also require hospitals and other health care providers with healthy profit margins to make a one-time $100 million contribution to health insurers to help bring relief to small businesses struggling to pay soaring health insurance premiums. This money would reduce premiums for small businesses by 2.5 percent, according to a statement from Senate President Therese Murray. The bill is now headed to the House where its chances are unclear.

MISSOURI: Lawmakers passed 106 bills in the 2010 session that drew to a close May 14, far fewer than in past years. Insiders attribute the legislative slow-down to the state's financial crisis. While some of the bills that passed were opposed by the insurance industry as introduced, each was amended significantly as a result of industry-led efforts. Bills that passed include an autism mandate for children up to 19 years of age and capped at $40,000 per year, an omnibus bill supported by the DOI, and a revision to the prompt-pay laws already on the books.  Among the many bills that did not pass were other benefit mandates, medical loss ratio restrictions, provider contract requirements, quality measurement constraints, and long-term care rate caps.

NEW MEXICO: The state's regulatory woes continue with the resignation of Acting State Insurance Superintendent Thomas Rushton. Thin resources will likely hamper the state's ability to implement federal health care reform. New Mexico signed on to operate a parallel high-risk pool and its own medical loss ratio law, in addition to conducting general business.

OHIO: In 2008, the state enacted a permanent ban on most favored nations (MFN) clauses in contracts between health insurers and physicians and left open the question of whether to permanently ban them in hospital contracts, placing a two-year moratorium on their use in new or renewed contracts. Last week, the Senate Health Committee, without objection, passed a substitute version of the bill that contained a one-year extension of Ohio's temporary ban on most favored nations clauses in hospital contracts. The bill, with the amendment, is expected to move through the full Senate next week and obtain House concurrence the following week. This bill would ensure that the temporary ban on MFN clauses, scheduled to end on June 25, 2010, is extended until June 25, 2011. An MFN clause essentially guarantees a particular insurer that a medical provider it contracts with would not be able to accept payment for covered services from another insurer that is less than the amount the provider is being paid by the insurer with the MFN clause.

PENNSYLVANIA: Governor Ed Rendell signed an executive order last week creating two task forces for implementing the federal health reforms. The principal task force consists of 12 members representing various agencies and the executive branch. Its focus includes developing a high-risk pool and an exchange, identifying state legislation that may be needed and coming up with the overall implementation strategy. The second task force is advisory and will give feedback to the principal task force; one member will come from for-profit insurers. The executive order describes the term of each member as lasting four years or until the requirements of the executive order have been fulfilled.

RHODE ISLAND: The Office of the Health Insurance Commissioner (OHIC) has issued minimum coverage, MLR, and disclosure requirements for student health benefit plans. All student health benefit contracts or plans issued or renewed on or after September 1, 2010 must meet certain requirements:

• Minimum Coverage: All student health benefit policies must meet the minimum coverage level of $50,000.00 per student per accident or occurrence, and may not impose annual or lifetime caps.
• MLR: All student health benefit contracts are required to have an 80 percent minimum loss ratio.
• Disclosure: All student health benefit plans are required to prominently disclose in the certificate form or in some other document provided to certificate holders any and all payments, charges, fees, or any other amounts that are paid to or retained by the policyholder (on a per capita basis).

WASHINGTON: Business groups are liming up to support a new statewide ballot initiative that would lift the state's ban on private workers' compensation coverage, opening up the market to more competition. Washington is one of only four states that maintain control — some would say monopoly — on workers' compensation insurance options for employers. Many in the business community have been pushing for reforms similar to those enacted in California in 2005. Some attribute the initiative to the frustration felt by many over the legislature's refusal to consider bipartisan reform proposals during the most recent legislative session.

ARRA Whistleblower Protections

The ARRA whistleblower protection provisions[4] protect employees of non-federal employers receiving ARRA funds from being discharged, demoted, or otherwise discriminated against for disclosing information that the employee reasonably believes is evidence of:

(1) a gross mismanagement of an agency contract or grant relating to covered funds;

(2) a gross waste of covered funds;

(3) a substantial and specific danger to public health or safety related to the implementation or use of covered funds;

(4) an abuse of authority related to the implementation or use of covered funds; or

(5) a violation of law, rule, or regulation related to an agency contract (including the competition for or negotiation of a contract) or grant awarded or issued relating to covered funds.

