Programs such as "pay-for-performance" or "pay-for-use" reimbursement from payers are a means to recoup the costs of health IT implementation and maintenance retrospectively (through enhanced reimbursement after the investment is made).  Demonstration projects involving adjustments to third party reimbursement policies are underway at the Federal and State levels and hold promise for helping subsidize the cost of health IT adoption.

Some of these payment initiatives are tied to quality reporting metrics.  For example, under Medicare's Physician Quality Reporting Initiative (PQRI), eligible health professionals can receive an incentive payment for satisfactorily reporting data on covered services furnished to Medicare beneficiaries.  Although this program does not directly fund health IT, the program does promote reporting efficiency that can be achieved more effectively with use of a health IT system.  Thus, the incentive payment received can be used to recoup health IT costs.    

Additional Resources on pay for performance:

• Resources on Pay for Performance - AHRQ
• Pay-for-Performance in State Medicaid Programs: A Survey of State Medicaid Directors and Programs - Commonwealth Fund Report
• Physician Quality Reporting Initiative - CMS

The American Recovery and Reinvestment Act of 2009 (ARRA) has a number of provisions that will impact rural health providers, including grants, loans and payment incentives.  Beginning in 2011, non-hospital-based providers enrolled in the Medicare program who implement and report meaningful use of electronic health records (EHR) can receive initial incentive payments up to $18,000.  Providers in rural health professional shortage areas will be eligible for a 10% increase on these payment amounts.  Incentive payment programs will also be available under the Medicaid program to rural health clinics and other providers who are not hospital-based.  Eligible providers will only be able to take advantage of programs under either Medicare or Medicaid.  However, acute care hospitals, including CAHs, are eligible for incentive payment programs under both the Medicare and Medicaid programs.     

Additional Resources on the American Recovery and Reinvestment Act of 2009:

• HIT Incentives and State Grant Opportunities American Recovery and Reinvestment Act of 2009  - Rural Health Resource Center
• Early Federal Action on Health Policy: The Impact on States - Commonwealth Fund
• American Recovery and Reinvestment Act Official Website
• CMS Information Related to the Economic Recovery Act of 2009
• ONC Funding Opportunities