Keep up to date on ARRA funding

There has been a great deal of excitement in the healthcare and information technology communities since mid-February. The American Recovery and Reinvestment Act of 2009 (ARRA) contains provisions for spending more than $19 billion for healthcare information technology (HIT) infrastructure and Medicare and Medicaid incentives to motivate providers to use HIT in a meaningful fashion within their organizations. The National eHealth Collaborative (NeHC) is encouraged by President Obama's and Congress's support to “ensure the utilization of an EHR [electronic health record] for each American by 2014.” NeHC touts the law's determination to solicit “full participation of stakeholders” in the process of recommending how to accelerate HIT adoption.1

It is important to note that when ARRA was first written, behavioral healthcare providers were excluded from both the Medicare and Medicaid incentives as well as the $2 billion in HIT grants that will be distributed through the Office of the National Coordinator for Health Information Technology (ONC). Yet because of the hard work of the Software and Technology Vendors' Association (SATVA), the National Council for Community Behavioral Healthcare, and the National Association of Counties, the legislation was modified so that behavioral healthcare providers are eligible for the ONC grants.2 Unfortunately, they still remain excluded from the $17 billion in Medicare and Medicaid incentives that go into effect in 2011. All interested parties are encouraged to lobby their members of Congress to make sure behavioral healthcare providers are added to this incentive program, perhaps as part of a healthcare reform package. With a coordinated effort, we can change this discriminatory policy.

Hospital systems and the physicians who are part of them are adopting medical EHR software as well as other IT tools to facilitate HIT's deployment in the general medical arena. These organizations' size and their available staff resources will make it easier for them to apply for some of the ARRA funding. Large community mental health centers with staff dedicated to acquiring, implementing, and upgrading HIT also may be able to successfully position themselves to obtain some of the $2 billion in grant funding. Less clear is whether small mental health group practices or small community-based behavioral healthcare organizations will be able to benefit from the available monies. To make sure your organization is able to take advantage of this and possible future funding, below are some steps to take.

Plug into as much information as possible. It's time consuming and therefore costly to read all that is available, but it will be much more costly to be poorly informed. Start by visiting as many free online resources as possible. Behavioral Healthcare (https://www.behavioral.net) and its sister publication, Healthcare Informatics (https://www.healthcare-informatics.com), are great places to start. Bookmark https://www.nationalehealthcollaborative.org and https://www.hhs.gov/healthit. Subscribe to whatever they offer so you can keep abreast of the rules developed for funding applications. Visit the National Governors Association's Center for Best Practices (https://www.nga.org/center) and get on its e-mail list (To subscribe, send a blank e-mail to join-nganews@talk.nga.org). This will keep you informed of events at the state level. Some states are moving forward with HIT much more rapidly than the federal government. Take a look at some of the outstanding documents on HIT prepared by the California HealthCare Foundation (https://www.chcf.org).

A lot of useful information can be found in places other than “traditional” Web sites. Obtain a blog-notification program or have blogs delivered to your browser's homepage. Visit https://www.technorati.com or https://blogsearch.google.com to find blogs that routinely provide HIT information. Some that I follow are EMR (EHR) and HIPAA at https://feeds2.feedburner.com/EmrAnd Hipaa; Healthcare Informatics' blogs (Instructions for following them are at https://www.healthcare-informatics.com under “Setting up your feeds” in the “Blog postings” section); and FierceHealthIT blogs at https://www.fiercehealthit.com/feed.

Also, read white papers offered by consulting organizations and vendors, and get guidance and assistance with applying for ARRA funds. Get referrals from colleagues who have used consultants. Don't try to go it alone.

Determine if it makes sense for your organization to seek a piece of ARRA's $2 billion in grant funding. If you plan to do so, sign up for any courses or free webinars that will assist you with the process. Press your professional or trade association to gather information and provide it to its members for free.

Participate in the National Council's lobbying efforts to include nonphysician Medicare and Medicaid providers in ARRA's $17 billion in incentive payments as part of a healthcare reform bill. Take part in the letter writing, phone calling, and “Hill Day” (June 9-10) campaigns organized by the National Council (https://www.thenationalcouncil.org). If you are a member of another professional or trade association, press it to partner with the National Council in its efforts to expand the list of providers eligible for this funding. Significant incentive dollars are available to eligible professionals demonstrating a meaningful use of EHR technology and proven performance during the reporting period for each payment year from 2011 to 2015.

Consider an alliance with primary care providers.Integration may become one of the bywords of healthcare reform. Patrick DeLeon, PhD, former American Psychological Association president, believes that mental healthcare providers and organizations may miss out on the larger healthcare picture if they do not embrace incorporating behavioral healthcare services into primary healthcare settings.3 Primary care providers may be important allies in securing additional HIT funding for behavioral healthcare.

Start to survey the behavioral healthcare EHR marketplace. If you don't have an EHR system or plan on upgrading what you have, find out about available products and what they cost. Learn if vendors you're interested in plan to seek CCHIT certification (See https://www.behavioral.net/pashel0308) when it's available for behavioral health products. Find out how long implementing these products takes and how they might integrate with your current systems. Determine what it will cost you to maintain a system (software and hardware) after you have purchased it. Begin to assess your work flow and determine what modifications will be necessary to smoothly incorporate automated processes. Start making work-flow changes now to facilitate automation later. Having taken these steps will look more impressive on a grant application than having no plan at all.

If your organization has an IT person, consider funding HIT certification for him/her. You will benefit significantly in the long run if your IT person has a greater understanding of HIT. Visit https://www.healthitcertification.com and https://www.guidetohealth careschools.com (Select “healthcare information systems”).

While ARRA provides outstanding potential for funding HIT, behavioral healthcare providers will benefit only if future legislation includes them in the list of eligible providers. SATVA members have hope that some of you will be stimulated to get involved in this ongoing conversation, participate in lobbying efforts, and express your opinions about what assistance you will need to adopt a behavioral health EHR in your organization.

Acknowledgment

Information about ARRA was provided in part by Kevin Scalia, executive vice-president of corporate development at Netsmart Technologies.

For more information, e-mail kep@sosoft.com.

References

1. National eHealth Collaborative Statement regarding the American Recovery and Reinvestment Act of 2009. Washington D.C. February 13, 2009.
2. Letter from Linda Rosenberg, MSW, president and CEO, National Council for Community Behavioral Healthcare. February 13, 2009.
3. Ready or Not, the 21st Century Has Arrived-The Future Always Builds Upon the Past. Newsletter of Division 42, American Psychological Association. March 2009.