The Act broadly defines non-federal employers to include (1) contractors, subcontractors, grantees or recipients of ARRA funds; (2) professional membership organizations, certification or other professional bodies, agents or licensees of the federal government; and (3) state and local governments with respect to covered funds. The provisions have a broad scope of prohibited retaliatory acts beyond discharge or demotion. Other discrimination or negative effects on terms and conditions of employment or any action that would dissuade a reasonable person from engaging in whistleblowing are covered.

The whistleblower provisions protect employees against any reprisal for disclosing information, including disclosures made in the ordinary course of business, to any person having supervisory authority over the employee, or to a designated compliance officer or other individual who has authority to perform internal investigations. The incorporation of protections for disclosures in the ordinary course of business in ARRA contrasts with interpretations of whistleblower protections under other statutes. Beyond the protections for internal disclosures, employee disclosures to a member of Congress or government personnel, including an inspector general or state or federal regulatory or law enforcement agency member, are protected. Given that ARRA whistleblowers can make protected disclosure to a wide array of entities and individuals, employers will want to foster an open dialogue with employees to encourage employees to report any perceived mismanagement or waste internally.

How HITECH and ARRA's Whistleblower Provisions Interrelate

The whistleblower provisions in ARRA pose significant risk to those persons or entities receiving money under the HITECH Act provisions of ARRA. Those at risk include entities receiving grants and loans from the federal government under the HITECH Act to assist them in the implementation of electronic health record (“EHR”) technology. HITECH was touted as a way to improve and facilitate the implementation of EHRs, which, it is believed, will result in overall cost savings and better quality health care. Because of the nature of the technology and the revolutionary concepts in evolving health information technology, it is likely that the EHR infrastructure and integration will go through many iterations before efficiently and effectively being implemented. It is becoming clear that current versions of EHR have unique properties that may not integrate and fully operate with other current and future technologies. Different entities working with EHRs have different platforms, and the development of the wider enterprise integration anticipated by the HITECH Act will require ongoing revisions and modifications to current strategies. Because of the broad nature of the whistleblower protections in ARRA, many of these first generation attempts in EHR may fall prey to ARRA's undefined terms of “gross mismanagement” or “waste of funds,” as noted above. This could be a particular risk area for those entities trying to incorporate existing systems with those contemplated under the HITECH Act. It is only natural that these transitions will be neither smooth nor flawless and the extent to which problems in this process may be deemed “gross mismanagement” or “waste” potentially opens up opportunities for employees to attract government scrutiny through the use of ARRA's whistleblower protections.

If a report of gross waste or mismanagement or abuse of authority in connection with ARRA funds is made, the inspector general of the agency having jurisdiction over the ARRA funds is required, within 180 days, to investigate and make a determination regarding the employee's complaint of reprisal. An employee alleging a reprisal must only prove that a protected disclosure was a “contributing factor” in the reprisal. It is important to note that circumstantial evidence including “(i) evidence that the official undertaking the reprisal knew of the disclosure; or (ii) evid

ence that the reprisal occurred within a period of time after the disclosure such that a reasonable person could conclude that the disclosure was a contributing factor in the reprisal” is permitted.[5] An employer's rebuttal must demonstrate with clear and convincing evidence that they would have taken the action in the absence of the employee's disclosure where the Inspector General finds a disclosure was “a” contributory factor in a reprisal. If, after reviewing the OIG report, the agency concerned with the ARRA funds finds that the employee was the victim of a reprisal, it has the authority to require the employer to (1) take affirmative steps to stop the reprisal; (2) reinstate the employee with back pay; and/or (3) pay compensatory damages, employment benefits or other awards to restore the employee to a position as if no reprisal had occurred. The employer may also be required to pay the costs and expenses associated with the complaint, including reasonable fees for the employee's attorneys and experts. In addition, there are no expressed caps on damages, making employer liability under this section largely unknown. If the agency decides not to take action, the whistleblower may proceed against the employer in court.

