7.wild ga partnership for tele health 3.19.2013 savannah,(2)Presentation Transcript
CMS Vision for e-Health; ValuePurchasing, and Accountable Care- Better Care, Better Health, and Lower Costs throughImprovementGeorgia Partnership for TeleHealth ConferenceSavannah, Ga.March 13, 2013 Richard E. Wild, MD,JD,MBA, FACEP Chief Medical Officer CMS -Atlanta
Disclaimers The presenter is a full time US Government employee and will represent the positions of the Centers for Medicare and Medicaid Services (CMS), US Dept. of Health and Human Services (DHHS). The presenter reports no activities or conflicts of interest. This presentation was current at the time it was published or uploaded onto the web. Medicare policy changes frequently so links to the source documents have been provided within the document for your reference. This presentation was prepared as a tool to assist providers and is not intended to grant rights or impose obligations. Although every reasonable effort has been made to assure the accuracy of the information within these pages, the ultimate responsibility for the correct submission of claims and response to any remittance advice lies with the provider of services. The Centers for Medicare & Medicaid Services (CMS) employees, agents, and staff make no representation, warranty, or guarantee that this compilation of Medicare information is error-free and will bear no responsibility or liability for the results or consequences of the use of this guide. This publication is a general summary that explains certain aspects of the Medicare Program, but is not a legal document. The official Medicare Program provisions are contained in the relevant laws, regulations, and rulings. (CPT only, copyright 2008 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable FARSDFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.)
The Triple Aim Goals of CMSBetter Care • Patient Safety • Quality • Patient ExperienceMore Efficient Care: (Reduce Per Capita Cost through improvement in care) • Reduce unnecessary and unjustified medical cost • Reduce administrative cost thru process simplificationImprove Population Health • Decrease health disparities • Improve chronic care management and outcome • Improve community health status
What’s Wrong with US HealthcareToday? Too Costly? Inefficient? Disparities in Access and Quality? Evidence Base foundation often lacking? Lack of Prevention focus? Fragmentation of care, between providers and sites of care? (Silos, care transitions) Poor information and data sharing and transfer? Patient safety and quality ? (Compare to aviation industry?) A payment system that rewards providing services rather than outcomes? Coordinated, accountable or Uncoordinated, Unaccountable care?
Aviation or Health Care ?
Why E-Prescribing? 98,000 die from medical errors annually • More than breast cancer, AIDS, or motor vehicle accidents 1.5 million preventable adverse drug events annually • Hospitals, long-term care, outpatient encounters • 530,000 among Medicare beneficiaries • $877 million per year for Medicare beneficiaries Source Institute of Medicine 1999, 2000, 2003, 2006
••• Potential to save up to $35 billion dollars over three years.
How to Get Involved!Join the Partnership for Patients – Sign the Pledge!Go to www.healthcare.gov/center/programs/partnership
The CMS Vision of LeveragingMeaningful Use of HIT
HIT Overview HIT and Congressional Initiatives ARRA of 2009, HITECH ACT, established CMS E.HR incentive program for Meaningful Use of HIT Recent Studies: Archives of Internal Medicine, Jan. 26 2009, Amarasingham, et.al,“Clinical Information Technologies and Inpatient Outcomes, a Multiple Hospital Study” -Hospitals with automated notes and records, order entry and clinical decision support had fewer complications, lower mortality rates, and lower costs.
Health Care Delivery SystemTransformation Adoption of Enhancing Health Health System Performance Transformation Information Competencies Barrier Technology Clinical Care Knowledge Infrastructure Barrier Barrier Integrated Care Accountable Care Personalized Episodic/ Health Care Uncoordinated Management
Timeline for Delivery SystemReform and Transformation2011-2019 MU Stage MU Stage 3 2 MU HealthcareStage Delivery System Program and Reform and 1 Policy Redesign Transformation Successful 2016-2019 Payment and Service Model 2014-2019 Innovation 2011-2019
Medical Home 1.0 E- Prescribing Electronic Medical Individual Health Home Patient Care Record 1.0 Plans Care Coordination Capable
Medical Home 2.0 Advance Chronic Disease Integrate Management Patient e-prescribing Registries and COEs E-Clinical HIE Connected Medical Decision Making Home 2.0 Electronic Population Patient Access Health Bio and Surveillance Communication Electronic Two Way Eligibility Quality System Report Interface
Medical Home 3.0 Advanced Care Management Fully e-Health Capable Capable Clinical Practice Translational Research Remote Bio Metrics Connected to Monitoring and Community Tele health Medical Resource Capable Databases Home 3..0 Integrated Electronic Clinical Patient E-Learning Network Center Interfaces Community Psycho/Social Health Evaluation and Surveillance Intervention Network
What are the Three Main Components of Meaningful Use?• The Recovery Act specifies the following 3 components of Meaningful Use: 1. Use of certified EHR in a meaningful manner (e.g., e-prescribing) 2. Use of certified EHR technology for electronic exchange of health information to improve quality of health care 3. Use of certified EHR technology to submit clinical quality measures (CQM) and other such measures selected by the Secretary 18
HITECH: How the Pieces Fit TogetherRegional Extension Centers Improved Individual &Medicaid EHR Program 1st Year Incentive ADOPTION Population HealthWorkforce Training Outcomes Increased Transparency & EfficiencyMedicare and Medicaid EHRIncentive Programs MEANINGFUL USE Improved Ability to Study & Improve Care DeliveryState Grants forHealth Information ExchangeMedicaid Administrative Funding for HIE EXCHANGEStandards & Certification FrameworkPrivacy & Security Framework Health IT Practice Research 19 19
