American Recovery and Reinvestment Act of 2009 HIT

American Recovery and Reinvestment Act of 2009 (ARRA) As of: March 13, 2009

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.

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.

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

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.

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.

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.

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.

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.

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!”

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!”

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.

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..

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.

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.

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?

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!

American Recovery and Reinvestment Act of 2009 HIT

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