DocuRehab's position is as follows:

Pros and Cons of the ARRA Incentive

The government incentive program, known as the American Recovery and Reinvestment Act (ARRA), generated urgency among EMR manufacturers to be certified for monetary incentives. The chiropractic profession is rarely immune to market pressure and claims of easy profit are now common EMR marketing campaigns.

Among chiropractors, the incentive pushed many professionals to study and consider implementing Electronic Medical Recording. Let’s be factual! In order for the ARRA to be financially interesting, it requires two aspects:

  1. to bring more money than cost to the professional
  2. to provide sufficient funds to compensate the headache of complying with government programs and Medicare; this “headache” amount being evaluated differently by each professional

Can a chiropractor make more money than it will cost to implement the report system demanded by Medicare?

As soon as we discuss costs with the chiropractor, the problems start to appear:

The first ARRA incentive addressed the medical profession with various requirements that were already integral parts of regular medical consultation. For years Medicare factored in their payment to the medical doctor through certain protocols (weight measurement, body fat evaluation, medication taken, medication conflict, contraindication etc…). Compared to medical doctors, Medicare never paid a chiropractor to perform these tasks. Medicare does not pay for a chiropractic evaluation, but rather Medicare pays only for four chiropractic codes! The incentive of ARRA is great for a medical doctor who needed to comply with these demands to begin with, but is much less intriguing to a chiropractor to comply without being paid. On top of that, asking a chiropractor to fulfill the obligations of ARRA with the promise of being paid only at the end of the first year is not appealing.

On average, a typical chiropractic payment from Medicare is roughly $25! This amounts to a small sum that no chiropractic professional can rely upon solely. Furthermore, when you consider that Medicare addresses a population at risk and takes more time to move around, responds slower to your questionnaire, and requires more attention, one might assume that the fee would be higher for the Medicare population. Medicare planned to reimburse the chiropractor for services that were originally never reimbursed and also for services that cost time and money to implement. In my opinion, this is not an incentive but rather deferred payment for services rendered -- this is an LOP from the federal government.

Do the added costs mean that chiropractors should turn away the ARRA?

No, it only means that the marketing expert’s claim that a doctor will clear $18,000 is not factual, since it will cost you at least half as much to implement the necessary procedures to qualify for the ARRA. In such, this does not cover software but rather the time required of both you and your office staff.

You also need at least 120 Medicare patients a month to reach the highest magic number for reimbursement.

And then, when Medicare has paid you, you are on the hook to keep doing what you were doing to get the money, but with no incentive this time. Unless chiropractic reimbursement procedures for Medicare patients changes, the government will come after the doctor for the money collected if the doctor stops implementing the steps to maintain Medicare’s requirements.

As a result, the doctor is legally bound to perform new services on all of your patients for this year and also for the following year (if you collect any money from the government and the ARRA incentive). The doctor will be paid only for the services performed during the first three years but the payout is delayed until the end of each year. The government creates and leads the process for providing these services in the future with no added benefit.

Yes, critics of this argument would discuss the wonderful medical benefits for the patient. The AARA will be beneficial for your patient but, remember, this is only a discussion of money.

So, what are the benefits for my practice to learn about the Medicare incentive and take the time to explain this to each new patient, track the required information, etc.? The answers depend on each individual and how hard you wish to work for the funds. We will discuss the advantages and disadvantages below:

How can I receive the incentive money without too much difficulty and work?

The answer to that is software: the software automates reporting tasks to Medicare and relieves the doctor from the menial task by shifting the work to either his staff or to the patient itself. The software needs to be designed not only to meet ARRA requirements but to ease the job of the doctor in fulfilling these requisites, which is another problem. Most software is not designed to ease the job of the doctor because the requirements did not exist prior to the development of the software.

The first issue is historical.

The final requirements for ARRA were established in September 2010. As a result, the EMR accreditation completed in 2011 did not include the newest AARA components. A clear example of that was the recommendation of several EMR companies to type in the patient’s drug and then search a PDR or the Internet for any medication interaction. Imagine doing this for every patient and only receiving an extra $20 at the end of the year! Additionally, the doctor is required to track every change made to the patient’s medication as long as they are treating them, which would lead to tedious and time-consuming work.

The second issue is linked to fast evolving technology.

Once the EMR is certified; the software modifications that the company may add are very limited: the product must remain as is for a length of time, limiting the prospect of new technology and add-ons over the next few months. Obviously a development company may hesitate to certify their software due to the inability to grow and change the technology. A clear example of that is web-based EMRs, which are the newest technology at large not certified. Yet, at the end of 2011, the web-based EMR provides the most promising technology with plenty of room for advancement in 2012.

The third issue is linked to the type of technology used.

The easiest way to not become overburdened with work is to defer your work and part of your employee’s work to the patient himself. This can be achieved by integrating a patient portal into the software. With the portal, the patient is able to complete the subjective section of the exam, demographic information, medications, insurance information, read information pertaining to his condition, and retrieve his file at will.

This brings us to the third issue with ARRA: reporting from home and filling in forms that will neither be printed nor scanned in, but rather directly integrated to the office software, requires a CLOUD BASED EMR with a patient portal. Most chiropractic EMRs are not Cloud based and, accordingly, do not have Patient Portals accessible via the Internet. In summary, the “no-headache” in accredited software is cloud-based dependent and you may have to wait a little longer to see many on the market.


In the push for electronic medical reporting, it would be beneficial to establish a requirement to document chiropractic techniques for peer duplication. This would greatly benefit the profession by eliminating bad techniques, assure enhanced continuity of care, educate the adjusters that foot the bill, and more. At DocuRehab we do not wait for the government to tell the chiropractor or other professional what to do…rather we set the trend for the future of EMR software.

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