Considerations for HITECH Fund Recipients

Because of the lack of clarity regarding how the expansive whistleblower protections will be implemented and enforced, recipients of HITECH funds should consider the following:

• There are specific posting requirements for entities receiving ARRA funds. Each entity must post a notice to employees of ARRA whistleblower rights and remedies.
• The whistleblower protections protect disclosures regardless of whether there was a claim of fraud or intentional misuse of ARRA funds. Therefore, any time an employee reasonably believes that a HITECH fund recipient has “grossly mismanaged” or “wasted” government funds, their disclosures or complaints are protected.
• Gross mismanagement or gross waste of ARRA funds can be highly subjective. The lack of definitions generally and specifically related to the “gross mismanagement” and “waste” provisions leave much more room for dispute over the appropriate use of ARRA funds or abuse of authority related to the use of the ARRA funds. Because of the nature of EHR and dramatic changes in the technology and processes, the lack of definitional guidance creates a situation ripe for an entity using HITECH funds to become scrutinized by an agency for gross management or waste or for the complaint of an employee about trial and error efforts.
• Organizations that may not have been on the OIG's radar for fraud and abuse matters may suddenly become the target of a broader investigation. Once the OIG has gained access to an entity's records in connection with a whistleblower's complaint, there is nothing to prevent it from reviewing the records for other potential violations, including overpayments, fraud, and compliance with regulatory conditions of participation. Those entities developing EHR using HITECH Act funds are especially susceptible to this, given the government's announced enforcement efforts directed at health care fraud and integrity in ARRA spending.

There are no express statutory provisions for an evidentiary hearing with cross examination or an administrative appeal. This is very different from procedures before the U.S. Department of Labor, which provide for hearings before administrative law judges and the Administrative Review Board under Sarbanes-Oxley and other statutes with whistleblower provisions. Because of this, it appears that an agency can take unilateral administrative action which could ultimately put an entity's HITECH funds at risk and expose the entity to other sanctions including qui tam actions and claims under state law. This again strongly suggests prompt attention to internal complaints and prompt and thorough responses in any whistleblower complaints and investigations.

Recommendations

For those entities using HITECH funds to develop EHR systems, the broadness of the ARRA whistleblower provisions make it clear that entities must be thinking both from a fraud and abuse and an employment law perspective to develop prevention and protection safeguards. Going forward, employers receiving HITECH funds may want to take specific actions to foster an open environment to ensure that employees feel that their complaints and concerns are heard and meaningfully addressed. In addition, the environment should be one that cultivates EHR development without focusing on blame for ineffective or unworkable technologies while maintaining performance standards. Good documentation of performance problems will be important in many cases. Specific actions should focus on (1) developing or reinforcing effective compliance and ethics programs; (2) enhancing corporate code of conducts; (3) establishing and publishing a system for handling and investigating internal reports of misconduct or complaints of retaliation; (4) developing strategies to respond properly to any governmental inquiry or investigation; and (5) implementing structures for how to intake and investigate allegations of waste or mismanagement, even those that come in the ordinary course of business. Because of the broadness of the ordinary course of business inclusion, supervisors must be trained to recognize potential whistleblowers and to take these more general day-to-day complaints seriously.

The State HIE Toolkit is a compilation of resources provided under a program sponsored by the Office of the National Coordinator for Health IT. The Toolkit is designed to support State Health Information Exchange
with practical “how to” guidance on developing and implementing plans for achieving statewide exchange of health information between providers.

The Toolkit addresses the five essential HIE components: governance, finance, technical infrastructure, business operations, and legal/policy. In addition, the HIE Toolkit offers information related to general planning, grant management and other cross-cutting areas such as coordination with federal programs.

Toolkit Content Development

Contributors to the Toolkit content include a collaborative team of experts with experience in the field, led by staff from the Office of the National Coordinator for Health Information Technology.

The Toolkit is inherently a “work in progress”, designed to be regularly updated to reflect the ongoing experiences and needs of states as well as the growing body of lessons learned about what constitute “best practices” in statewide Health Information Exchange.

* Throughout the Toolkit are some examples from the

field of state Health Information Exchange development as it has been evolving to date.
* As it becomes available, information and examples from ONC approved strategic and operational plans will be integrated into the Toolkit.
* The Toolkit will continue to link to relevant Program documents as information becomes available from the Office of the National Coordinator

Toolkit Organization & Updates

The number of Toolkit modules will be expanded and all of the modules will be updated on a regular basis as additional information becomes available.

