A. Applicants are not required to fill out the following sections of the application: Performance Results, and Payment Methodology & Budget Neutrality. The Payment Methodology & Budget Neutrality sections of the application are not required because CMS is not providing any funds to community partners as part of this demonstration initiative. There is also no need to provide, as part of the “Medicare Waiver Demonstration Applicant Data Sheet,” the Medicare Provider number, as the community partners will not be providing any Medicare services to Medicare beneficiaries, nor the Employer Identification Number. In addition, under the Organizational Structure & Capabilities section of the application, applicants do not need to provide copies of applicable Federal and State licenses, provide financial statements or audit opinions, indicate if the applicant is a Medicare provider in good standing, or describe any other applicable accreditation, credentialing, and/or certification processes and results. However, applicants must include, as part of this section, detail regarding the entities that will be part of the community partnership (if multiple stakeholder organizations are involved); how, specifically, each will support CMS in outreach, education and physician practice recruitment efforts (newsletters, mailings, etc.); and the resources they will provide (e.g., staff, meeting space). The application must also provide the lead contact for the proposed community partner organization(s); we will expect this individual to be accountable for the activities of the community partner. Contact information for this individual must be provided.

A. Community partners will assist with education, outreach activities, and recruitment of all potentially-eligible physician practices in the defined site. (See the response to the question above for examples of such activities.) Community partners will also collaborate with CMS on an ongoing basis in an effort to assist us in achieving our goal of leveraging the combined forces of private and public payers to drive physician practices to widespread adoption and use of EHRs. As such, we are seeking organizational entities that have the necessary infrastructure and a strong commitment to advancing the adoption and use of EHRs and are capable of supporting CMS in these activities.

A. CMS will start recruiting physician practices in the four Phase I communities in the fall of 2008. Practices in the remaining eight communities (Phase II) will be recruited the following year (fall 2009).

A. Physician practices that are interested in participating in the demonstration will be asked to complete and submit an application form developed by CMS. The application period for practices located in communities identified as being part of the Phase 1 implementation will begin in the fall 2008, after the selection of sites and community partners. The application period for practices located in Phase 2 sites will begin one year later, in the fall 2009. CMS will review all applications and be solely responsible for all decisions regarding physician practice eligibility and selection to participate in the demonstration. Eligible practices will be randomly assigned to either a treatment or control group. Community partners will not determine which practices are selected to participate in the demonstration or which practices are assigned to the treatment or control group.

A. In order to determine the effectiveness of the financial incentives on the adoption of EHRs and the impact on the quality of care, this demonstration incorporates a “randomized” design whereby half of the practices will be eligible to receive the incentive and the other half will not. Practices that apply to participate in the demonstration are equally likely to be randomly assigned to the demonstration “treatment” group or to the control group. Therefore, the only way for a practice to enjoy the benefits of financial incentives under this demonstration is to apply to participate and possibly be assigned to the treatment group. While it is true that control group practices will not be eligible to receive financial incentives under the demonstration, neither treatment nor control group practices are restricted in any way from participating in other incentive programs that we hope the presence of this demonstration will encourage. In addition, the demonstration will place no reporting requirements on control group practices. In order to earn incentives under the demonstration, treatment group practices will be required to submit clinical quality data in years 2 through 5 and complete an annual Office Systems Survey (OSS). Control group practices will only be asked to complete the OSS at the end of years 2 and 5 and will be given a modest payment for the time required to complete the survey. Control group practices will not be required to submit any clinical quality data. Thus, while the potential direct benefits may be less, there will be minimal, if any, burdens on control group practices. More importantly, if this program is successful, it may provide a model for future Medicare policy or similar incentive programs outside of Medicare. However, the success of this initiative cannot be measured without an appropriate and rigorous evaluation design, which requires a randomized control group for the purpose of comparing outcomes. By participating as part of the control group, practices will provide a valuable contribution towards the possible long-term impact of this demonstration and future programs.