Michael Stearns, MD, CPC, CPFCPresident and CEO, e-MDs, Inc.
Before ARRA (American Recovery and Reinvestment Act of 2009) PQRI E-Prescribing EHR Adoption and Reporting Grant Programs Medical Home Pilot Project Since ARRA “Meaningful use” Medicaid, Medicare incentives HIT Regional Extension Centers HIE grants Multiple HIT related workforce development and research grants
American Reinvestment and Recovery Act Economic stimulus Job creation HITECH (HIT for Economic and Clinical Health) Act Focus on the use of health information technology Improve healthcare outcomes Improve healthcare system performance Huge appropriation of money to healthcare IT industry
Over $36B for Provider Incentives (Medicare/Medicaid) Over $4.5B for National Telecommunications Program $2.5B for USDA Telemedicine efforts $2B for HIE development (infrastructure) $1.5B for FQHCs/CHCs Over $1B for Research $500M for Social Security Administration $85M for Indian Health Service $50M for Veterans Administration This is the largest HIT specific appropriation in US history!
Government to lead standards development for nationwide exchange and use of health information Goal is to improve quality and coordination of care Over $40B for HIT infrastructure, HIE, and especially Medicare/Medicaid incentives to doctors and hospitals for “meaningful” use of certified HIT Saves federal funds and generates additional savings throughout the health sector through improved quality and care coordination, reductions in medical errors and duplicative care Strengthens HIPAA to protect identifiable health information from misuse as use of HIT increases
Physicians must elect to receive incentives EITHER through the Medicaid or Medicare program (but can switch once) Incentives do not penalize physicians who already have adopted EHR (just need to demonstrate meaningful use). Hospital-based physicians, e.g., ED, pathologists, anesthesiologists, are not eligible for these incentives
EPs that provide substantially all of their professional services (90% or greater) in an inpatient or outpatient hospital setting are considered hospital-based EPs and not eligible for incentive payments. POS (place of service codes will be used to determine eligibility) Rule subsequently relaxed to allow for hospital employed physicians who practice in clinical settings to receive incentive payments
The “Carrots” Incentives begin in Calendar Year 2011 (1/1/2011) For maximum bonus ($44,000), must be a “meaningful” user of certified EHR in CY11 or CY12 Only need to be a meaningful user for a 90-day-period in first year! Incentive amount is calculated as 75% of allowable Part B charges for the payment year with an annual caps (defined below) Maximum incentive payments are as follows Year 1 - $18,000 (If year 1 is 2011 or 2012, otherwise $15,000) Year 2 - $12,000 Year 3 - $8,000 Year 4 - $4,000 Year 5 - $2,000 Year 6 - $0 Physicians in health professional shortage areas receive a 10% increase (e.g., $19,800 in year one)
The “Sticks” Bonus amounts decrease starting in CY13 If not a “meaningful” user by CY15, No bonus payments Penalties will be applied Physicians receive a reduction in fee schedule 2015 - 1% reduction 2016 - 2% reduction 2017 - 3% reduction 2018 - HHS Secretary has authority to increase penalties if percentage of physicians who are “meaningful” users is less than 75% Maximum reduction is 5%
Eligibility Requirements for Providers Non-hospital-based professionals with ≥ 30% patient volume attributable to individuals receiving medical assistance Non-hospital-based pediatricians with ≥ 20% of patient volume attributable to individuals receiving medical assistance Eligible professionals (physicians, dentists, nurse midwives, rural practice setting PAs, nurse practitioners) who practice predominately in a Federally-qualified health center or rural health clinic with ≥ 30% patient volume attributable to needy individuals
States authorized to make payments of $21,250.00 per provider for either purchasing or implementing an EHR Just purchasing alone released funds (Adopt, Implement or Upgrade to certified EHR – AIU) Maximum is $63,750 for physicians Canskip years and still be eligible for payments
For professional who see over 30% Medicaid $21,250 in year one $8,500 in years 2-6 Total of $63,750 over 6 years For pediatricians with more than 20% but less than 30% Medicaid $14,167 in year one $5,667 in years 2-6 Total of $42,500 over 6 years Medicaid incentives will have the same total amount over 6 years regardless of start year (through 2016) Provider starting MU in 2016 will still receive up to $63,750
