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American Recovery and Reinvestment Act of 2009 HIT

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American Recovery and Reinvestment Act of 2009 Summary

American Recovery and Reinvestment Act of 2009 Summary

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  • 1. American Recovery and Reinvestment Act of 2009 (ARRA) As of: March 13, 2009
  • 2. Why is ARRA Important?
    • It is now the Law.
    • It Will be a Major Source of HIT Funding.
    • THE Source of Major Funding for EHRs.
    • It Will Determine Who Gets What.
    • It Will Determine EHR Standards.
  • 3. How Does ARRA Relate to Health Care?
    • Promote Health Information Technology.
    • Improve Health Care Quality, Safety, Efficiency.
    • Improve the Quality of HIT.
    • Provide Standards: Development & Adoption of HIT.
  • 4. ARRA Organization & Funding of HIT ARRA Funding: $787 Billion HIT Related Funding (~ $22 Billion?) Medicare/Medicaid $17.7 Billion (2019?) National Coordinator for HIT $2.0 Billion Regional/State Health Exchanges Mandated $300 Million Infrastructure Grants Implement/Improvements National Institute of Standards/Technology $20 Million Policy Committee Standards Committee Chief Privacy Officer. IHS: ~$85 Million HHS: ~ $2-3 Billion CHC: $1+ Billion Agriculture: 2.5 Billion Medicare Providers: Enterprise: DC-Based MDs: ~$40K Medicaid Providers: Enterprise: DC ~ $2 M Providers: ~$75K
  • 5. Overall Funding Definitions
    • Provides Medicare and Medicaid incentive payments for Critical Access Hospitals, Federally qualified health centers, rural health clinics and children’s hospitals.
    • Phases in Medicare payment penalties beginning in FY 2015 for physicians and hospitals not using EHRs.
    • Heavily emphasizes EHR Integrity, Interoperability, Security, Confidentiality, Patient Notification.
    • Provides temporary bonus payments up to $6 million for individual hospitals that “meaningfully” use EHRs. Physicians are eligible for payments as well.
  • 6. Salient Financial Points
    • Medicaid: $ Dispersed by States, ~ $70K Incentive for Non-Hospital Based Physicians.
    • All incentives are based on meeting goals of HIT use, time related, an incorporate penalties with time.
    • Medicare: Incentives to Hospitals (2-6 Million), ~$40K to Physicians.
    • Grants/Loans for EHRs are competitive, grants for Infrastructure would be immediate.
    • Broad emphasis on funding for Underserved.
  • 7. HIT Definitions
    • Certified EHR Technology: Ambulatory or Hospital.
    • Enterprise Integration: “ Interoperability ”
    • Health Care Provider: Enterprise, Groups, Providers operated by or under IHS.
    • HIT: Hardware, Software, Integrated Technologies, etc.
  • 8. EHR Definitions “ Qualified Electronic Health Record”
    • Patient Demographics.
    • Clinical Health Information: History, Problems.
    • Has the Capacity to:
    i. Provide Clinical Decision Support. ii. Support Physician Order Entry. iii. Capture/Query Information Relevant to Health Care Quality. iv. Exchange/Integrate Information from Other Sources.
  • 9. Office of National Coordinator of HIT
    • Improve Patient Care, Safety, Security, Privacy.
    • Reducing Costs by Reducing Med Errors, Duplicate and Unnecessary Care.
    • Uses HIT to Achieve these Goals.
    • Standardizing Care Across the Health Care Continuum.
    • Producing, Testing, Deploying and Monitoring Standards as They Apply to HIT.
    • Reporting to Congress & the Public on the Progress of this Effort.
  • 10. HIT Policy Committee
    • Recommend Policies for HIT Plan and Infrastructure.
    • Update Policies as Required or Necessary.
    • Develop Policies that Support Developed Standards.
    • Recommend Technologies for Security, Privacy, Interoperability, Demographics, Children’s Needs.
    • Bio Surveillance, Public Health, Research, Drug Safety, Telemedicine, Home Health, Health Care Continuity.
    • “ What to Do!”
  • 11. HIT Standards Committee
    • Recommend Standards, Implementation Specifications, & Certification Criteria for HIT.
    • “ Harmonize” These Standards to Produce Uniformity.
    • Update and Make New Recommendations as Appropriate.
    • Pilot Testing of Standards and Implementation Specifics.
    • Serve as a Forum for Input from a Variety of Sources.
    • “ How to Do It!”
  • 12. Areas Highlighted For Funding
    • Immediate Funding to Strengthen HIT Infrastructure.
    • HIT Implementation Assistance: Forums, Regional Extension Centers.
    • State Grants for Planning and Implementation.
    • Competitive Grants to States and Indian Tribes for Loans.
    • Demonstration Programs to Integrate HIT into Clinical Education.
    • Information Technology Professionals in Health Care.
  • 13. Medicare Incentives and Penalties:
    • User Class: Year 1 Year 2 Year 3 Year 4 Year 5
    • Physicians: $18K/$15K $12K $8K $4K $2K
    • Non User
    • Physicians: 2015:1% Dec 2016: 2% Dec 2017: 3% Dec 2017 on: 3% Dec
    • Hospital-Based Physicians are NOT included in this incentive program.
    • Hospitals: Full Incentive 25% Dec 50% Dec 75% Dec 100% Dec
    • Non User
    • Hospitals: 2015: 33% Dec 2016: 67% Dec 2017: 100% Dec
    • These decreases are in the “Market Basket Adjustments in Medicare” or in the Inflation Adjustments..
  • 14. Preliminary Calculation of ARRA Medicare Benefits
    • If a hospital (>25 Beds) has the “Meaningful Use” of a “Qualified EHR” which is capable of the “Exchange of Health Care Information”, the following yearly calculation may apply:
    • ($2million Incentive + Discharge Incentive) * X
    • ( Part A Days + Part C Days)
    • ((Total Eligible Charges/Est Total Charges) x Total Bed Days.)
    • * Incentive = $200/Discharge from 1,150 to 23,000 Hospital Discharges/Year.
    • Note: The Total incentive payments decrease by 25% in year 2, by 50% year 3, by 75% year 4, and no incentive thereafter.
  • 15. Preliminary Calculation of ARRA Medicaid Benefits
    • Medicaid Providers: $25,000 in year 1 for purchase and implementation of an EHR by 2016, up to $10,000/year for 5 years for maintenance.
    • Hospitals (10% Medicaid patients): Incentives similar to that of Medicare (Incentive + Discharge premium), actual payment may not exceed 50% of that amount in1year or 90% of that amount for 2 years.
    • There are no duplicate payments for certified EHR technology under Medicare and Medicaid.
  • 16. Precautions:
    • Too Much, Too Soon, Too Little Detail??
    • Will No Standards Cause a Pause in the Market?
    • Will ANY of the Current EHRs Actually Qualify?
    • The Money Looks Good: Spread Over Years, with Hooks, Penalties, Time Limits, Matching Funds.
    • Is Everyone Using a “Certified EHR” by 2014 Even Possible?
    • Is Spending Money “Quickly” and “Wisely” an Oxymoron?
  • 17. Recommendations:
    • Be Ready for Unintended Consequences. Nimble!
    • Key Words: “Interoperability” & “Security”: Use them!
    • Stress Our “Affordability” Especially in Rural and Underserved Areas.
    • Mayhem!!! Be Secure, Confident, Competent, & Informed. Provide Shelter for our Partners.
    • Quantify Outcomes: Midland will be Key! Wyoming?
    • Broaden Our Academia Position.
    • We Should ALL Be Involved. All Can Contribute!

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