Health reform is a hot topic, and how physician assistants (PAs) will be included is of great interest. As the debate continues regarding healthcare delivery and cost effectiveness, there are many changes also pending on the documentation side of the clinical record. There are a multitude of terms in the media right now: ARRA, MU, EHR, ONC. They may appear confusing and are often misunderstood and misrepresented. Check out my article in the December 2010 issue of PA Professional, a publication of the American Academy of Physician Assistants (AAPA), which explains the overview of meaningful use (MU) and who is eligible to receive incentive payments (page 36). In 2009, the American Recovery and Reinvestment Act (ARRA) was passed. A portion of this legislation set aside financial incentives for medical practices to adopt electronic health records (EHR) that meet specific requirements. The HITECH (Health Information Technology for Economic and Clinical Health) Act has a primary purpose to encourage the adoption of EHR/EMR by providing billions in financial incentives. As a result, many medical practices are feeling pressured to embrace EHRs in an effort to receive some of the financial incentives. In order to meet the financial requirements and receive the incentives, you must use the EHR in a meaningful way, i.e., meet the criteria for meaningful use. The Office of the National Coordinator for Health Information Technology (ONC) issues the rules identifying the standards and certification criteria for EHR technology to be certified. If you are not using a system that is certified, you will not receive incentive payments. You must also be an eligible provider, or EP, recognized by the government in order to receive incentive funds. Under the current legislation, a Medicaid-eligible provider is a physician, dentist, nurse practitioner, certified nurse midwife or physician assistant practicing predominantly in a federally qualified health center or rural health clinic (FQHC/RHC) directed by a physician assistant. Therefore, the only PAs that qualify for incentive payments are those practicing in a federally qualified health clinic, collecting Medicaid incentive payments. Currently, there is a great deal of debate regarding Medicaid-qualifying incentive payments. AAPA is encouraging all members to contact their congressional representatives to urge them to amend the HITECH Act to extend the electronic health record (EHR) Medicaid incentive payment to all physician assistants whose patient volume includes at least 30 percent Medicaid recipients. By placing a restriction on which populations of working PAs can receive incentive payments, patient access to care and exposure to EHR practices may be limited. Such regulations also disincentivize and potentially limit the hiring and placement of PAs in underserved areas. PAs do qualify as authorized healthcare professionals under the federal e-prescribing and physician quality reporting initiative programs, and should therefore be included in the Medicaid incentive program. The exclusion of PAs as professionals that deliver primary care health services may possibly undermine EHR adoption efforts and negate the original intentions of meaningful use.