CMS and the Office of the National Coordinator Based MU Criteria on the recommendation of the HIT Policy Committee Five policy goals Based on NQF National Priorities Partnership
Improve quality, safety, efficiency, and reduce health disparities Engage patients and families Improve care coordination Improve population and public health Ensure adequate privacy and security protections for personal health information
Using certified EHR technology Certified – Certification Process Final Rule recently released E-prescribing Interoperability Reports on clinical quality measures Final meaningful use criteria published July 13th, 2010 Three stages of meaningful use to be rolled out
By the HIT Policy Committee2011 2013 2015 *From HIT Policy Comm. update Achieving Meaningful Use of Health Data
The Stage 1 meaningful use criteria focus on: Electronically capturing health information in a coded format Using that information to track key clinical conditions and communicating that information for care coordination purposes Structured or unstructured, but structured preferred Implementing clinical decision support tools to facilitate disease and medication management Testing the ability to report clinical quality measures and public health information.
Criteria will be proposed by the end of 2011 Goals for the Stage 2 meaningful use: Expand on Stage 1 criteria Encourage the use of health IT for continuous quality improvement at the point of care Exchange information in the most structured format possible: E.g., electronic transmission of orders entered using computerized provider order entry (CPOE) E.g., electronic transmission of diagnostic test results (such as blood tests, microbiology, urinalysis, pathology tests, radiology, cardiac imaging, nuclear medicine tests, pulmonary function tests, etc.
Criteria to be proposed by the end of 2013 Goals: Promote improvements in quality, safety and efficiency Focus on decision support for national high priority conditions Increase patient access to self management tools Provide increased access to comprehensive patient data Improve population health
Measurement Concepts (proposed by HIT Policy Committee to guide later stages of MU) Increased codification of health care data Expanded interoperability Patient engagement Outcomes based analysis Medical genomics Order tracking 100% HIT Adoption
1. “Measures of patient activation, including skills, knowledge and self-efficacy2. “Measures of patient self management”3. “Measures of shared decision making or decision quality that address a combination of patient knowledge and incorporation of patient”4. “Measures of patient preferences/experiences of care”5. “Measures of patient health outcomes, including health risk status, functional health status, and global measures of patient health”6. “Measures of patient access to community resources for improved/sustainable care coordination”
“Measures assessing ambulatory care-sensitive preventable admissions” Defined as “This measure concept relates to admissions caused by unaddressed ambulatory conditions at the onset of symptoms due to multiple reasons such as inappropriate clinical management or inefficient systems issues.” Physicians need to be engaged to make sure this type of measure concept is used appropriately
Requirements: Core Set (15) Menu Set (pick 5 of 10, include one population/public health measure) Thresholds for use reduced Administrative requirements removed Decision Support requirements reduced Reduced Quality Metrics Additional Quality options
1. Record patient demographics ¥ Sex ¥ Race ¥ Ethnicity ¥ Date of Birth ¥ Preferred language ¥ For hospitals date and preliminary cause of death in the event of mortality). More than 50% of patients’ demographic data must be recorded as structured data
1. Record vital signs and chart changes Height Weight Blood pressure Body mass index (BMI) Growth charts for children More than 50% of patients 2 years of age or older must have height, weight and blood pressure recorded as structured data. (Pulse and respirations not required)2. Maintain up-to-date problem list of current and active diagnoses. More than 80% of patients must have at least one entry recorded as structured data.
1. Maintain an active medication list. More than 80% of patients have at least one entry recorded as structured data.2. Maintain an active medication allergy list. More than 80% of patients have at least one entry recorded as structured data.3. Record smoking status for patients 13 and older More than 50% if patients age 13 or older have smoking status recorded as structured data.