Toolkit v1 – Planning Fundamentals – December 2009 Release

Includes Modules:

Planning Overview
Governance
Finance
Technical Infrastructure
Nationwide Health Information Network
Grants Management

Toolkit v2 – Additional Modules – Early 2010 Release

Includes Modules:

Business Operations
Technical Operations
Legal/Policy
Privacy and Security
Program Coordination and Leverage
Guidance on Meaningful Use

Module Content and Structure

Each module of the Toolkit contains a variety of information designed to foster learning on the topic and support states making design decisions and carrying out implementation approaches. Each Module is structured to include:

* Overview information about the topic
* Frequently Asked Questions (FAQ’s), updated regularly in response to states’ issues and inquiries
* Resources, including reference materials, tools and other decision supports
* Case Studies and Examples
* Links to Federal Program documents and guidance released by ONC

To learn more about the HIE Toolkit click here

The heat on the Obama Administration and Congressional leadership over the cost of health care reform is not expected to ease anytime soon, with the release last week of additional information from the Congressional Budget Office on the Patient Protection and Affordable Care Act. The updated analysis shows the cost of the new law could easily exceed $1 trillion because of possible discretionary spending of at least $115 billion over the 2010-2019 period.

The number of states now challenging the new law in court stands at 20, and the states have been joined in the suit by the National Federation of Independent Business. Also last week, the Milliman Medical Index for 2010 was released, and it contains more worrisome news — health care costs continue to rise at an unsustainable rate. The report found that costs increased $1,303 for the typical family of four in the past year and now stand at $18,074.

Federal

As the comment period ended with respect to medical loss ratio (MLR) regulations, a flurry of letters were sent last week to both the National Association of Insurance Commissioners and the U.S. Department of Health and Human Services. Several insurers and several employer groups have written with comments and concerns, including the American Benefits Council, the National Coalition on Benefits and the National Retail Federation. In all cases, the comments point out that it's important to assure that positive, quality-oriented elements of health care, such as health information technology, disease management and wellness programs, fraud and abuse regimens, all should count as quality measures when calculating a company's MLR. The National Retail Federation in particular noted the need for a national MLR for large employer business.

In the never-ending roll-out of proposed health care reform regulations, the Administration last week published yet another set of Interim Final Regulations. This set deals with coverage for dependent children up to age 26 pursuant to the requirement that insurers and group plans allow kids to stay on their parents' policies or coverage until age 26.  Comments are due by August 11, but the rule is effective July 12, 2010. Many insurers have already announced that they will implement this provision early (e.g., May 31 for Aetna) to cover graduating college students who may have otherwise faced the summer without insurance. Whether self-funded employers follow suit is not as clear. Also, with the temporary fix of Medicare physician reimbursement rates set to run out the end of May, the House is expected to take up a more lasting fix sometime this week. If the House proceeds as expected it will attempt to install a five-year suspension of any physician rate cuts. Aetna supports the change, as it will give this market predictability.

States

COLORADO: The General Assembly recently adjourned a 2010 session that was focused heavily on health care issues. Outgoing Governor Bill Ritter succeeded in his goal of leaving a health care reform legacy with the passage of unisex rating in the individual market, a plain language requirement for insurance forms and contracts, an all-payer database and the creation of a task force to develop standard coding and edits for claims. Although the oral chemotherapy mandate passed, the industry was successful in helping to defeat a bill that would have prohibited carriers from setting rates for non-covered services and one making the wrongful denial of a claim an unfair claim practice.

DELAWARE: Debate resumed last week on a bill that would prohibit health insurers from denying coverage for medically necessary procedures and tests. The bill was voted out of committee with the understanding that significant changes are needed before a full vote occurs. The Department of Insurance presented testimony applauding the intent of the sponsor but reserving full support, indicating there is benefit in allowing preauthorization to limit unnecessary medical testing. Additionally the Comptroller General provided testimony on the potential cost impact to the state health benefits plan.  An actual dollar figure has not yet been quantified.The legislature will be in recess for the next two weeks, returning June 1.

FLORIDA: The legislature adjourned for 2010 with no significant health care bills passing. The only exception was in the area of Medicaid, legislation regarding provider-sponsored networks was passed. Legislation that was defeated includes mandates for coverage of Down's Syndrome and other developmental disabilities, and problematic pharmacy legislation.

GEORGIA: The legislature adjourned for 2010 after a number of negative health care bills were defeated, including a proposed tax on health plans and restrictions on rental networks. Among the legislation that did pass was, most significantly, a bill that would

apply state prompt-pay laws to self-funded plans. The bill also contains an extension of time for payment of paper claims and a compliance threshold of 95 percent before any fines are imposed. Several interested parties are working with the Governor's office to encourage a veto of the bill, but this is unlikely.