What do the Meaningful Use objectives andmeasures really mean? 20
What are the Requirements ofStage 1 Meaningful Use?• Stage 1 Objectives and Measures Reporting• Eligible Professionals must complete: • 15 Core Objectives • 5 objectives out of 10 from menu set • 6 total Clinical Quality Measures (3 core or alternate core, and 3 out of 38 from additional set)• Hospitals must complete: • 14 core objectives • 5 objectives out of 10 from menu set • 15 Clinical Quality Measures 21
Meaningful Use: Core Objectives - Stage 1• Eligible Professionals – 15 Core Objectives 1. Computerized provider order entry (CPOE) 2. E-Prescribing (eRx) 3. Report ambulatory clinical quality measures to CMS/States 4. Implement one clinical decision support rule 5. Provide patients with an electronic copy of their health information, upon request 6. Provide clinical summaries for patients for each office visit 7. Drug-drug and drug-allergy interaction checks 8. Record demographics 9. Maintain an up-to-date problem list of current and active diagnoses 10. Maintain active medication list 11. Maintain active medication allergy list 12. Record and chart changes in vital signs 13. Record smoking status for patients 13 years or older 14. Capability to exchange key clinical information among providers of care and patient-authorized entities electronically 15. Protect electronic health information 22
What is in the Stage 2 MU Rule• Minor changes to Stage 1 of meaningful use• Stage 2 of meaningful use beginning in 2014• New clinical quality measures• New clinical quality measure reporting mechanisms• Appeals• Details on the Medicare payment adjustments• Minor Medicare Advantage program changes• Minor Medicaid program changes 23
Meaningful Use:Changes from Stage 1 to Stage 2 Stage 1 Stage 2Eligible Professionals Eligible Professionals 15 core objectives 17 core objectives5 of 10 menu objectives 3 of 6 menu objectives 20 total objectives 20 total objectivesEligible Hospitals & Eligible Hospitals & CAHs CAHs 14 core objectives 16 core objectives5 of 10 menu objectives 3 of 6 menu objectives 19 total objectives 19 total objectives 24
Closer Look at Stage 2:Electronic ExchangeStage 2 focuses on actual use cases of electronicinformation exchange:• Stage 2 requires that a provider send a summary of care record for more than 50% of transitions of care and referrals.• The rule also requires that a provider electronically transmit a summary of care for more than 10% of transitions of care and referrals.• At least one summary of care document sent electronically to recipient with different EHR vendor or to CMS test EHR. 25
Medicare Shared Savings ProgramAccountable Care Organizations (ACOs) Program For more information: www.cms.gov/sharedsavingsprogram/ Shared Savings Program http://www.cms.gov/savingsprogram http://www.cms.gov/savingsprogram/ http://www.cms.gov/savingspr
Medicare Shared Savings Program GoalsThe Shared Savings Program is a new approach to the delivery of health care aimed at reducing fragmentation, improving population health, and lowering overall growth in expenditures by: • Promoting accountability for the care of Medicare fee-for-service beneficiaries • Improving coordination of care for services provided under Medicare Parts A and B • Encouraging investment in infrastructure and redesigned care processes
What entities could form an ACO?Existing or newly formed organizations may form an ACO: • ACO professionals in group practice arrangements • Networks of individual practices of ACO professionals • Joint ventures/partnerships of hospitals and ACO professionals • Hospitals employing ACO professionals • Federal Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) • Critical Access Hospitals (CAHs) that bill under method IISecretarial discretion for other providers and suppliers of services • Other Medicare-enrolled entities may join the groups above as ACO participants.
ACO Quality Measurement & PerformanceQuality measures are separated into the following four key domains that will serve as the basis for assessing, benchmarking, rewarding and improving ACO quality performance: • Better Care 1. Patient/Caregiver Experience 2. Care Coordination/Patient Safety • Better Health 3. Preventative Health 4. At-Risk Population
ACO Quality Measurement & Performance ContinuedACO Quality Performance Standard made up of 33measures intended to do the following:Improve individual health and the health of populationsAddress quality aims such as prevention, care of chronic illness, high prevalence conditions, patient safety, patient and caregiver engagement and care coordinationSupport the Shared Savings Program goals of better care, better health and lower growth in expendituresAlign with other incentive programs like PQRS and EHR
ACO Quality Data ReportingQuality data collected three ways: • Claims and other internal data • ACO-GPRO tool • SurveyComplete and accurate reporting in the first year qualifies the ACO to share in the maximum available quality sharing ratePay for reporting is phased in for the remaining performance yearsShared savings payments are linked to quality performance based on a sliding scale that rewards attainment • High performing ACOs receive a higher sharing rate
Return on Investment from HIT Wide Spread Adoption of Electronic Health Information (EHI) Technologies for Better Outcomes , Lower Cost , Improve Population Health Improving Health Care Quality, Cost Performance, Population Health BetterROI of EHI at Point of Care: Outcomes• Improved Patient Safety• Reduced Complications Rates Lower• Reduced Cost per Patient Episode of Costs Care• Enhanced cost & quality performance accountability• Improved Quality Performance Population• Improve Community Health Health Surveillance
More information:NEW!!! CMS eHealth Webpage:http://www.cms.gov/ehealth/• http://www.cms.gov/EHRIncentivePrograms• http://www.cms.gov/ERXIncentive/• http://www.cms.gov/PQRS/• http://www.cms.gov/center/physician.asp• www.healthcare.gov/center/programs/partnership• www.healthcare.gov/partnershipforpatients• www.cms.gov/sharedsavingsprogram/ Thank You !! Questions ?? 34