1. For professionals, provide patients with clinical summaries for each office visit; for hospitals provide an electronic copy of hospital discharge instructions upon request. Clinical summaries provided to patients for more than 50% of all visits within 3 business days. More than 50% of all patients who are discharged from an inpatient or ED of a hospital who request an electronic copy of their discharge instructions must be provided with it.
1. Upon request, provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication list, medication allergies, and for hospitals discharge summary and procedures). More than 50% of requesting patients must receive an electronic copy within 3 business days. Patient portal and personal health records are seen as vehicles for this transfer
1. Generate and transmit permissible prescriptions electronically (does not apply to hospitals). More than 40% must be transmitted electronically using certified EHR technology.2. Computerized Provider Order Entry for Medication Orders. More than 30% of patients with at least one medication in their medication list must have at least one medication ordered through CPOE
1. Implement drug-drug and drug-allergy interaction checks. Functionality must be enabled for these checks for the entire reporting period.2. Implement capability to electronically exchange key clinical information among providers and patient- authorized entities. Must perform at least one test of the EHR’s capacity to electronically exchange information.
1. Implement one clinical decision support rule and track compliance with that rule. One rule must be implemented.2. Implement systems to protect privacy and security of patient data in the EHR Must conduct or review a security risk analysis, implement security updates as necessary and correct identified security deficiencies
1. Report clinical quality measures to CMS or states. For 2011, provide aggregate numerator and denominator through attestation For 2012, electronically submit measures
Implement drug formulary checks. Drug formulary check system must be implemented and it must provide access at least one internal or external drug formulary during the reporting period. Incorporate clinical laboratory test results into EHRs as structured data More than 40% of clinical laboratory test results are in positive/negative or numerical format and are incorporated into EHRs as structured data
Generate lists of patients by specific conditions for use for quality improvement, reduction of disparities, research or outreach. Must generate one listing of patients with a specific condition Use EHR technology to identify patient-specific education resources and provide those to the patient as appropriate. More than 10% of patients are provided patient specific education resources
Perform Medication reconciliation between care settings. Medication reconciliation must be performed for more than 50% of transitions of care. Provide summary of care record for patients referred or transitioned to another provider or setting. Summary of care record must be provided for more than 50% of patient transitions or referrals
Submission of electronic immunization data to immunization registries or immunization information systems. Must perform at least one test of data submission and follow-up submission (where registries can accept electronic submissions) Submission of electronic syndromic surveillance data to public health agencies. Must perform at least one test of data submission and follow-up submission (where public health agencies can accept electronic data)
For hospitals - record advanced directives for patients 65 years or older More than 50% of patients aged 65 or older must have an indication of an advanced directive status recorded. For hospitals - submission of electronic data on reportable laboratory results to public health agencies. Perform at least one test of data submission and follow-up submission (where public health agencies can accept electronic data)
For professionals - Send reminders to patients (per patient preference) for preventative and follow-up care. More than 20% of patients aged 65 or older or age 5 or younger must be sent appropriate reminders. For professionals - Provide patients with timely electronic access to their health information (including laboratory results, problem list, medication list, medication allergies). More than 10% of patients must be provided with electronic access to information within 4 days of its being updated in the EHR.
Criteria to be proposed by the end of 2013 Reach the full extent of HIT in clinical care Advanced interoperability including extensive sharing of structured data via HIEs Lifecycle of structured data Captured at the point of care as codified data Concept and modifiers E.g., Doubt seizure, myocardial infarction ruled out, etc. Stored locally and in data warehouses Relationships to modifiers must be preserved Retrieved and used for clinical care, reporting, research Must be “recomposed” accurately with appropriate context Must be in a standard format to allow for cross-platform usage Data integrity issues will need to be a focal point to ensure patient safety and reap the benefits of HIT
Speaker Contact Information Michael Stearns, MD, CPCPresident and CEO, e-MDs, Inc. email@example.com