INDIANA: After a financial review of the Patient Protection and Affordable Care Act's impact on the Indiana Medicaid program and the state budget, Milliman reported its findings last week to the State Budget Committee. Milliman placed the total fiscal impact to the budget during the next 10 years at an estimated $3.6 billion. The predominant driver is expected to be enrollment expansions, which are estimated to increase from 1 million in 2010 to 1.55 million under PPACA. Other cost drivers include the impact of a reduced FMAP on Medicaid eligibles, pharmacy rebate loss, administrative expenditures (personnel and data systems), and increases to the Indiana Medicaid fee schedule from 60-65 percent of Medicare today to 80 percent of Medicare, to assure access to care. It was stressed that the final actual cost will be largely dependent on how many residents enroll in health care programs while eligible for Medicaid.

IOWA: Insurance Commissioner Susan Voss held a meeting with insurance industry representatives on May 7 to discuss the implementation of a health care cost bill. Specifically,certain provisions require the Iowa Insurance Division to 1) hold a public hearing regarding any proposed rate increases that exceed national health care spending by at least 15 percent; and 2) convene a work group to consider ways to reduce the cost of health care and health insurance premiums. Commissioner Voss noted that the requirement for a hearing applies only to rates filed for approval – the individual market in Iowa. Also, there will be only one hearing per carrier even when the carrier makes filings for several products. Hearings are intended to collect comments from consumers; carriers are not expected to address comments or make a presentation.  Commissioner Voss announced that the work group on reducing costs will not be convened until at least July 1, 2010.  The Commissioner is requesting input from health insurance industry representatives and consumer groups on costs.

MASSACHUSETTS: Small businesses are opposing a proposal they say would shift more health insurance costs onto them for the treatment of developmentally disabled children. The proposal would require insurance companies to absorb the cost of copayments and deductibles for physical and speech therapy and other services provided through a state-run, early intervention program for children up to 3 years old. Until now, the state has funded co-pays and deductibles for the program, but it now faces a $10 million shortfall. Businesses leaders say this would add about $4 million in costs onto smaller companies. The Retailers Association of Massachusetts and 11 other business and insurance groups sent a letter last week to Senate Ways and Means Chairman Steven Panagiotakos urging him to kill the proposal. Panagiotakos said his committee has not decided whether to include the measure in the proposed state budget but that it has the support of many of his colleagues. Currently, families with developmentally disabled children are charged a fee, based on their income, to participate in the program. The Patrick administration has said those fees could go up by as much as 600 percent. Advocacy groups developed a plan, approved by the House last month, that would cut the program’s shortfall nearly in half. It would raise fees more modestly but would also require insurers to pick up the $4 million in co-pays and deductibles currently covered by the state.

MISSOURI: An autism mandate bill was passed by the legislature just prior to the conclusion of the current session last week. It is now on its way to the desk of Governor Jay Nixon, who has spoken publicly in support of the measure. Effective with all policies renewed or delivered on or after January 1, 2011, coverage of autism disorder treatment would be mandated for children through age 18 and capped at $40,000 annually; coverage may exceed that amount with approval of the health plan. The coverage limit would be raised every three years per the consumer pricing index. Small employers can ask for a waiver if their costs exceed 2.5 percent of total claims in a year.

NEW JERSEY: Governor Chris Christie is establishing an executive work group to oversee implementation of federal health care reform. The full membership has yet to be announced, but it is expected to include key leadership from the Banking & Insurance Department, Health & Senior Services, and Human Services. In other business, the June 30 budget deadline and the state’s nearly $11 billion deficit have set the stage for an ideological showdown. Despite the governor’s outright defiance in refusing to signany legislation that increases taxes, Senate and Assembly leadership have introduced legislation to temporarily raise the income tax on residents earning more than $1 million. The revenue generated from this proposed tax would be used to restore cuts made to the senior pharmaceutical assistance program and property tax rebates.

Legislative action was taken on a bill designed to lighten the impact of an employer tax for the state’s unemployment fund. A significant deficit in the fund triggered a $1 billion employer tax to replenish the fund, which currently equates to an approximate tax of $400 per employee.  In response to advocacy from the business community, the legislature is attempting to do a phased-in reduction of the tax to $300 million this year.